Posted in Volume 15 - Number 4
ASHOK KUMAR NARSANI, MUHAMMAD MUNEER QURAISHY, MAHESH KUMAR LOHANA, SHAFI MUHAMMAD JATOI, MAHTAB ALAM KHANZADA
ABSTRACT | Full Text PDF
PURPOSE: To analyze the demographic pattern, risk factors, clinical and microbiological characteristics of microbial keratitis in patients seen at tertiary care centre.
DESIGN: Quasi experimental
SETTING: Department of Ophthalmology Unit I, Eye Hospital, Liaquat University of Medical and Health Sciences Hyderabad Sindh from April 2006 to March 2009.
MATERIAL AND METHODS: Patients above 15 years of age with suspected microbial keratitis attending the outpatients department were included in this study. After detailed history, every patient underwent slit lamp bio-microscopical examination, for characteristics of corneal ulcer. Corneal scrapings were collected under aseptic conditions under magnification of slit lamp or operating microscope. The scraping material obtained from leading edge and base of each ulcer was spread onto labeled slides for staining. Another portion was inoculated on to the surface of solid and the liquid culture medias. The inoculated medias were incubated at appropriate temperature for appropriate time. The treatment started soon after taking material, which was further modified if needed.
RESULT: Three hundred and ninety seven eyes of 397 patients were enrolled, of these 67 patients were lost in follow up were excluded from study. Of the remaining 330 patients 139 (42.12%) were examined first time in the out patients department. The age of patients ranged from 16 years to 79 years. Of the 330 patients 194 patients were male and 136 females. Two hundred and twenty eight patients belongs rural and 102 from urban population. One hundred and eighty two patients were farmer by occupation, trauma with vegetative material was by far the most common risk factor; encountered in 161 patients. The diameter of the corneal ulceration was of 1-3 mm in 149 patients. Hypopyon was found in 138 patients. Other signs included feathery projection of ulcer, satellite lesions, anterior chamber reaction, endothelial plaques, and pigmentation of lesion, suppuration and stromal infiltration. Out of 330 patients, 161(48.80%) has positive culture for bacteria, 87 (26.36%) has positive culture for only fungi, in 12 (3.64%) were found positive culture for both bacteria and fungi, and 2 (0.61%) has the positive culture for Acanthamoeba. The Staphylococcus aureus was the most common isolated bacteria, and Candida albicans was the most common isolated fungi. Forty percent of patients had good visual out come with visual acuity same or better than the level at admission. Among the others 60% patient’s final outcome was poor. Secondary glaucoma was develop in 28 patients, other rare complications included, endophthalmitis, anterior staphyloma, cataract, corneal perforation, and descmetocele
CONCLUSION: The suppurative keratitis, most often occurs after a vegetative or non vegetative trauma. Bacterial ulcers are more common than fungal ulcers. Staphylococcus aureus and canddida species’ were the most common bacteria and fungus respectively. The regional variations in causative organisms are clinically important for initiating intensive ocular antimicrobial agents represent decisive steps in the management of such pathologies
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