Epidemiology and the Estimated Burden of Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based Study

An exploration of the ocular mysteries linking nanoparticles to the patho-therapeutic effects against keratitis

Microbial keratitis, a sight-threatening corneal infection, remains a significant global health concern. Conventional therapies using antimicrobial agents often suffers from limitations such as poor drug penetration, side effects, and occurrence of drug resistance, with poor prognosis. Novel treatment techniques, with their unique properties and targeted delivery capabilities, offers a promising solution to overcome these challenges. This review delves into timely update of the state-of-the-art advance therapeutics for keratitis treatment. The diverse microbial origins of keratitis, including viral, bacterial, and fungal infections, exploring their complex pathogenic mechanisms, followed by the drug resistance mechanisms in keratitis pathogens are reviewed briefly. Importantly, the emerging therapeutic techniques for keratitis treatment including piezodynamic therapy, photothermal therapy, photodynamic therapy, nanoenzyme therapy, and metal ion therapy are summarized in this review showcasing their potential to overcome the limitations of traditional treatments. The challenges and future directions for advance therapies and nanotechnology-based approaches are discussed, focusing on safety, targeting strategies, drug resistance, and combination therapies. This review aims to inspire researchers to revolutionize and accelerate the development of functional materials using different therapies for keratitis treatment.

Diagnosis of microbial keratitis using smartphone-captured images; a deep-learning model

BACKGROUND

Microbial keratitis (MK) poses a substantial threat to vision and is the leading cause of corneal blindness. The outcome of MK is heavily reliant on immediate treatment following an accurate diagnosis. The current diagnostics are often hindered by the difficulties faced in low and middle-income countries where there may be a lack of access to ophthalmic units with clinical experts and standardized investigating equipment. Hence, it is crucial to develop new and expeditious diagnostic approaches. This study explores the application of deep learning (DL) in diagnosing and differentiating subtypes of MK using smartphone-captured images.

MATERIALS AND METHODS

The dataset comprised 889 cases of bacterial keratitis (BK), fungal keratitis (FK), and acanthamoeba keratitis (AK) collected from 2020 to 2023. A convolutional neural network-based model was developed and trained for classification.

RESULTS

The study demonstrates the model's overall classification accuracy of 83.8%, with specific accuracies for AK, BK, and FK at 81.2%, 82.3%, and 86.6%, respectively, with an AUC of 0.92 for the ROC curves.

CONCLUSION

The model exhibits practicality, especially with the ease of image acquisition using smartphones, making it applicable in diverse settings.

Clinical evaluation of corneal ulcer with a portable and smartphone-attachable slit lamp device: Smart Eye Camera

Corneal ulcer is one of the most important ophthalmic emergencies. A portable, recordable, and smartphone-attachable slit-lamp device called the "Smart Eye Camera" (SEC) is introduced to compare evaluating corneal ulcers between the SEC and the conventional slit-lamp. A total of 110 participants were included in the study, consisting of 55 patients with corneal ulcers and 55 age- and gender-matched healthy volunteers as controls. The participants were first subjected to examination by a conventional slit lamp. The video recording with SEC and imaging with a slit lamp were done by a non-medical person. Both SEC videos and slit-lamp photos were reported by two independent ophthalmologists and compared with a slit-lamp examination as a gold standard. The average age of the study participants was 48.85 ± 20.45 years and 68 participants (61.8%) were male. All corneal ulcers were detected by two ophthalmologists using SEC. Ulcer size evaluated in slit lamp and SEC horizontally (Intraclass Correlation Coefficient (ICC); 0.90, 95% CI; 0.84-0.94) and vertically (ICC; 0.90, 95% CI; 0.84-0.94) is correlated about 90%. Hypopyon size (ICC; 0.95, 95% CI; 0.92-0.97), and corneal epithelial defect (CED) size horizontally (ICC; 0.94, 95% CI; 0.91-0.96) and vertically (ICC; 0.94, 95% CI; 0.91-0.96) also correlated about 94%. The infiltration pattern evaluated by SEC was consistent with the pattern evaluated in slit lamps in more than 80% of patients. The SEC is so accurate in diagnosing corneal ulcers and its reliability makes it a valuable telemedicine device.

Genetic liability to higher frailty index may increase the risk of ophthalmic disease

PURPOSE

Frailty and age-related eye diseases are common in older people; however, whether there is a causal link remains unknown. We aimed to explore the causal associations between the frailty index (FI) and ophthalmic traits and identify modifiable mediators.

