Green Matthew D, Apel Andrew J G, Naduvilath Thomas, Stapleton Fiona J
Gold Coast Hospital, Southport, and Vision CRC, Sydney, NSW, Australia.
Clin Exp Ophthalmol. 2007 Jul;35(5):421-6. doi: 10.1111/j.1442-9071.2007.01511.x.
To analyse the patient, clinical and microbiological variables associated with poor outcomes from keratitis in patients presenting to a major public hospital in Australia.
A retrospective audit of the records of all patients who had a corneal scraping in 5 years at Princess Alexandra Hospital (Brisbane, Australia) was carried out. The outcome of a patient's episode of keratitis was classified as poor if they had final visual acuity of 6/60 or worse; had vision loss during treatment; or a complication of keratitis; or needed surgical intervention.
A final outcome was established in 207 cases during the 5-year period. Final vision of 6/12 or better was found in 48% (100) of cases while a poor outcome was seen in 28% (58). Linear regression showed poor outcomes were directly associated with age (P < 0.001) and disease severity (P < 0.001). Univariate analysis indicated that poor outcomes were more likely in patients who had had prior ocular surgery (P = 0.005) or ocular surface disease (P = 0.01) and were also associated with presenting visual acuity of worse than 6/60 (P < 0.001) and isolation of Streptococcus pneumoniae (P = 0.002). While patients with traumatic keratitis, contact lens-related keratitis or negative corneal cultures (P = 0.009) were more likely to have good outcomes. Multivariate analysis showed that the relative risk of a patient having a poor outcome was 4.3x (CI 2.0-9.5) if they had severe keratitis, 4.1x (CI 1.8-9.5) if they had keratitis related to ocular surface disease and 3.8x (CI 1.8-8.3) if they were over 50 years old.
An outcome of poor vision, vision loss during treatment, surgical intervention or complication of keratitis is more likely in patients with severe keratitis, keratitis related to prior ocular surface disease or older age.
分析澳大利亚一家大型公立医院中与角膜炎不良预后相关的患者、临床及微生物学变量。
对澳大利亚布里斯班亚历山德拉公主医院5年内所有接受角膜刮片检查的患者记录进行回顾性审计。如果患者最终视力为6/60或更差；在治疗期间视力下降；或出现角膜炎并发症；或需要手术干预，则将其角膜炎发作的结果分类为不良。
在5年期间确定了207例患者的最终结果。48%（100例）患者的最终视力为6/12或更好，而28%（58例）患者的预后不良。线性回归显示不良预后与年龄（P<0.001）和疾病严重程度（P<0.001）直接相关。单因素分析表明，既往有眼部手术史（P = 0.005）或眼表疾病（P = 0.01）的患者预后不良的可能性更大，并且还与就诊时视力低于6/60（P<0.001）以及分离出肺炎链球菌（P = 0.002）有关。而外伤性角膜炎、与隐形眼镜相关的角膜炎或角膜培养阴性的患者（P = 0.009）预后良好的可能性更大。多因素分析表明，如果患者患有严重角膜炎，其预后不良的相对风险为4.3倍（置信区间2.0 - 9.5）；如果患有与眼表疾病相关的角膜炎，相对风险为4.1倍（置信区间1.8 - 9.5）；如果年龄超过50岁，相对风险为3.8倍（置信区间1.8 - 8.3）。
患有严重角膜炎、与既往眼表疾病相关的角膜炎或年龄较大的患者更有可能出现视力不良、治疗期间视力丧失、手术干预或角膜炎并发症的预后。
