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Leire Irusteta, Enrique O Graue-Hernandez, Arturo J Ramirez-Miranda, Alejandro Navas, Eduardo Jose Polania-Baron; Clinical profile and age related risk factors in microbial keratitis in the elderly in a referral center in Mexico City. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6510.
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© ARVO (1962-2015); The Authors (2016-present)
Describe the epidemiologic, clinical profile and age related risk factors of microbial keratitis in elderly patients in a referral Ophthalmology center in Mexico City
Retrospective study conducted in the Institute of Ophthalmology “Hospital Conde de Valenciana” in Mexico City. Records of all patients aged 65 years and older, between January 2013 to December 2017 that had diagnosis of infectious keratitis demonstrated by microbiological culture where examined. Data recorded was: age, gender, time of onset of the symptoms, history of ocular trauma, previous surgery, contact lens use or topical medication and results of microbiological tests. Descriptive statistics, means, and SD were used. The Ethics Committee and the Research Council of our institution approved the study
221 corneal scrapes were performed. Female patients represented 61%, male patients 39%. Mean age was 75,33 years. Systemic diseases were present in 28%, Diabetes Mellitus in 33% and hypertension in 29%. The right eye was affected in 35% and the left in 24.7%, only one patient had bilateral affection. Clinical suspicion in the first assessment was bacterial in 50.7 %, micotic in 5.8% and herpetic in 4.9%. 18.4% of the patients had hypopion.The mean visual acuity recorded at the first visit was 1.47 using logMAR scale. Past ocular pathology was present in 99%. 27% of the patients had previous ocular surgery, penetrating keratoplasty and cataract surgery together occurred in 48% of all cases. 19% had received previous treatment with topical antibiotics and 17% had used topical corticosteroids. There was a total of 199 pathogens isolated; 90% were bacteria and 10% were fungus. Gram positive bacteria were the 83% and gram negative bacteria were 17%. Associated risk factors and non resolution of the ulcer are shown in Table 2
Elderly patients are known to have immunologic senescence, comorbidities, alteration of the lids and conjunctival flora, poor lacrimal drainage, fragility of the corneal epithelium, and reduction of corneal sensitivity. These are responsible for a specific susceptibility to certain causative agents of microbial keratitis and the establishment of a more aggressive disease. More than half of our patients had at least one identifiable risk factor. Glaucoma was the major associated ocular comorbidity factor associated with no resuloution of the ulcer.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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