Agarwal Shweta, Khan Tanveer A, Vanathi Murugesan, Srinivasan Bhaskar, Iyer Geetha, Tandon Radhika
Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, C. J. Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
Cornea, Lens and Refractive Surgery Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2022 May;70(5):1475-1490. doi: 10.4103/ijo.IJO_2273_21.
Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis.
感染性角膜炎是一种导致严重视力损害的眼科急症。不加区分地使用抗菌药物导致耐药或难治性微生物的出现，进一步恶化了预后。并存的眼表疾病、因微生物样本不足导致的诊断延迟、生长缓慢/毒性强的病原体或全身免疫抑制状态均导致溃疡的难治性反应。随着对这些导致微生物难治性的各种眼部和全身因素的认识不断提高，生物膜形成的作用以及近期关于提高药物生物利用度的研究以及替代疗法的发展，有助于提供所需的多维度方法，以有效诊断和管理难治性角膜溃疡病例，并预防角膜穿孔或疾病的进一步传播。在本综述中，我们探讨了难治性角膜炎诊断和治疗的当前文献及未来方向。
