Abstract
Purpose :
Corneal ulcers are associated with ocular morbidity and if left untreated, can progress and cause significant vision loss. They can be caused by infectious or noninfectious etiologies. This study aims to identify the demographics and microbiological profile of corneal ulcers treated at Montefiore Medical Center (MMC).
Methods :
A retrospective chart review was conducted on all patients with diagnosis of corneal ulcer between 2016-2022 at MMC. The following variables were extracted: patient demographics, medical history, clinical characteristics of ulcer, best corrected visual acuity (BCVA), microbial culture results, and clinical outcomes. BCVA was recorded as a quantitative measure using a LogMAR chart. Clinical outcomes were categorized as follows: 1) ‘Good’: Improved BCVA, no surgery or severe complications, 2) ‘Poor’: Decline in BCVA, no surgery or severe complications, 3) ‘Very Poor’: Decline in BCVA with surgery required for a severe complication. Statistical analyses were performed and P-value <0.05 was considered statistically significant.
Results :
206 patients (n=206 eyes) were included with mean age 55.3 +/- 21.1 (5-100) years. 31.2% had diabetes, 21% were systemically immunosuppressed, and 40.8% had ocular surface disease. 25.4% had previous eye surgery, 11.8% reported a history of eye trauma, and 30.6% were contact lens users. The average BCVA was a LogMAR of 1.2 (~20/317 on Snellen chart) and average ulcer size was 7 +/- 10.5 mm at presentation.
Of 206 cases, 135 (65.5%) were cultured. Of these, 91 (67.4%) showed microbiologic growth and 44 (32.6%) were culture negative. Figures 1A and 1B display the most common organisms that grew overall and in contact lens users, respectively. Presence of gram negative rods was associated with larger ulcer size (p<0.001) and lower visual acuity (p=0.023) at presentation. Presence of fungi was associated with having a worse clinical outcome (p=0.017).
Conclusions :
The most common infectious etiology of culture positive corneal ulcers were Staphylococcus, Streptococcus, and Pseudomonas. Patients infected with gram negative rods (i.e. Pseudomonas) had lower visual acuity and larger ulcer size at presentation. Patients infected with fungi were associated with worse clinical outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.