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T. K. Ramjattan, S. Tuli; Microbial Keratitis in Central Florida: Epidemiology, Treatment, and Outcomes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4292.
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To study the clinical features, treatment, and outcomes of bacterial, fungal, and viral keratitis.
Retrospective chart review of 502 consecutive patients treated for microbial keratitis at the University of Florida between July 2001 to June 2006. Data includes patient demographics, prior treatment, visual acuity at presentation, risk factors, presenting symptoms, clinical exam, culture results, treatment modality, and final visual acuity.
The average age of patients was 45.3 years. The most common symptoms at presentation were pain (81%) and photophobia (46%). Contact lens wear was the most common risk factor (35%), followed by trauma (24%). 6% were located at the graft margin of a previous penetrating keratoplasty. Most corneal infiltrates (80%) were smaller than 3 mm. 46% had associated anterior chamber inflammation and 14% had a hypopyon at presentation. 1% presented with corneal perforation. The average presenting visual acuity was 20/125 and the average final visual acuity was 20/70. Although 66% of patients were on antibiotics at presentation, 56% of bacterial cultures were positive. Gram positive cocci were the most common isolated organism (85%), while gram negative rods were present in 22%. 29% had more than one organism isolated. 11% of Fungal cultures were positive, one third of which grew Fusarium. 5% of viral cultures and 7.6% of Acanthamoeba cultures were positive. 20% had positive Gram Stains and 17% had positive Gomori methenamine silver stains. 14 patients had Confocal Microscopy at an outside institution; 10 (73%) were positive for Acanthamoeba. Most patients received only medical treatment (88%). Surgical interventions (12%) included corneal glue (52%), therapeutic penetrating keratoplasty (33%), tarsorraphy (26%), and enucleation (15%).
Microbial keratitis is commonly seen at the University of Florida. Contact lens use is the most common risk factor. Corneal cultures to guide medical therapy are useful even if patients are on topical antibiotics at presentation. Good outcomes can be achieved with appropriate therapy.
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