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Daisuke Shimizu, Dai Miyazaki, Yoshitsugu Inoue; Advanced age is the most significant risk factor of persistent epithelial defect after treatment of refractory keratitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):330. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Neurosensory loss, persistent inflammation , or drug toxicity can disturb corneal healing and can cause epithelial keratopathy, ulcer formation , and perforation. However, few literatures have reported actual risks associated with impaired epithelial healing. In this study, we evaluated associations of possible risk factors for persistent epithelial defect (PED) after treatment of refractory keratitis of infectious or non-infectious etiology.
Consecutive case series of 280 eyes of 280 patients with infectious or non-infectious keratitis, referred to Tottori University Hospital for treatment from 2009 August to 2014 December, were retrospectively analyzed. PED was defined as the following; irregular or round corneal epithelium defect with one or more raised edges, and poor healing response slow to respond to conventional treatments. During the treatment course of keratitis, DNA amount of pathogens, including bacteria, fungi, HSV, VZV, and acanthamoeba was quantified for keratitis lesions by using real-time PCR.Clinical characteristics and DNA amount of pathogens were assessed for associations with the development of PED after treatment using principal component analysis (PCA) and logistic regression analysis.
Mean age was 59±22 (SD) years, and 141 patients (50%) were male. Forty-three patients (15%) resisted conventional therapy and developed PED. Mean age of patients with PED was 70±18 years, and were significantly older than patients without PED (70±18 years, P<0.01). For 36 diabetic patients, PED developed in 12 eyes (33%, p<0.05). In 28 herpetic keratitis patients, 10 eyes (36%) developed PED (P<0.05). When pathogenic DNA amount together with clinical characteristic were assessed using PCA, age and diabetes were positively contributed to PED-related primary component, and HSV DNA amount was associated with secondary component.Risk assessment of clinical characteristics developing PED using Logistic regression analysis indicated highly significant effect of older age (quintile, odds ratio [OR], 1.61 ; 95% confidence interval [CI], 1.25-2.09, P<0.0005), followed by pre-existing condition of HSV keratitis(OR, 2.68; 95% CI, 1.01-5.08, P<0.05 ), and diabetes(OR, 2.16; 95% CI, 1.02-4.60, P<0.05 ).
Advanced age is the most significant risk factor for PED. The risk is further increased in HSV keratitis and diabetes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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