METHODS

Linkage disequilibrium score regression and two-sample Mendelian randomization were applied to identify genetic correlations and causal associations between FI and ophthalmic traits. Summary data for FI was obtained from a genome-wide association study that included 175,226 individuals of European ancestry. Summary-level statistics for ophthalmic traits were obtained from relative GWASs. Summary-level data for cardiovascular risk factors, inflammatory biomarkers, and the central nervous system were used to identify the possible mediators.

RESULTS

FI had a significant genetic correlation with 10 ophthalmic traits. Per SD increment of FI, the odds ratio was 1.329 (95% CI, 1.123, 1.573; P = 9.5 × 10-4) for cataracts, 1.825 (95% CI, 1.115, 2.986; P = 0.016) for keratitis, 1.798 (95% CI, 1.039, 3.11; P = 0.036) for disorders of vitreous body and 1.478 (95% CI, 1.005, 2.173; P = 0.046) for disorders of sclera, cornea, iris and ciliary body. The MR effect estimates of FI on ophthalmic traits were attenuated after adjusting for mental disorders, type 2 diabetes, triglyceride, and interleukin-8 (IL-8) levels.

CONCLUSION

This study reports a genetic correlation and causal association between FI and ophthalmic traits, in which mental disorders, type 2 diabetes, triglycerides, and IL-8 may play a mediating role. These findings highlight a possible method to reduce the risk of FI-related ophthalmic diseases.

Genetic liability to higher frailty index may increase the risk of ophthalmic disease

PURPOSE

Frailty and age-related eye diseases are common in older people; however, whether there is a causal link remains unknown. We aimed to explore the causal associations between the frailty index (FI) and ophthalmic traits and identify modifiable mediators.

METHODS

Linkage disequilibrium score regression and two-sample Mendelian randomization were applied to identify genetic correlations and causal associations between FI and ophthalmic traits. Summary data for FI was obtained from a genome-wide association study that included 175,226 individuals of European ancestry. Summary-level statistics for ophthalmic traits were obtained from relative GWASs. Summary-level data for cardiovascular risk factors, inflammatory biomarkers, and the central nervous system were used to identify the possible mediators.

RESULTS

FI had a significant genetic correlation with 10 ophthalmic traits. Per SD increment of FI, the odds ratio was 1.329 (95% CI, 1.123, 1.573; P = 9.5 × 10-4) for cataracts, 1.825 (95% CI, 1.115, 2.986; P = 0.016) for keratitis, 1.798 (95% CI, 1.039, 3.11; P = 0.036) for disorders of vitreous body and 1.478 (95% CI, 1.005, 2.173; P = 0.046) for disorders of sclera, cornea, iris and ciliary body. The MR effect estimates of FI on ophthalmic traits were attenuated after adjusting for mental disorders, type 2 diabetes, triglyceride, and interleukin-8 (IL-8) levels.

CONCLUSION

This study reports a genetic correlation and causal association between FI and ophthalmic traits, in which mental disorders, type 2 diabetes, triglycerides, and IL-8 may play a mediating role. These findings highlight a possible method to reduce the risk of FI-related ophthalmic diseases.

Clinical characteristics, predisposing factors, and management of moraxella keratitis in a tertiary eye hospital

PURPOSE

The Moraxella species is a very uncommon pathogen that leads to microbial keratitis (MK). This study aimed to evaluate the clinical features, predisposing factors, and outcomes of Moraxella keratitis in patients of a tertiary eye hospital.

METHODS

This retrospective study was conducted from 2015 to 2022, on patients who were admitted with the diagnosis of Moraxella keratitis confirmed by positive culture in a referral eye hospital. Demographics, predisposing factors, best-corrected visual acuity (BCVA), and prognosis were assessed.

RESULTS

A total of 106 individuals diagnosed with Moraxella keratitis, were analyzed. The mean age was 54.42 ± 19.43 years. The mean baseline BCVA of the patients was 2.28 ± 0.6 LogMAR, while this amount reached 1.49 ± 0.81 in the 6-month follow-up (P-value = 0.02). The mean BCVA in the six-month follow-up of the patients who needed surgical interventions was significantly lower than the patients who received only medical treatment (2.15 ± 0.65 vs. 1.29 ± 0.75 LogMAR, P-value = 0.02). Patients with diabetes and those without diabetes did not substantially vary in the prevalence of corneal perforation (P-value = 0.515). Three predisposing factors including corneal perforation (odds ratio = 19.27, P-value = 0.001), hypertension (HTN) (odds ratio = 3.62, P-value = 0.03), and older age (odds ratio = 1.03, P-value = 0.008) were significantly associated with more need for surgical interventions.

