J Korean Ophthalmol Soc > Volume 63(7); 2022 > Article |
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Twenty-eight eyes were polymicrobial infection: two isolates were observed in 24 eyes, three isolates were observed in three eyes and four isolates were observed in one eye. E. cloacae, S. aureus (two cases); E. aerogenes, S. marcescens (two cases); E. cloacae, S. maltophilia (two cases); S. marcescens, K. pneumoniae (one case); S. marcescens, E. cloacae (one case); P. aeruginosa, S. maltophilia (one case); S. epidermidis, E. cloacae (one case); P. putida, A.denitrificans (one case); P. aeruginosa, E. aerogenes (one case); S. epidermidis, P. stutzeri (one case); S. marcescens, S. maltophilia (one case); A. xylosoxidans, P. putida (one case); M. catarrhalis, P. stutzeri (one case); P. aeruginosa, S. epidermidis (one case); E. faecalis, S. aureus (one case); E. faecalis, E. cloacae (one case); E. faecium, P. putida (one case); P. putida, S. aureus (one case); A. baumannii, S. maltophilia (one case); A. baumannii, S. epidermidis (one case); U. urealyticum, M. hominis (one case); S. mitis, S. oralis, E. faecalis (one case); E. cloacae, A. baumannii, E. aerogenes (one case); E. cloacae, E. aerogenes, S. epidermidis (one case); S. marcescens, A. xylosoxidans, S. epidermidis, E. cloacae (one case).
Characteristic | Poor visual outcome (n = 44) | Good visual outcome (n = 186) | p-value (χ2-test) |
---|---|---|---|
Male sex | 20 (45.5) | 97 (52.2) | 0.424 |
Age (years) | 67.9 ± 15.2 | 51.9 ± 21.1 | <0.001* |
Median | 71.5 (10-92) | 56.0 (7-93) | <0.001† |
<20 | 1 (2.3) | 19 (10.2) | 0.135‡ |
20-39 | 2 (4.5) | 35 (18.8) | 0.021‡ |
40-59 | 6 (13.6) | 50 (26.9) | 0.066 |
60-79 | 27 (61.4) | 74 (39.8) | 0.009 |
≥80 | 8 (18.2) | 8 (4.3) | 0.001 |
Seasonal distribution | 0.994 | ||
Spring (Mar-May) | 13 (29.5) | 59 (31.7) | |
Summer (Jun-Aug) | 11 (25.0) | 45 (24.2) | |
Autumn (Sep-Nov) | 11 (25.0) | 45 (24.2) | |
Winter (Dec-Feb) | 9 (20.5) | 37 (19.9) | |
Symptom duration ≥7 days | 25 (56.8) | 67 (36.0) | 0.011 |
Rural residency | 21 (47.7) | 87 (46.8) | 0.909 |
Agricultural worker§ | 9 (75.0) | 42 (44.7) | 0.048 |
Predisposing factor* | Poor visual outcome (n = 44) | Good visual outcome (n = 186) | p-value (χ2-test) |
---|---|---|---|
Corneal trauma | 21 (47.7) | 110 (59.1) | 0.169 |
Previous OSD | 18 (40.9) | 33 (17.7) | 0.001 |
Old corneal ulcer | 4 (9.1) | 5 (2.7) | 0.071† |
Herpetic keratitis/keratouveitis | 5 (11.4) | 15 (8.1) | 0.551† |
Bullous keratopathy | 8 (18.2) | 0 (0.0) | <0.001† |
Exposure keratopathy | 0 (0.0) | 3 (1.6) | 1.000† |
Others | 7 (15.9) | 18 (9.7) | 0.232 |
Use of antiglaucoma eye drops | 4 (9.1) | 5 (2.7) | 0.071† |
Prior topical steroid use | 8 (18.2) | 26 (14.0) | 0.480 |
Prior ocular surgery | 18 (40.9) | 30 (16.1) | <0.001 |
Contact lens wear | 1 (2.3) | 43 (23.1) | 0.001† |
Systemic disease | |||
Diabetes | 10 (22.7) | 13 (7.0) | 0.002 |
