Cornea and Refractive Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India.
Microbiologist, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Indian J Ophthalmol. 2024 Aug 1;72(8):1130-1135. doi: 10.4103/IJO.IJO_2794_23. Epub 2024 Jul 29.
To study the risk factors, clinical features, and treatment outcomes of patients with culture-negative keratitis (CNK).
A retrospective data review of 933 patients with CNK was performed from January 2018 to December 2020. The variables such as the history of injury, visual acuity, slit-lamp findings with measurements of size and depth of ulcer, microbiological evaluation, duct patency, blood glucose levels, and treatment were considered, and clinical outcome was analyzed.
Of the 933 patients with CNK, 763 (81.8%) were medically managed, with a mean treatment duration of 2.08 ± 1.7 weeks. Among them, 622 (66.7%) were both smear and culture-negative, and 311 (33.3%) showed only smear positivity. Smear-positive patients showed a positive correlation with the history of injury. A higher incidence of fungal growth on repeat culture was observed. Surgical interventions were done only in 18.2% of the patients; the rest were treated with topical medications alone.
High clinical suspicion, differentiation of causative organisms based on clinical findings, and initiating empirical therapy with broad-spectrum antibiotics and antifungals improve the ultimate prognosis in patients with CNK, even though a standard protocol for empirical medical treatment may differ among institutions and surgeons based on their clinical experience and geographical variations.
研究培养阴性角膜炎（CNK）患者的危险因素、临床特征和治疗结果。
回顾性分析了 2018 年 1 月至 2020 年 12 月期间 933 例 CNK 患者的资料。考虑了外伤史、视力、溃疡大小和深度的裂隙灯检查结果、微生物评估、导管通畅性、血糖水平和治疗等变量，并分析了临床结果。
933 例 CNK 患者中，763 例（81.8%）接受药物治疗，平均治疗时间为 2.08 ± 1.7 周。其中，622 例（66.7%）既无涂片也无培养结果，311 例（33.3%）仅涂片阳性。涂片阳性患者与外伤史呈正相关。重复培养时真菌生长的发生率更高。仅 18.2%的患者接受了手术干预；其余患者仅接受了局部药物治疗。
高度的临床怀疑、根据临床发现区分致病微生物、并使用广谱抗生素和抗真菌药物进行经验性治疗，可改善 CNK 患者的最终预后，尽管基于临床经验和地理差异，各机构和外科医生的经验性药物治疗标准方案可能有所不同。
