Abstract
Purpose :
Streptococcus pneumoniae is a leading cause of ocular surface infection and pneumococcal keratitis is commonly severe at presentation. Despite its heavy burden of disease, the clinical profile of pneumococcal keratitis has not been well characterized in scientific literature, especially outside of Southern India where it is most common. This study thus aims to analyze treatment-based visual acuity outcomes and to identify clinical, demographic, ocular, and systemic risk factors related to pneumococcal keratitis.
Methods :
We reviewed 63 clinical records of patients treated at the Massachusetts Eye and Ear (2014-2019) for clinically diagnosed, culture positive pneumococcal ocular surface disease. Patients were stratified into two groups: Keratitis (n=41) and Conjunctivitis (n=22). The study protocol was approved by the IRB board of Mass General Brigham.
Results :
Pneumococcal keratitis and conjunctivitis were compared in terms of demographic, systemic, and ocular risk factors. There was no significant difference in sex or ethnicity. There was a significant difference in age (median age 66 years vs 43 years for conjunctivitis; p=0.006). Keratitis patients had significantly more organ transplant history (p=0.006), cardiovascular disease (p=0.011), liver disease (0.012), alcoholism (p=0.006), and COPD (p=0.023). The most apparent predisposing factors for development of keratitis in this population were ocular surface disease (29.2%), history of eye trauma (29.2%), and corneal transplantation (21.9%). Only 12.2% of keratitis patients were contact-lens wearers. Corneal ulcer was found at presentation for 80.5% and hypopyon for 53.6% of keratitis patients. Overall, 78% of keratitis patients presented with a visual acuity > 20/150, and most (73.7%) did not improve to a visual acuity <20/150 following treatment. There was no significant difference in visual acuity outcomes in keratitis patients managed surgically versus medically (p=0.711583).
Conclusions :
In our population, pneumococcal keratitis was associated with older patients with a high number of comorbidities and severe outcomes. Surgical and medical interventions both lead to similar outcomes and were not associated with significant visual acuity improvements. The characterization of pneumococcal keratitis can be used to explore better prediction for the course of disease and analyze the need for invasive measures.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.