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I. van der Meulen, C.P. Nieuwendaal, L. Remeijer, H. van Cleynenbreugel, A.J. Geerards, J. van Rooij; Risk Factors and Culture Outcomes of Patients Admitted With a Corneal Ulcer 2002–2004 . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4751.
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– To evaluate age–related risk factors (RF) for the development of a corneal ulcer and the effect of age on the incidence of complications and prognosis – To determine culture outcomes of these ulcers and their effect on topical treatment.
Clinical histories and outcomes of patients with a corneal ulcer admitted to 2 tertiary referral centers during a period of 3 consecutive years were reviewed.
49 patients were admitted to the Academic Medical Center and 108 to the Rotterdam Eye Hospital. As no significant differences exist between these 2 groups with respect to age, sex or length of stay, they are considered as one (N = 157 patients, 164 stays). Mean age was 57 years (range 0–97) and mean hospital stay 8 days (range 1–25). 77 patients were ≥ 60 years (49%). Contact lens wear was an important RF in the group < 60 years (63%), but not in the group ≥ 60 years (13%). The older group more often had multiple RF, of which systemic illness (36%), previous ocular surgery (34%), topical steroids (26%), blepharitis (21%) and recurrent HSV keratitis (29%) were the most important. Patients with multiple RF contributing to the development of the ulcer had longer admissions than patients with a single RF. Patients aged ≥ 60 years had a significantly higher risk of a corneal perforation (28% vs. 11% in patients < 60 years), a worse visual outcome (mean VA 20/100 vs. 20/40) and more often needed surgery to assist corneal healing or to preserve the integrity of the globe (56% vs. 23%; p<0.05 in all cases). 57% of cultures were positive: the most prevalent organisms were Pseudomonas aeruginosa (36%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (14%). In patients receiving topical antibiotics at presentation, the positive culture rate was 41%. Admitted patients were treated according to protocol with two fortified topical antibiotics (cephazoline and either tobramycine or gentamycine) given hourly. In 14% antibiotic therapy was changed based on culture results, mostly by replacing the fortified antibiotics by ofloxacin. In 3% antiviral or antifungal therapy was added.
– The elderly present a distinct clinical constellation with often multiple RF, a high complication and surgical intervention rate and a poor visual outcome. – In a tertiary referral practice it is useful to culture all ulcers, even in pretreated patients. In 14% of hospitalized patients antibiotic therapy was changed based on the culture results.
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