Abstract
Purpose :
Infectious keratitis is a leading cause of ocular morbidity globally, and approximately one-third of all cases are culture-negative. We sought to better understand these cases by investigating risk factors, clinical manifestations, and treatment outcomes.
Methods :
This single-center, retrospective case series included all culture-negative infectious keratitis cases at the UPMC Eye Center from January 2016 through December 2020. Cases were reviewed for suspected etiology, ocular and systemic risk factors, visual acuity, symptom duration, management, and outcomes.
Results :
256 cases of culture-negative infectious keratitis were identified (55.08% female, 50.11±20.34 years). 167 cases had complete medical records. Antimicrobial medication was used by 59.88% patients prior to presentation. Majority of cases were presumed to be viral at presentation (45.70%). The most prevalent ocular risk factors were history of ocular surface disease (44.14%), contact lens use (32.34%), and prior ocular surgery (36.84%). Mean presenting VA was 0.91±0.87 logMAR with average defect size of 7.81±12.53 mm2 and hypopyon in 12.57% cases. Most common initial management was with topical moxifloxacin (26.95%). Management was modified in the majority of cases with 29.34% switched to antiviral therapy. Adjunctive treatment was required in 45.51% cases. Average time to defect resolution was 46.15±65.10 days. Cases with presumed viral etiology had the longest treatment duration and follow-up time. Cases with presumed bacterial etiology had significantly younger age at presentation (41.39±22.10 years) (p=0.004). Worse final visual acuity was significantly associated with older age at presentation (p<0.001), history of ocular surgery (p=0.005), topical corticosteroid use (p=0.008), history of corneal disease (p=0.023).
Conclusions :
Management of culture-negative keratitis relies on clinical suspicion. Viral etiology is commonly suspected in culture-negative keratitis cases, however younger age is significantly associated with bacterial etiology. There is significant variability in presentation and management duration depending on type of etiology. These cases generally have favorable outcomes with prompt intervention.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.