CONCLUSION

In this cohort, poor prognosis necessitating surgical interventions in Moraxella keratitis was found to be associated with corneal perforation, HTN, and older age.

Clinical comparative analysis of bacterial keratitis according to contact lens use: a retrospective study in a tertiary referral center of South Korea

PURPOSE

To compare the clinical aspects and treatment outcomes of contact lens-related bacterial keratitis (CLBK) and non-CLBK patients.

METHODS

Altogether 217 patients of bacterial keratitis (CLBK; 62, non-CLBK; 155) hospitalized between January 2012 and December 2020 were retrospectively analyzed for epidemiology, microbiological profiles, predisposing factors, clinical characteristics, and treatment outcomes. Poor treatment outcomes (PTO) were defined as a final BCVA < 0.3 (Snellen), a decreased visual acuity after treatment, complications, or surgical intervention. Relative importance of the initial clinical features leading to PTO was assessed using the random forest model and two-proportion Z-test.

RESULTS

The most common predisposing factors were sleeping with wearing CL (51.6%) in the CLBK group and trauma (55.5%) in the non-CLBK group. There were significant differences between the two groups in mean age (35.1:55.1 years, p < 0.001), female sex (56.5:34.8%, p = 0.003), symptom duration (6.2:6.9 days, p = 0.019), gram-negative organisms (83.3:48.3%, p = 0.008), epithelial healing time (8.5:14.1 days, p = 0.004), final BCVA (0.15:0.46 logMAR, p = 0.015), and PTO (9.7:21.9%, p = 0.035). For the entire group, the initial BCVA < 0.1 (27.9%), symptom duration ≥ 5 days (19.4%), age ≥ 60 years (16.4%), and hypopyon (14.0%) were important initial clinical features leading to PTO in the random forest model. In CLBK group, the type of CL or CL-related history was not significantly related to PTO.

CONCLUSION

CLBK patients had a higher proportion of females, younger age, gram-negative bacteria, and better treatment outcomes than those of non-CLBK patients. There were no significant risk factors leading to PTO in either the type of CL or CL-related history.

Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study

Objective

To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital.

Design

Retrospective study.

Methods

A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis.

Results

The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1-3, US$5866.56-24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1-3, US$2582.79-10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1-3, US$8064.17-29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1-3, US$5177.98-21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014-2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease.

Conclusion

There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.

A Case Series of Infectious Keratitis After Corneal Cross-linking

PURPOSE

To present the 7-year experience of a tertiary eye hospital while exploring possible risk factors and incidence of infectious keratitis in patients undergoing standard corneal cross-linking (CXL).

METHODS

This retrospective cohort study included patients with progressive keratoconus undergoing standard CXL in the Farabi Eye Hospital and all other patients who had undergone CXL in other facilities and were diagnosed as having infectious keratitis in the 7-year period of the study.

RESULTS

Among the total of 4,863 eyes that underwent CXL, 6 eyes developed infectious keratitis, yielding an incidence rate of 0.12%. Additionally, 13 eyes from 10 patients with a CXL history in other facilities who developed infectious keratitis were included. The mean age was 23.75 years, and 75% of patients were men and 25% were women. Gram-positive bacteria and Staphylococcus aureus were the most prevalent pathogens. Meibomian gland dysfunction, dry eye disease, or blepharitis were present in 12 patients. Medical treatment did not arrest the disease progress in 5 patients, which eventually required cases to undergo keratoplasty.

CONCLUSIONS

This study supports the need for proper patient selection by using a comprehensive medical history. It also highlights the imperative role of rigorous patient education and follow-up, particularly in the first postoperative week. Finally, the study emphasizes aggressive early therapy for patients with suspicious findings. [J Refract Surg. 2023;39(8):564-572.].

Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study

PURPOSE

To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure.

METHODS

A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food.

RESULTS

A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001).

CONCLUSION

Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis

Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.

The epidemiology of infectious keratitis

Infectious keratitis is a rare but potentially severe sight-threatening disease, associated with considerable societal burden, cost and morbidity. This review summarises the most recent evidence for the incidence, risk factors and impact of disease, all of which vary widely according to region, access to health care, socioeconomic and environmental factors, predisposing conditions and causative organisms. The frequency and societal impact of infectious keratitis are significantly higher in low-income countries. In non-viral infectious keratitis, bacterial causes predominate in most regions. Fungi, particularly linked with agricultural trauma, are more frequently associated with infectious keratitis in low-income regions, particularly in India and certain African countries. The disease impact is compounded by poverty and limited access to services and treatment. Early diagnosis, access to appropriate treatment, prophylaxis in ocular trauma, availability of eye protection, awareness of risk factors may be associated with reduced disease severity and vision loss. Evidence for the incidence and burden of disease is lacking in certain regions and well-designed epidemiological studies to identify independent risk factors for the disease and those associated with more severe outcomes may better identify causation and guide resource allocation and preventative strategies.

