Dago Tolcha Regasa, Woldemichael Dagmawit Kifle, Daba Fekede Bekele
School of Pharmacy, College of Medicine and Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia.
Department of Ophthalmology, Institute of Health, Jimma University, Jimma, Ethiopia.
Clin Ophthalmol. 2021 Mar 22;15:1223-1237. doi: 10.2147/OPTH.S291880. eCollection 2021.
Infectious keratitis is a major global cause of visual impairment and irreversible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis.
Prospective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a -value of <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of poor treatment outcome and variables with a -value of <0.05 were considered statistically significant.
The research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment outcome. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5-25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16-27.3), poor adherence (AOR=5.3, 95%CI: 1.8-25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8-25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48-48.23) and farm workers (AOR=3.59, 95%CI: 1.09-11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%).
Our study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.
感染性角膜炎是全球角膜疾病中导致视力损害和不可逆失明的主要原因。其诊断和治疗仍然具有挑战性。在发展中国家，临床和视觉预后仍然很差。本研究的目的是确定感染性角膜炎患者的治疗结果及其预测因素。
2019年4月1日至9月30日，在吉姆马大学医学中心眼科对诊断为感染性角膜炎的成年患者进行了前瞻性观察研究。主要结局指标是溃疡对经验性治疗的反应。未愈合且需要手术的溃疡预后较差。将P值<0.25的变量纳入多因素逻辑回归模型，以确定治疗效果不佳的独立预测因素，P值<0.05的变量被认为具有统计学意义。
该研究纳入了131名成年患者。87名（66.4%）为男性。平均年龄为39.38（±18.9）岁。83名（63.4%）患者治疗效果不佳。平均住院时间为17.38（±12.563）天。71名（54.2%）参与者出现视力不良结局。7名（5.3%）患者进行了眼球摘除术。治疗效果不佳的独立预测因素包括入院时穿孔（比值比[AOR]=6.1，95%置信区间[CI]：1.5-25.1）、合并症（AOR=7.7，95%CI：2.16-27.3）、依从性差（AOR=5.3，95%CI：1.8-25.9）、使用传统药物（AOR=6.7，95%CI：1.8-25.4）、溃疡深度>1/3（AOR=7.6，95%CI：2.48-48.23）以及农场工人（AOR=3.59，95%CI：1.09-11.77）。入院后发生的主要并发症为穿孔（14.5%），其次是眼内炎（7.63%）和角膜混浊（6.87%）。
我们的研究发现治疗效果不佳和视力不良结局的发生率很高。合并症、入院时穿孔、使用传统药物、从事农业工作、依从性差以及溃疡深度是治疗效果不佳的预测因素。这种高不良结局需要在全国范围内进行干预性研究，并采取可能惠及农村社区的紧急干预措施。
