Abstract：
OBJECTIVE: Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre.
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.
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.
摘要：
目的：微生物角膜炎是一种威胁视力的疾病，在农业人群中发病率较高。在人口众多的国家,由于资金和其他限制，患者更喜欢在当地寻求治疗，而不是前往高级中心。这项研究的目的是描述流行病学，临床特征,以及在农村中心治疗的60例微生物性角膜炎连续患者的结局。
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。
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。
