Abstract
Purpose :
Infectious keratitis (IK) is a devastating disease that, in some patients, can lead to blindness or even loss of the eye despite immediate and intensive topical antimicrobial therapy. To inform clinical prognosis, this retrospective, clinical study examined patient demographics, systemic and ocular comorbidities, as well as microbial data to determine those factors associated with treatment failure.
Methods :
A retrospective study was conducted of 407 patients with IK at the University of Rochester, between July 2018 and December 2021 who had documented clinical follow up for at least 2 weeks. Treatment failure was defined as no clinical improvement within 2 weeks of initial presentation and/or need for surgical intervention, including corneal gluing, patch graft, transplant or evisceration. Tests of two proportions were used for statistical analysis to compare patients with treatment failure vs success with regards to a wide range of patient characteristics and microbiologic data.
Results :
Of 407 patients, 62 (15.2%) experienced treatment failure, of which 37 (58.1%) required surgical intervention. The treatment failure group had significantly higher rates of Pseudomonas aeruginosa (p=0.037), fungi (p=0.008), and polymicrobial (p=0.034) cultures. Additionally, age 65+ (p=1.79e-5), systemic immunosuppression (p=0.011) and smoking history (p=0.018) were significantly associated with treatment failure. Ocular history associated with treatment failure included prior corneal transplant (p=8.33e-6), prior transplant rejection (p=1.67e-5), use of topical steroids (p=1.38e-6), history of intraocular surgery (p=2.4e-10) and visual acuity of 20/250 or worse (p=1.94e-6). Patients with treatment failure had significantly higher rates of prescribed fortified antibiotics (p=7.21e-7) and bandage contact lenses (p= 7.51e-10) during their treatment course.
Conclusions :
These results highlight significant factors associated with IK treatment failure including age >65, immunosuppression, smoking history, and ocular comorbidities (including prior intraocular surgery and poor visual acuity). Patients with treatment failure were also more likely to have polymicrobial, P. aeruginosa or fungal infections. This study improves our understanding of IK by identifying key prognostic indicators of treatment failure for this blinding disease.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.