Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy.
The Cornea Institute, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India.
Cornea. 2022 Sep 1;41(9):1103-1109. doi: 10.1097/ICO.0000000000002957. Epub 2021 Dec 22.
The aim of this study was to analyze the risk factors, microbiological profile, and treatment efficacy in pediatric microbial keratitis (MK) and to identify clinical biomarkers prognosticating outcome.
A retrospective analysis was conducted from patients younger than 16 years with MK-excluding viral, marginal, or interstitial keratitis. Data pertaining to predisposing factors, symptom duration, prior treatment, ulcer characteristics, microbiological profile, time to resolution, and final outcome were recorded. Statistical analysis was performed. The mixed-effects linear regression model with random intercept was used to evaluate factors affecting time to resolution.
Among 218 episodes of 215 pediatric patients with MK, the geometric mean of central [median 3 mm, interquartile range (IQR) 1-4.3 mm] and peripheral ulcers (median 1 mm, IQR 1-2.5 mm) was significantly different ( P < 0.0001). Organisms identified were bacteria (56.9%), fungi (31.5%), and acanthamoebae (2.3%). Of 172 cases (78.8%), which resolved in a median resolution time of 22 days (IQR, 11-44 days), 107 (81.6%) with absent/negative microbiology healed on empirical therapy. On multivariate analysis, peripheral ulcers and geometric mean ulcer size affected time to resolution. Significantly higher percentage of eyes, which worsened or perforated, were on topical steroids compared with those which healed (31.8% vs. 9.2%, P = 0.0061).
Good outcome even in culture negative cases suggests empirical therapy may be instituted for nonsevere peripheral pediatric MK; however, the importance of a microbiological workup cannot be underscored enough. Ulcer location and geometric mean size of ulcer may be used as clinical prognostic markers for resolution.
本研究旨在分析小儿微生物性角膜炎（MK）的危险因素、微生物谱和治疗效果，并确定预测结局的临床生物标志物。
对年龄小于 16 岁、不包括病毒性、边缘性或间质性角膜炎的 MK 患者进行回顾性分析。记录与易患因素、症状持续时间、既往治疗、溃疡特征、微生物谱、愈合时间和最终结局相关的数据。进行统计分析。采用具有随机截距的混合效应线性回归模型评估影响愈合时间的因素。
在 215 例小儿 MK 患者的 218 个发作中，中央溃疡（中位 3 毫米，四分位距 1-4.3 毫米）和周边溃疡（中位 1 毫米，四分位距 1-2.5 毫米）的几何均数有显著差异（P<0.0001）。鉴定出的病原体包括细菌（56.9%）、真菌（31.5%）和棘阿米巴（2.3%）。172 例（78.8%）患者的溃疡愈合，中位愈合时间为 22 天（四分位距 11-44 天），其中 107 例（81.6%）无/阴性微生物学的患者在经验性治疗后痊愈。多变量分析显示，周边溃疡和溃疡几何均数大小影响愈合时间。与愈合的患者相比，恶化或穿孔的患者使用局部皮质类固醇的比例明显更高（31.8%比 9.2%，P=0.0061）。
即使在培养阴性的情况下，良好的结局也提示在非严重的小儿周边 MK 中可以进行经验性治疗，但微生物学检查的重要性不容忽视。溃疡位置和溃疡的几何均数大小可能是预测愈合的临床预后标志物。
