Moshirfar Majid, Hopping Grant C, Vaidyanathan Uma, Liu Harry, Somani Anisha N, Ronquillo Yasmyne C, Hoopes Phillip C
Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA.
Utah Lions Eye Bank, Murray, UT, USA.
Med Hypothesis Discov Innov Ophthalmol. 2019 Fall;8(3):145-151.
Infectious keratitis causes significant, financial burden and is only increasing in frequency with contact lens use. Despite this, no retrospective studies, prospective studies, or clinical trials have evaluated the diagnostic validity of clinical guidelines in cases of infectious keratitis. Currently, standard of care recommends that corneal samples be obtained for staining and culturing in select patients showing evidence of corneal ulceration. Ideally, diagnostic information from corneal sampling is thought to help guide therapeutic interventions, prevent disease progression, reduce antibiotic resistance, and decrease overall expenditures for the management and treatment of infectious keratitis. However, current staining and culturing methods are limited by poor sensitivity in non-bacterial cases (i.e. fungal, viral) and lengthy turnaround times, and these methods do not frequently change clinical decision making. Newer fluoroquinolones and broad-spectrum antibiotics resolve the vast majority of cases of infectious keratitis, rendering cultures less essential for management. We studied the clinical utility of obtaining corneal samples for culturing and staining and the need for future research to establish superior diagnostic guidelines for their use in infectious keratitis.
感染性角膜炎造成了巨大的经济负担，并且随着隐形眼镜的使用，其发病率还在不断上升。尽管如此，尚无回顾性研究、前瞻性研究或临床试验评估过临床指南在感染性角膜炎病例中的诊断有效性。目前，护理标准建议，对于有角膜溃疡迹象的特定患者，应获取角膜样本进行染色和培养。理想情况下，角膜采样的诊断信息被认为有助于指导治疗干预、预防疾病进展、降低抗生素耐药性，并减少感染性角膜炎管理和治疗的总体支出。然而，目前的染色和培养方法存在局限性，在非细菌性病例（即真菌性、病毒性）中敏感性较差，且周转时间较长，这些方法并不常改变临床决策。新型氟喹诺酮类药物和广谱抗生素可解决绝大多数感染性角膜炎病例问题，使得培养对于管理而言不再那么必要。我们研究了获取角膜样本进行培养和染色的临床实用性，以及未来开展研究以建立用于感染性角膜炎的更优诊断指南的必要性。
