Keay Lisa, Edwards Katie, Naduvilath Thomas, Taylor Hugh R, Snibson Grant R, Forde Kevin, Stapleton Fiona
School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Ophthalmology. 2006 Jan;113(1):109-16. doi: 10.1016/j.ophtha.2005.08.013. Epub 2005 Dec 19.
To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population.
Retrospective medical records review.
Fifteen- to 64-year-olds with microbial keratitis treated at the Royal Victorian Eye and Ear Hospital between May 2001 and April 2003 (n = 291).
Risk factors were identified from patient files. Demographic, clinical, and microbiological data; severity; outpatient visits; hospital bed days; and vision loss were examined.
Cost to treat (Australian dollars), vision loss, and factors influencing these outcomes.
Ocular trauma (106/291 [36.4%]) and contact lens (CL) wear (98/291 [33.7%]) were the most commonly identified predisposing factors; 18 (6.1%) had multiple predisposing factors; 17 (5.8%), ocular surface disease; 20 (6.9%), herpetic eye disease; 4 (1.4%), systemic associations; 5 (1.7%), other; and 23 (7.9%), unknown cause. Of trauma cases, 90.6% involved males, compared with 44% to 57% for other groups (P<0.001). Contact lens wearers were younger than the other groups--mean age 30 years, compared with 40 to 47 years (P<0.01). Gram-negative organisms were isolated more frequently in CL wearers than trauma cases (18.7% vs. 6.5%, P = 0.01). The number of outpatient visits was 4+/-1 (median +/- interquartile range), and 19.6% (57/291) were hospitalized for 5+/-2 days. Hospital resource use and vision loss were similar for predisposing factors but differed by causative microorganism. Eighty-eight percent of cases were scraped: acanthamoeba keratitis was the most expensive to treat, followed by fungal and herpetic keratitis and, lastly, culture-proven bacterial keratitis or culture-negative cases (P<0.0001). After treatment, 21.7% exhibited >2 lines of vision loss, and 1.6% of cases had > or =10 lines of vision loss. Vision loss was associated with clinical severity (P = 0.005).
Ocular trauma and CL wear are the major predisposing factors for microbial keratitis in this age range. These cases require significant hospital resources during treatment, and the keratitis may result in loss of vision.
研究眼科急诊及住院患者中微生物性角膜炎的易感因素、治疗费用及视力转归。
回顾性病历研究。
2001年5月至2003年4月在皇家维多利亚眼耳医院接受治疗的15至64岁微生物性角膜炎患者（n = 291）。
从患者病历中确定危险因素。对人口统计学、临床和微生物学数据、严重程度、门诊就诊次数、住院天数及视力丧失情况进行研究。
治疗费用（澳元）、视力丧失及影响这些转归的因素。
眼外伤（106/291 [36.4%]）和佩戴隐形眼镜（CL）（98/291 [33.7%]）是最常见的易感因素；18例（6.1%）有多种易感因素；17例（5.8%）有眼表疾病；20例（6.9%）有疱疹性眼病；4例（1.4%）有全身相关性疾病；5例（1.7%）有其他因素；23例（7.9%）病因不明。在外伤病例中，90.6%为男性，而其他组为44%至57%（P<0.001）。佩戴隐形眼镜者比其他组年轻——平均年龄30岁，而其他组为40至47岁（P<0.01）。革兰阴性菌在佩戴隐形眼镜者中比外伤病例中分离得更频繁（18.7% 对6.5%，P = 0.01）。门诊就诊次数为4±1次（中位数±四分位间距），19.6%（57/291）住院5±2天。不同易感因素的医院资源利用和视力丧失情况相似，但因致病微生物不同而有所差异。88%的病例进行了刮片检查：棘阿米巴角膜炎治疗费用最高，其次是真菌性和疱疹性角膜炎，最后是培养证实的细菌性角膜炎或培养阴性病例（P<0.0001）。治疗后，21.7%的患者视力丧失超过2行，1.6%的病例视力丧失≥10行。视力丧失与临床严重程度相关（P = 0.005）。
眼外伤和佩戴隐形眼镜是该年龄范围内微生物性角膜炎的主要易感因素。这些病例在治疗期间需要大量医院资源，且角膜炎可能导致视力丧失。
