Department of Ophthalmology, University of California, San Francisco, San Francisco, CA.
Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; and.
Cornea. 2023 Sep 1;42(9):1069-1073. doi: 10.1097/ICO.0000000000003121. Epub 2022 Aug 24.
Infectious keratitis is a vision-threatening condition requiring close follow-up and disciplined eye drop administration to achieve resolution. Although patients presenting to county hospitals often have more severe presentations, there is a paucity of risk and outcomes data in this setting. This study investigates risk factors predicting loss to follow-up (LTFU), medication noncompliance, and poor outcomes for infectious keratitis in the county hospital setting.
This was a retrospective case-control study at Zuckerberg San Francisco General Hospital and Trauma Center. Inclusion criteria were patients who had corneal cultures for suspected infectious bacterial or fungal keratitis between 2010 and 2021. Exclusion criteria were patients with viral keratitis only. Multivariable logistic regression was used to analyze the relationship of social and medical risk factors with LTFU, medication noncompliance, worsened visual acuity (VA), and delayed resolution time.
Of 174 patients with infectious keratitis in this analysis, 69 (40.0%) had LTFU. Unemployment was associated with increased risk of LTFU (odds ratio 2.58, P = 0.049) and worse final VA ( P = 0.001). Noncompliance trended toward an association with homelessness (odds ratio 3.48, P = 0.095). Increasing age correlated with longer resolution time, with each 1-year increase associated with delayed resolution by 0.549 days ( P = 0.042).
Patients experiencing unemployment, homelessness, or increased age demonstrate higher risk for treatment barriers including loss to follow-up and medication noncompliance, resulting in worse VA and delayed time to resolution. These risk factors should be considered when determining the need for more deliberate follow-up measures in patients with infectious keratitis.
感染性角膜炎是一种威胁视力的疾病，需要密切随访和规范的滴眼剂治疗才能痊愈。虽然到县级医院就诊的患者病情往往更严重，但在这种环境下，关于风险和结局的数据很少。本研究旨在调查预测县级医院感染性角膜炎患者失访、药物不依从和结局不良的风险因素。
这是在 Zuckerberg 旧金山总医院和创伤中心进行的回顾性病例对照研究。纳入标准为 2010 年至 2021 年间进行疑似细菌性或真菌性感染性角膜炎角膜培养的患者。排除标准为单纯病毒性角膜炎患者。采用多变量逻辑回归分析社会和医疗风险因素与失访、药物不依从、视力下降和延迟愈合时间之间的关系。
在这项分析中，174 例感染性角膜炎患者中有 69 例（40.0%）失访。失业与失访风险增加相关（优势比 2.58，P=0.049），且最终视力更差（P=0.001）。药物不依从与无家可归呈趋势相关（优势比 3.48，P=0.095）。年龄增加与愈合时间延长相关，每增加 1 岁，愈合时间延迟 0.549 天（P=0.042）。
失业、无家可归或年龄较大的患者表现出更高的治疗障碍风险，包括失访和药物不依从，导致视力更差和愈合时间延迟。在确定是否需要对感染性角膜炎患者进行更精心的随访措施时，应考虑这些风险因素。
