Br J Ophthalmol 1999;83:1027-1031
( September )
Risk factors for treatment outcome of suspected microbial
keratitis
Nigel Morlet, Darwin Minassian, Jeremy Butcher, the Ofloxacin Study Group*
Correspondence to: J K G Dart,
Moorfields Eye Hospital, City Road, London EC1V 2PD.
Accepted for publication 4 May 1999
BACKGROUND Primary
treatment for suspected microbial keratitis is generally successful.
Although risks such as contact lens use are well recognised as
causative factors for microbial keratitis, little is known about the
risk factors that influence treatment outcome. The present study
evaluates the risk factors assessed at diagnosis as prognostic
indicators of primary treatment failure.
METHODSPatients were
prospectively enrolled in the ofloxacin treatment trial and data
concerning symptoms, treatments, past and concurrent eye disease were
collected along with the measurement of corneal ulcer size at the slit
lamp. All patients were scraped for microbiological investigation, and
treated with either ofloxacin (0.3%) or standard therapy of fortified
cefuroxime and gentamicin drops. Treatment success was complete healing
of the ulcer with zero dimensions of the epithelial defect within 2 weeks of start of treatment. The important prognostic indicators were
selected by comparison among those who failed treatment, had delayed
healing, or were culture positive with other patients using univariate
and stratified analysis. These were then used in a Poisson model for
multiple regression analysis to estimate the relative risk of the main prognostic variables.
RESULTSOf the 118 patients enrolled in the study, 14 were identified as primary treatment
failures, 17 had slow healing, and 15 indolent ulcers. There were 49 culture positive patients. The multivariate analysis identified that
large culture positive ulcers in patients 60 years or older had 5.5 times the risk of primary treatment failure (p<0.001). Significant
predictors of slow healing were previous ocular disease and a positive
culture; significant predictors of indolent ulceration were previous
ocular disease and steroid use at diagnosis; the main predictor of a
culture positive result was ulcer size.
CONCLUSIONSElderly
patients with large ulcers were more likely to be culture positive,
fail primary therapy, and require surgical intervention. A positive
microbial culture provided prognostic information regardless of the
organism isolated. However, this information was of less value for
those with small ulcers and for younger patients.
*
Members listed at the end of the paper.
© 1999 by British Journal of Ophthalmology
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