METHODS: Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scrapings were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution.
RESULTS: Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10-26 days).
CONCLUSIONS: Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres.
方法:描述性案例系列。包括临床诊断为感染性角膜炎的所有患者。获得角膜刮片,并通过革兰氏染色进行微生物鉴定。根据涂片检查结果开始抗微生物治疗,并对患者进行随访直至疾病消退。
结果:60例患者的60只眼在研究期间被诊断为微生物性角膜炎。平均年龄为47.43±18.69岁。男女比例为47:53。大多数患者的危险因素包括眼外伤(46/60;76.7%)。在75.6%的涂片上鉴定出微生物,真菌丝(65.4%)是最常见的。溃疡位于中央超过一半(32/60;53.3%),超过四分之三(81.6%)的患者直径>3毫米。44名患者(73.3%)获得了治疗成功,而16/60(26.6%)则需要转诊到我们的三级眼科护理机构进行管理。中位消退时间为14天(IQR10-26天)。
结论:我们的系列研究证明了在二级农村眼科护理层面,眼科医生在微生物性角膜炎中进行微生物学指导治疗的可行性。三分之二的患者可以在农村中心成功治疗,只有严重病例需要转诊到三级中心。