Hypertension | 17 (38.6) | 32 (17.2) | 0.002 |
No apparent causes | 3 (6.8) | 21 (11.3) | 0.583† |
Poor visual outcome (n = 44) | Good visual outcome (n = 186) | p-value (χ2-test) | |
---|---|---|---|
Initial clinical characteristic | |||
Central lesion* | 37 (84.1) | 98 (52.7) | <0.001 |
Epithelial defect size ≥5 mm2 | 32 (72.7) | 77 (41.4) | <0.001 |
Hypopyon | 19 (43.2) | 35 (18.8) | 0.001 |
Endothelial plaque | 3 (6.8) | 14 (7.5) | 1.000† |
Deep infiltration | 13 (29.5) | 24 (12.9) | 0.007 |
Presenting BCVA (logMAR)‡ | 2.47 ± 0.72 | 1.18 ± 0.96 | <0.001§ |
<0.1, Snellen | 40 (90.9) | 83 (44.6) | <0.001† |
Treatment outcome | |||
Epithelial healing time ≥10 days | 26 (59.1) | 86 (46.2) | 0.125 |
Surgical treatment | 11 (25.0) | 10 (5.4) | <0.001 |
AMT | 8 (18.2) | 8 (4.3) | 0.001 |
Evisceration | 3 (6.8) | 0 (0.0) | 0.007† |
Conjunctival flap | 1 (2.3) | 0 (0.0) | 0.191† |
Tarsorrhaphy | 0 (0.0) | 1 (0.5) | 1.000† |
Scleral lamellar graft | 0 (0.0) | 1 (0.5) | 1.000† |
Penetrating keratoplasty | 0 (0.0) | 1 (0.5) | 1.000† |
Final BCVA (logMAR)‡ | 2.67 ± 0.56 | 0.35 ± 0.51 | <0.001§ |
Values are presented as mean ± standard deviation or number (%).
BCVA = best-corrected visual acuity; logMAR = logarithm of minimal angle of resolution; AMT = amniotic membrane transplantation.
Variable |
Total group (n = 230) |
||
---|---|---|---|
Incidence of poor visual outcome | Z-score† | p-value | |
Sex (male:female) | 17.1:21.2 | -0.797 | 0.424 |
Age (≥60 years:<60 years) | 29.9:8.0 | 4.222 | <0.001 |
Diabetes (+):(-) | 43.5:16.4 | 3.122 | 0.002 |
Previous OSD (+):(-) | 35.3:14.5 | 3.319 | 0.001 |
Prior ocular surgery (+):(-) | 37.5:14.3 | 3.629 | <0.001 |
Contact lens wear (+):(-) | 2.3:23.1 | -3.155 | 0.001‡ |
Prior topical antibiotics use (+):(-) | 12.1:24.4 | -2.344 | 0.019 |
Prior topical steroid use (+):(-) | 23.5:18.4 | 0.705 | 0.480 |
Corneal lesion (central:peripheral)* | 27.4:7.4 | 3.796 | <0.001 |
Hypopyon (+):(-) | 35.2:14.2 | 3.421 | 0.001 |
Epithelial defect size (≥5 mm2:<5 mm2) | 29.4:9.9 | 3.735 | <0.001 |
Symptom duration (≥10 days:<10 days) | 27.3:16.6 | 1.756 | 0.078 |
Epithelial healing time (≥10 days:<10 days) | 23.2:15.3 | 1.531 | 0.125 |
Staphylococcus spp. (+):(-) | 18.2:19.4 | -0.205 | 0.838 |
Pseudomonas spp. (+):(-) | 20.8:18.6 | 0.342 | 0.732 |
Enterobacter spp. (+):(-) | 15.4:19.9 | -0.651 | 0.514 |
† a two-proportion Z-test was used to test for a difference between two population proportions. The value of the Z-score for a factor indicates how far away from the mean value of the normal population, as a multiple of the standard deviation. For each variable, the positive direction of the Z-score was defined based on the first of the two independent variable conditions. The Z-scores for each confidence levels of 95%, 99%, and 99.9% are ±1.96, ±2.58, and ±3.29, respectively [39];
Study | Study design (No. of eyes) | Definition of PTO | Risk factors for PTO |
---|---|---|---|
