Br J Ophthalmol 2000;84:54-59
( January )
Corneal ulceration in the elderly in Hyderabad, south India
Derek Y Kunimotoa, Savitri Sharmab, Prashant Gargb, Usha Gopinathanb, David Millera, Gullapalli N Raob
a Harvard Medical
School, Department of Ophthalmology, Boston, MA, USA, b LV Prasad Eye
Institute, Hyderabad, India
Correspondence to: Savitri Sharma, LV Prasad Eye Institute, Road No 2, Bajara Hills,
Hyderabad 500 034, India
Accepted for publication 18 August 1999
AIMS To report
demographic, microbiological, therapeutic, anatomical, and visual
results of corneal ulceration in the elderly patients seen at a
tertiary eye care centre in south India.
METHODS102
consecutive cases of microbial keratitis in patients 65 years and older
were studied. Inclusion criteria were: (i) presence of corneal stromal
infiltrate upon slit lamp examination; and (ii) microbiological
evaluation of corneal scrapings for suspected microbial keratitis.
RESULTSThe principal
predisposing factors identified in this study were ocular disease
(38.2%), previous ocular surgery in the same eye (29.4%), trauma
(17.6%), and severe systemic disease (16.7%). Contact lens wear was
associated with only two cases (2.0%). 99 organisms were isolated in
cultures of corneal scrapings from 74 (72.5%) of the 102 cases.
Staphylococcus epidermidis (31.1%), filamentous fungi (25.7%), and Streptococcus
pneumoniae (13.5%) were the most common isolates. 12 eyes
(11.8%) required surgery, 15 (14.7%) eventually required
evisceration, and nine (9.6%) of the 94 followed patients achieved an
unaided vision of 20/60 or better at last follow up.
CONCLUSIONSThis work
represents the largest recent single centre study on (non-viral)
microbial keratitis in the elderly, its management, and outcomes of
therapy. While the predisposing factors differ from those of general
population, the spectrum of microbes responsible for keratitis in the
elderly appears to reflect the local microbial flora rather than a
predilection for elderly patients. Delay in diagnosis and systemic
conditions associated with advancing age probably contribute to poorer
outcome from therapeutic measures.
© 2000 by British Journal of Ophthalmology
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