University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh Medical Centre, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Am J Ophthalmol. 2019 Jan;197:17-22. doi: 10.1016/j.ajo.2018.08.055. Epub 2018 Sep 8.
To analyze the risk factors, clinical characteristics, management, and treatment outcomes of culture-proven cases of Moraxella keratitis at our center.
Retrospective observational case series.
Thirty-nine culture-proven cases of Moraxella keratitis (39 eyes) diagnosed and treated between January 2003 and April 2018 at the University of Pittsburgh Medical Center were identified and retrospectively reviewed for ocular and systemic risk factors, treatment modalities, and outcomes, as well as for antimicrobial sensitivity and resistance data.
The mean age of the 39 patients was 63.0 (range 4-95 years) with median follow-up time of 170 days. Thirty-four of 39 patients (87.2%) had an ocular risk factor, the most common of which were blepharitis in 12 (30.8%), dry eyes in 12 (30.8%), and history of ocular surgery in 9 (23.1%). History of diabetes mellitus was found in 8 patients (20.5%). Thirty-six of 39 patients (92.3%) received a fluoroquinolone (92.3%) and 30 of 39 (76.7%) received topical fortified antibiotics. Resistance to fluoroquinolones, gentamicin, and tobramycin was seen in 1 patient each, respectively. Four patients (10.3%) required tarsorrhaphy, 6 patients (15.4%) required penetrating keratoplasty, and 1 patient required enucleation. Of the 35 patients for whom visual acuity information was available, 19 (54.3%) were count fingers or worse at most recent follow-up.
Ocular risk factors, especially poor ocular surface, were identified in the vast majority of patients with Moraxella keratitis. Moraxella isolates in our study were susceptible to fluoroquinolones and aminoglycosides. Many patients required surgical intervention and the final visual acuity was often poor.
分析本中心培养阳性的莫拉氏菌角膜炎病例的危险因素、临床特征、处理方法和治疗效果。
回顾性观察性病例系列。
我们在 2003 年 1 月至 2018 年 4 月期间于匹兹堡大学医学中心确诊并治疗了 39 例培养阳性的莫拉氏菌角膜炎患者（39 只眼），对这些患者的眼部和全身危险因素、治疗方式和结果，以及抗生素药敏和耐药数据进行了回顾性分析。
39 例患者的平均年龄为 63.0 岁（范围 4-95 岁），中位随访时间为 170 天。39 例患者中有 34 例（87.2%）存在眼部危险因素，其中最常见的是睑缘炎 12 例（30.8%）、干眼症 12 例（30.8%）和眼部手术史 9 例（23.1%）。8 例（20.5%）患者有糖尿病史。36 例（92.3%）患者接受了氟喹诺酮类药物（92.3%）治疗，30 例（76.7%）患者接受了局部强化抗生素治疗。1 例患者对氟喹诺酮类药物、庆大霉素和妥布霉素分别出现耐药。4 例（10.3%）患者行睑裂缝合术，6 例（15.4%）患者行穿透性角膜移植术，1 例患者行眼球摘除术。在 35 例可获得视力信息的患者中，19 例（54.3%）患者在最近一次随访时视力最差为指数或更差。
在绝大多数莫拉氏菌角膜炎患者中，都发现了眼部危险因素，特别是眼表状况不佳。本研究中莫拉氏菌分离株对氟喹诺酮类药物和氨基糖苷类药物敏感。许多患者需要手术干预，最终视力往往较差。
