July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Microbial keratitis resulting in evisceration and enucleation in Sydney, Australia
Author Affiliations & Notes
  • Maria Paulina Cabrera Aguas
    University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
    Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Pauline Khoo
    University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
    Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Stephanie L Watson
    University of Sydney, Save Sight Institute, Sydney, New South Wales, Australia
    Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Maria Cabrera Aguas, None; Pauline Khoo, None; Stephanie Watson, None
  • Footnotes
    Support  Sydney Eye Hospital Foundation
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 849. doi:
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      Maria Paulina Cabrera Aguas, Pauline Khoo, Stephanie L Watson; Microbial keratitis resulting in evisceration and enucleation in Sydney, Australia. Invest. Ophthalmol. Vis. Sci. 2019;60(9):849.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Microbial keratitis is an ocular emergency needing prompt and effective antimicrobial therapy to prevent significant visual impairment or loss of the eye. This study describes ocular factors, clinical features, pathogens, antimicrobial resistance, and management in patients with microbial keratitis resulting in evisceration/enucleation over a five-year period at Sydney Eye Hospital, New South Wales, Australia

Methods : A retrospective case review included patients with microbial keratitis who underwent an evisceration/ enucleation. Cases were identified from pathology and hospital coding data from 2012 to 2016. Patient demographics, clinical details, pathology tests, and management were collated from the medical records.

Results : Thirty-three patients were included; median age 85 years (range 38 to 100), 64% female. Median time from start of symptoms to presentation was 6 days (range 0-93). Major associated ocular factors included use of topical corticosteroids in 13/33 patients (39%), lid malposition in 7 (21%), and recent ocular surgery in 4 (12%). The most common systemic factor was diabetes mellitus in 12 patients (36%). Most of patients presented with an epithelial defect (n=29, 88%) with a median area of 34 mm2, and infiltrates (n=22, 67%) with a median area of 14 mm2. Combination of topical cefalotin and gentamicin was the preferred initial antimicrobial therapy.

Thirty corneal scrapes were performed, positive culture in 80%. Pseudomonas aeruginosa 9/28 isolates (32.1%), coagulase-negative staphylococci (CoNS) 6 (21.4%), and Streptococcus spp. 4 (14.3%) were the most common isolates. Pseudomonas aeruginosa were 100% sensitive to ciprofloxacin and gentamicin. 33% (2/6) of CoNS were resistant to cefalotin, chloramphenicol and ciprofloxacin, 40% (2/5) to gentamicin.

Thirty patients underwent evisceration and 3, enucleation. Indications included endophthalmitis (n=15, 45%), non-resolving microbial keratitis (n=11, 33%), corneal perforation secondary to microbial keratitis (n=5, 55%), eye pain in a blind eye (n=2, 6%). Median time for evisceration/enucleation was 8 days (range 1-270).

Conclusions : In our setting, loss of the eye resulting from microbial keratitis occurred mostly in the elderly. Lid malposition and topical corticosteroid use were common associated factors, and Pseudomonas aeruginosa was the main causal organism. About half of the patients developed endophthalmitis within a week of presentation.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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