This study (Korea, 2007-2020) | BK (230) | Final BCVA <0.1 and did not improve compared to the initial BCVA | Age ≥60 years, central lesion, epithelial defect size ≥5 mm2, prior ocular surgery, hypopyon, previous OSD, diabetes |
Kim et al [40] (Korea, 2011-2016) | BK (98) | Final BCVA <0.1 or VA loss or surgical treatment | Previous OSD, previous ocular surgery |
Kim et al [41] (Korea, 2000-2007) | BK (128) | Final VA equal or decrease or increased infiltrate or PKP for perforation | Previous OSD, large ulcer size (≥7 mm2) |
You et al [4] (Korea, 2008-2017) | BK, FK, AK (956) | Final BCVA <0.1 or VA loss or complications or surgical treatment | Initial BCVA <0.02, age ≥65 years, central lesion, hypopyon |
Mun et al [8] (Korea, 2007-2016) | BK (129) | Evisceration | Topical glaucoma medication, previous ocular surgery |
Yoon et al [2] (Korea, 2000-2018) | BK (433) | Final VA < hand motion or surgical treatment | Age ≥60 years |
Ng et al [42] (Hong Kong, 2004-2013) | BK, HK, FK, AK (347) | Any VA loss or major complications or therapeutic keratoplasty | Older age group (average 62.7 years), previous ocular trauma, large ulcer size (>3 mm2) |
Chidambaram et al [37] (South India, 2012-2013) | BK, HK, AK (252) | Enlarged infiltrate size or perforation or surgical treatment | Age ≥50 years, female, no formal education |
Bourcier et al [1] (Paris, France, 1998-1999) | BK (300) | VA loss (>4 lines) or complications or PKP | Previous OSD, systemic disease, depth of infiltrate, severe anterior chamber inflammation |
Khoo et al [32] (Sydney, Australia, 2012-2016) | BK, HK, FK, AK (1052) | Final VA <6/60 or VA loss (≥1 line) or complications or surgical treatment | Increase in age, poor initial VA, epithelial defect size >9.1 mm2, previous topical steroid use, history of corneal transplant |
Green et al [36] (Brisbane, Australia, 1999-2004) | BK, HK, AK (207) | Final BCVA ≤0.1 or complications or surgical treatment | Previous OSD, age ≥50 years |
Ting et al [6] (Nottingham, UK, 2015-2019) | BK (283) | Final CDVA <6/24 (Snellen) and delayed corneal healing (>30 days from initial presentation) | Age ≥50 years, large infiltrate (>3 mm2), poor presenting vision |
Morlet et al [5] (Manchester, UK, 1999) | BK, HK, AK (118) | Increase in ulcer size or perforation | Age ≥60 years, large ulcer size (>5 mm2) |
Miedziak et al [43] (Pennsylvania, USA, 1989-1995) | BK, HK, FK, AK (162) | PKP | Older age, referral delay, previous topical steroid use, previous ocular surgery, initial VA ≤ FC, large ulcer size (>16 mm2), central lesion |
PTO = poor treatment outcome; BK = bacterial keratitis; BCVA = best-corrected visual acuity; OSD = ocular surface disease; VA = visual acuity; PKP = penetrating keratoplasty; FK = fungal keratitis; AK = acanthamoeba keratitis; HK = herpetic keratitis; CDVA = corrected distance visual acuity; FC = finger count.
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