Clinical Profile of Infectious Keratitis in Children
Clinical Profile of Infectious Keratitis in Children
The study was approved by the ethics committee of the Institute of Ophthalmology "Conde de Valenciana", Mexico City. This is a retrospective review of clinical records of patients younger than 16 years with diagnosis of infectious keratitis seen at the Cornea and External Disease Unit at Institute of Ophthalmology "Conde de Valenciana", in Mexico City between January 2006 to December 2011. Microbiological data were obtained from the Department of Microbiology and Ocular Proteomics of the same institution.
The studied variables included demographic data, medical history, risk factors (history of ocular trauma, use of contact lenses, associated eye diseases, systemic diseases, previous ocular surgery), clinical presentation, initial and final visual acuity, medication use before and after diagnosis, and need for surgical therapy.
All patients had a detailed clinical evaluation followed by corneal scrapings. The material obtained on scraping was subjected to standard microbiology evaluation. Initial medical treatment was based on fourth-generation fluoroquinolones monotherapy and modified in accordance with clinical response, culture and antibiotic susceptibility results.
Every patient underwent a comprehensive ophthalmic examination, including but not limited to, presenting uncorrected distance visual acuity (UDVA) and pinhole corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, fundoscopy and intraocular pressure. With respect to corrected visual acuity, patients were classified according to the revised ICD-10. The location, depth and size of the ulcer, as well as infiltrate appearance, presence or absence of lysis, hypopyon or neovascularization were documented at each visit. The longest diameter of the ulcer at presentation was defined as the size of the ulcer. The ulcer was defined, as being central if it involved the pupillary area otherwise it was recorded as peripheral. Follow-up was done as needed.
In all patients, corneal scrapings were obtained, smears were prepared for standard microbiologic evaluation including Gram and Giemsa stains. The sample was sowed in Columbia agar + 5% sheep, chocolate agar + PolyViteX (PVX) and Brain-Heart Infusion (BHI), those were incubated at 37°C and 5% CO2; and Sabouraud dextrose agar, which was incubated at 28°C and 5% CO2. The bacteria were identified using the Vitek 2 Compact system (bioMérieux, France) with GP-test Vitek card. The drug sensitivity was determined by the Kirby-Baüer method using the following antibiotic discs: polymyxin, oxacillin, neomycin, sulfamethoxazole, vancomycin, gentamicin, ciprofloxacin, ofloxacin, cephalothin, cephazolin and ceftazidime and according to Clinical and Laboratory Standards Institute guidelines. Criteria for culture positivity were growth of the organism at the site of inoculation on two or more solid phase cultures, or growth at the site of inoculation on one solid phase media of an organism consistent with microscopy, or confluent growth on one media.
The statistical analysis was performed with SPSS 17.0 software (SPSS Inc, Chicago, IL, USA). Descriptive statistics were obtained to determine the frequency and proportions. One-way analysis of variance (ANOVA) and linear regression model were used to evaluate the change of visual acuity from admission to discharge.
Methods
The study was approved by the ethics committee of the Institute of Ophthalmology "Conde de Valenciana", Mexico City. This is a retrospective review of clinical records of patients younger than 16 years with diagnosis of infectious keratitis seen at the Cornea and External Disease Unit at Institute of Ophthalmology "Conde de Valenciana", in Mexico City between January 2006 to December 2011. Microbiological data were obtained from the Department of Microbiology and Ocular Proteomics of the same institution.
The studied variables included demographic data, medical history, risk factors (history of ocular trauma, use of contact lenses, associated eye diseases, systemic diseases, previous ocular surgery), clinical presentation, initial and final visual acuity, medication use before and after diagnosis, and need for surgical therapy.
Ophthalmic Examination
All patients had a detailed clinical evaluation followed by corneal scrapings. The material obtained on scraping was subjected to standard microbiology evaluation. Initial medical treatment was based on fourth-generation fluoroquinolones monotherapy and modified in accordance with clinical response, culture and antibiotic susceptibility results.
Every patient underwent a comprehensive ophthalmic examination, including but not limited to, presenting uncorrected distance visual acuity (UDVA) and pinhole corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, fundoscopy and intraocular pressure. With respect to corrected visual acuity, patients were classified according to the revised ICD-10. The location, depth and size of the ulcer, as well as infiltrate appearance, presence or absence of lysis, hypopyon or neovascularization were documented at each visit. The longest diameter of the ulcer at presentation was defined as the size of the ulcer. The ulcer was defined, as being central if it involved the pupillary area otherwise it was recorded as peripheral. Follow-up was done as needed.
Microbiology Workup
In all patients, corneal scrapings were obtained, smears were prepared for standard microbiologic evaluation including Gram and Giemsa stains. The sample was sowed in Columbia agar + 5% sheep, chocolate agar + PolyViteX (PVX) and Brain-Heart Infusion (BHI), those were incubated at 37°C and 5% CO2; and Sabouraud dextrose agar, which was incubated at 28°C and 5% CO2. The bacteria were identified using the Vitek 2 Compact system (bioMérieux, France) with GP-test Vitek card. The drug sensitivity was determined by the Kirby-Baüer method using the following antibiotic discs: polymyxin, oxacillin, neomycin, sulfamethoxazole, vancomycin, gentamicin, ciprofloxacin, ofloxacin, cephalothin, cephazolin and ceftazidime and according to Clinical and Laboratory Standards Institute guidelines. Criteria for culture positivity were growth of the organism at the site of inoculation on two or more solid phase cultures, or growth at the site of inoculation on one solid phase media of an organism consistent with microscopy, or confluent growth on one media.
Statistical Evaluation
The statistical analysis was performed with SPSS 17.0 software (SPSS Inc, Chicago, IL, USA). Descriptive statistics were obtained to determine the frequency and proportions. One-way analysis of variance (ANOVA) and linear regression model were used to evaluate the change of visual acuity from admission to discharge.
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