Wong T, Ormonde S, Gamble G, McGhee C N J
Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Br J Ophthalmol. 2003 Sep;87(9):1103-8. doi: 10.1136/bjo.87.9.1103.
To identify key risk factors and the management and outcome of severe infective keratitis leading to public hospital admission in New Zealand.
Over a 2 year period, all admissions of presumed infective keratitis to Auckland Hospital were identified. The clinical records of all 103 cases were retrospectively reviewed with respect to clinical features, risk factors, management, and outcomes.
The mean time from first symptoms or signs and presentation to hospital was 8.9 (SD 15.5) days. The majority of subjects, 88%, had at least one of the risk factors commonly associated with infective keratitis including previous ocular surgery (30%), contact lens wear (26%), topical corticosteroid use (25%), and ocular trauma (24%). Corneal scraping was performed in 92% and of a total of 105 scrapes, 71% were positive. Bacteria were isolated in all these cases, the majority being Gram positive organisms (72%). The most common isolates identified were coagulase negative Staphylococcus (16%), Propionibacterium acnes (14%), Staphylococcus epidermidis (11%), and Streptococcus pneumoniae (9%). In addition, yeasts were isolated in 5%, fungi in 4%, virus in 2%, and chlamydia in 1%. Importantly, polymicrobial infection accounted for 33% of culture positive cases. Antimicrobial treatment was changed on the basis of culture results in 17 cases (16.5%). Median initial visual and final best corrected visual acuity was 6/36-6/48 (logMAR 0.86) (IQR 0.39-2.00) and 6/12-6/15 (logMAR 0.360) (IQR 0.15-1.70), respectively. Previous ocular surgery and topical corticosteroid use were significantly associated with poorer visual acuity. The mean hospital stay was 5.8 days and the median 4.0 (IQR 2.0-8.0) days. Longer duration of stay was associated with the presence of hypopyon, larger ulcers, previous ocular surgery, and poor visual acuity.
Infectious keratitis is an important cause of ocular morbidity. A significant proportion of cases have potentially modifiable risk factors. Previous ocular surgery and topical corticosteroid use, in particular, were associated with poorer visual outcomes. Many cases of severe keratitis might be avoided, or their severity reduced, by appropriate education of patients and ophthalmologists.
确定导致新西兰公立医院收治的严重感染性角膜炎的关键危险因素、管理措施及治疗结果。
在两年期间，确定所有入住奥克兰医院的疑似感染性角膜炎患者。对103例患者的临床记录进行回顾性分析，内容包括临床特征、危险因素、管理措施及治疗结果。
从首次出现症状或体征到入院的平均时间为8.9（标准差15.5）天。大多数患者（88%）至少有一项与感染性角膜炎相关的常见危险因素，包括既往眼部手术（30%）、佩戴隐形眼镜（26%）、局部使用皮质类固醇（25%）及眼外伤（24%）。92%的患者进行了角膜刮片检查，在总共105次刮片中，71%呈阳性。所有这些病例均分离出细菌，大多数为革兰氏阳性菌（72%）。最常见的分离菌为凝固酶阴性葡萄球菌（16%）、痤疮丙酸杆菌（14%）、表皮葡萄球菌（11%）及肺炎链球菌（9%）。此外，5%的病例分离出酵母菌，4%分离出真菌，2%分离出病毒，1%分离出衣原体。重要的是，混合感染占培养阳性病例的33%。17例（16.5%）患者根据培养结果更改了抗菌治疗方案。初始视力和最终最佳矫正视力的中位数分别为6/36 - 6/48（logMAR 0.86）（四分位间距0.39 - 2.00）和6/12 - 6/15（logMAR 0.360）（四分位间距0.15 - 1.70）。既往眼部手术和局部使用皮质类固醇与较差的视力显著相关。平均住院时间为5.8天，中位数为4.0（四分位间距2.0 - 8.0）天。住院时间延长与前房积脓、较大溃疡、既往眼部手术及视力差有关。
感染性角膜炎是眼部发病的重要原因。相当一部分病例存在潜在可改变的危险因素。特别是既往眼部手术和局部使用皮质类固醇与较差的视力结果相关。通过对患者和眼科医生进行适当教育，许多严重角膜炎病例或许可以避免，或其严重程度可以降低。
