Arunga Simon, Wiafe Geoffrey, Habtamu Esmael, Onyango John, Gichuhi Stephen, Leck Astrid, Macleod David, Hu Victor, Burton Matthew
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK, UK.
Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.
BMJ Open Ophthalmol. 2019 Dec 23;4(1):e000351. doi: 10.1136/bmjophth-2019-000351. eCollection 2019.
Microbial keratitis (MK) is a frequent cause of sight loss in sub-Saharan Africa. However, no studies have formally measured its impact on quality of life (QoL) in this context.
As part of a nested case-control design for risk factors of MK, we recruited patients presenting with MK at two eye units in Southern Uganda between December 2016 and March 2018 and unaffected individuals, individually matched for sex, age and location. QoL was measured using WHO Health-Related and Vision-Related QoL tools (at presentation and 3 months after start of treatment in cases). Mean QoL scores for both groups were compared. Factors associated with QoL among the cases were analysed in a linear regression model.
215 case-controls pairs were enrolled. The presentation QoL scores for the cases ranged from 20 to 65 points. The lowest QoL was visual symptom domain; mean 20.7 (95% CI 18.8 to 22.7) and the highest was psychosocial domain; mean 65.6 (95% CI 62.5 to 68.8). At 3 months, QoL scores for the patients ranged from 80 to 90 points while scores for the controls ranged from 90 to 100. The mean QoL scores of the cases were lower than controls across all domains. Determinants of QoL among the cases at 3 months included visual acuity at 3 months and history of eye loss.
MK severely reduces QoL in the acute phase. With treatment and healing, QoL subsequently improves. Despite this improvement, QoL of someone affected by MK (even with normal vision) remains lower than unaffected controls.
在撒哈拉以南非洲地区，微生物性角膜炎（MK）是导致视力丧失的常见原因。然而，在此背景下，尚无研究正式衡量其对生活质量（QoL）的影响。
作为MK危险因素嵌套病例对照设计的一部分，我们在2016年12月至2018年3月期间，在乌干达南部的两个眼科单位招募了患有MK的患者以及未受影响的个体，并根据性别、年龄和地点进行个体匹配。使用世界卫生组织与健康相关及与视力相关的生活质量工具（病例在就诊时及开始治疗3个月后）测量生活质量。比较两组的平均生活质量得分。在病例组中，采用线性回归模型分析与生活质量相关的因素。
共纳入215对病例对照。病例组就诊时的生活质量得分在20至65分之间。生活质量最低的是视觉症状领域，平均为20.7（95%置信区间18.8至22.7），最高的是心理社会领域，平均为65.6（95%置信区间62.5至68.8）。3个月时，患者的生活质量得分在80至90分之间，而对照组的得分在90至100分之间。病例组在所有领域的平均生活质量得分均低于对照组。病例组3个月时生活质量的决定因素包括3个月时的视力和失明史。
MK在急性期严重降低生活质量。随着治疗和愈合，生活质量随后得到改善。尽管有这种改善，但受MK影响的人的生活质量（即使视力正常）仍低于未受影响的对照组。
