Br J Ophthalmol 2001;85:388-392
( April )
The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis
for the prevention of corneal ulceration in Nepal
M P Upadhyaya, P C Karmacharyaa, S Koiralaa, D N Shaha, S Shakyaa, J K Shresthaa, H Bajracharyaa, C K Gurunga, J P Whitcherb
a Bhaktapur
Eye Study, BP Koirala Lions Center for Ophthalmic Studies, Tribhuvan
University Institute of Medicine and Teaching Hospital, Kathmandu,
Nepal, b Francis I Proctor
Foundation for Research in Ophthalmology, University of California San
Francisco, San Francisco, CA 94143-0944, USA
Correspondence to: Dr M P Upadhyay
bpkeye{at}mos.com.np
Dr J P Whitcher
nepal{at}itsa.ucsf.edu
Accepted for publication 27 November
2000
AIMS To determine the
incidence of ocular trauma and corneal ulceration in the district of
Bhaktapur in Kathmandu Valley, and to determine whether or not topical
antibiotic prophylaxis can prevent the development of ulceration after
corneal abrasion.
METHODSA defined
population of 34 902 individuals was closely followed prospectively
for 2 years by 81 primary eye care workers who referred all cases of
ocular trauma and/or infection to one of the three local secondary eye
study centres in Bhaktapur for examination, treatment, and follow up by
an ophthalmologist. All cases of ocular trauma were documented and
treated at the centres. Individuals with corneal abrasion confirmed by
clinical examination who presented within 48 hours of the injury
without signs of corneal infection were enrolled in the study and
treated with 1% chloramphenicol ophthalmic ointment to the injured eye
three times a day for 3 days.
RESULTSOver the 2 year period there were 1248 cases of ocular trauma reported in the
population of 34 902 (1788/100 000 annual incidence) and 551 cases of
corneal abrasion (789/100 000 annual incidence). The number of
clinically documented corneal ulcers was 558 (799/100 000 annual
incidence). Of the 442 eligible patients with corneal abrasion enrolled
in the prophylaxis study, 424 (96%) healed without infection, and none
of the 284 patients who were started on treatment within 18 hours after
the injury developed ulcers. Four of the 109 patients (3.7%) who
presented 18-24 hours after injury developed infections, and 14 (28.6%) of the 49 patients who presented 24-48 hours subsequently
developed corneal ulceration.
CONCLUSIONSOcular
trauma and corneal ulceration are serious public health problems that
are occurring in epidemic proportions in Nepal. This study conclusively
shows that post-traumatic corneal ulceration can be prevented by
topical application of 1% chloramphenicol ophthalmic ointment in a
timely fashion to the eyes of individuals who have suffered a corneal
abrasion in a rural setting. Maximum benefit is obtained if prophylaxis
is started within 18 hours after injury.
© 2001 by British Journal of Ophthalmology
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