Department of Ocular Microbiology, Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, Tamil Nadu, India; and.
Department of Cornea & Refractive Surgery Services, Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, Tamil Nadu, India.
Cornea. 2023 Mar 1;42(3):359-364. doi: 10.1097/ICO.0000000000003194. Epub 2022 Dec 12.
The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa ) at a tertiary eye care center.
Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes.
Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida , 26.7% as Pseudomonas stutzeri , 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes . We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer.
Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.
本研究旨在研究一家三级眼科护理中心中罕见假单胞菌角膜炎（除绿脓假单胞菌外）的发病率、人口统计学特征、临床过程、特征分析和管理。
回顾性研究了 2017 年 1 月至 2021 年 12 月期间经培养证实的 30 例罕见假单胞菌角膜炎病例。分析了发病率、人口统计学和临床特征、诱发因素、微生物结果、治疗和视力结果。我们评估了不良治疗结果的危险因素。
在细菌性角膜炎病例中，罕见假单胞菌角膜炎的发生率为 2.2%。发病时的平均年龄为 51.37 岁，最常见的诱发因素是角膜外伤（36.7%）。就诊时的平均最佳矫正视力（BCVA）[以最小分辨角对数（logMAR）表示]为 1.99，平均溃疡大小为 5.75mm。在培养中，56.7%的病例鉴定为恶臭假单胞菌，26.7%的病例鉴定为斯氏假单胞菌，10%的病例鉴定为门多西纳假单胞菌，3.3%的病例分别为栖稻假单胞菌和产碱假单胞菌。我们用广谱抗生素联合治疗的方法记录了 66.7%的病例有良好的治疗反应，而 33.3%的病例需要手术干预。临床结局不佳的危险因素包括年龄较大、眼外伤、既往眼部手术、就诊时 BCVA 较差、溃疡较大、治疗延迟、前房积脓以及穿孔、角巩膜缘受累和全层溃疡等早期并发症。
罕见假单胞菌角膜炎与角膜外伤等诱发因素以及既往眼部手术、年龄较大、大溃疡、治疗时间较长、复杂病例早期手术干预以及视力预后较差等其他因素密切相关。
