Priyadarshini Kshyanaprava, Priyadarshini Smruti Rekha, Sahu Srikant Kumar, Behera Himansu Sekhar, Das Sujata
Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Ocular Microbiology Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Indian J Ophthalmol. 2025 Mar 1;73(3):404-407. doi: 10.4103/IJO.IJO_3338_23. Epub 2024 Aug 14.
To identify the predisposing factors, clinico-microbiological profiles, and treatment responses in patients with atypical mycobacterial keratitis.
The study retrospectively analyzed patients who presented at a tertiary eyecare center in eastern India with atypical mycobacterial keratitis between 2008 and 2021. The diagnostic criteria included cases positive for acid-fast bacilli on Ziehl-Nielsen stain or culture. The antibiotic susceptibility pattern was observed, and treatment was initiated accordingly.
Out of the 29 cases, ocular predisposing factors were present in 62.1% with an antecedent history of trauma, and vegetative matter was the most common risk factor. There was no predisposing association with systemic conditions in any case. A long lag time was observed between the onset of corneal infection and presentation in 79.3% of cases, with the average time being 43.7 days. Clinical signs mimicked fungal keratitis in most cases. Typical cracked windshield appearance was only observed in two cases. Two patients presented with clinical pictures like peripheral ulcerative keratitis. Topical amikacin was used as treatment in 28 cases. Based on disk diffusion assay, 28 (96.5%) isolates were sensitive to amikacin. Twelve (41.3%) were sensitive to vancomycin, six (20.6%) to gatifloxacin, six (20.6%) to ciprofloxacin, and four (13.7%) to moxifloxacin. Twelve participants showed good final visual acuity posttreatment, which improved to over two lines of Snellen's visual acuity chart (44.5%).
Atypical mycobacteria keratitis may not present with classically described clinical features. The duration of presentation, clinical presentation, special microbiological stains, targeted therapy, and antibiotic susceptibility patterns are the key to successfully managing these intractable infections and obtaining favorable outcomes.
确定非结核分枝杆菌角膜炎患者的易感因素、临床微生物学特征及治疗反应。
本研究回顾性分析了2008年至2021年期间在印度东部一家三级眼科护理中心就诊的非结核分枝杆菌角膜炎患者。诊断标准包括齐-尼氏染色或培养中抗酸杆菌阳性的病例。观察抗生素敏感性模式，并据此开始治疗。
29例患者中，62.1%存在眼部易感因素，有外伤史，植物性物质是最常见的危险因素。所有病例均与全身状况无易感关联。79.3%的病例在角膜感染发作与就诊之间观察到较长的延迟时间，平均时间为43.7天。大多数病例的临床体征类似真菌性角膜炎。仅在2例中观察到典型的碎玻璃样外观。2例患者表现出类似周边溃疡性角膜炎的临床表现。28例患者使用局部阿米卡星进行治疗。基于纸片扩散法，28株（96.5%）分离株对阿米卡星敏感。12株（41.3%）对万古霉素敏感，6株（20.6%）对加替沙星敏感，6株（20.6%）对环丙沙星敏感，4株（13.7%）对莫西沙星敏感。12名参与者治疗后最终视力良好，视力提高到超过斯内伦视力表两行以上（44.5%）。
非结核分枝杆菌角膜炎可能不表现出经典描述的临床特征。就诊时间、临床表现、特殊微生物染色、靶向治疗和抗生素敏感性模式是成功管理这些难治性感染并获得良好结果的关键。