Epidemiology and Economic Cost Analysis of Microbial Keratitis from a Tertiary Referral Hospital in Australia

Microbial keratitis is the most common cause of infective vision loss. The causative organism varies by region, and most cases require intensive antimicrobial therapy. The purpose of this study was to analyse the causative organisms of microbial keratitis, its presentation and economic burden from a tertiary referral hospital in Australia. A retrospective review of 160 cases of microbial keratitis was performed, over a 5-year period from 2015–2020. A wide variety of costs were considered to determine the economic burden, using standardized data from the Independent Hospital Pricing Authority and the cost of personal income loss. Our study showed the most commonly occurring pathogens were Herpes Simplex (16%), Staphylococcus aureus (15.1%) and Pseudomonas aeruginosa (14.3%). A total of 59.3% of patients were admitted, with a median length of admission of 7 days. Median cost for all presentations of microbial keratitis was AUD 8013 (USD 5447), with costs significantly increasing with admission. The total annual cost of microbial keratitis within Australia is estimated to be AUD 13.58 million (USD 9.23 million). Our findings demonstrate that microbial keratitis represents a significant economic burden for eye-related diseases and the key driving factor for the cost is the length of admission. Minimizing the duration of admission, or opting for outpatient management where appropriate, would significantly reduce the cost of treatment for microbial keratitis.

Evaluation of central corneal epithelial thickness with anterior segment OCT in patients with type 2 diabetes mellitus

BACKGROUND

This study aimed to evaluate the central corneal thickness (CCT) and central corneal epithelial thickness (CCET) in patients with Type 2 diabetes mellitus (DM), and the effect of the duration of diabetes, the degree of diabetic retinopathy (DR), and HbA1c level.

METHODS

CCT and CCET values of 72 patients diagnosed with type 2 DM and 72 healthy individuals were measured by anterior segment optical coherence tomography. The eye tear function was evaluated with the Tear Break-up Time test (TBUT) and the Schirmer test. From the results of fundus examination, the diabetic patients were grouped as those without DR, non-proliferative DR, and proliferative DR. The disease duration and the HbA1c levels were recorded.

RESULTS

In the diabetic patients, the mean CCT was determined to be thicker (p = 0.025), the CCET was thinner (p = 0.003), and the TBUT and Schirmer values were lower (p <0.001, p <0.001, respectively). The duration of diabetes and the HbA1c level was not found to have any statistically significant effect on these parameters (p >0.05). The presence of retinopathy had no significant effect on CCT, TBUT, and Schirmer values. The CCET was determined to be thinner in patients with retinopathy (p <0.001).

CONCLUSIONS

As the corneal epithelial thickness is reduced in patients with advanced diabetic retinopathy, corneal epithelial pathologies can be seen more often. Therefore, early and effective treatment can be started by taking into consideration the complications which may develop associated with the corneal epithelium following surgical procedures, especially those applied to the cornea.

Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns

Infectious keratitis (IK) represents a major cause of corneal blindness. This study aims to investigate the demographics, risk factors, microbiological characteristics and antibiotic susceptibility patterns of IK in Taiwan over the past 15 years. A retrospective population-based study was conducted using the Chang Gung Research Database. Patients with IK were identified by diagnostic codes for corneal ulcer from 2004 to 2019. Of 7807 included subjects, 45.2% of patients had positive corneal cultures. The proportion of contact lens-related IK declined, while that of IK related to systemic diseases grew. The percentage of isolated gram-positive bacteria surpassed that of gram-negative bacteria in the 15-year period. The prevalence of Pseudomonas aeruginosa showed a decreasing trend (p = 0.004), whereas coagulase-negative Staphylococcus (CNS) and Propionibacterium species were increasingly detected (p < 0.001). Overall, the trend of antibiotic susceptibility of both gram-positive and gram-negative bacteria did not change throughout the study period. The susceptibility to the test antibiotics maintained over 90% in gram-negative isolates over 15 years. Vancomycin preserved 100% susceptibility to all gram-positive isolates. Since most tested antibiotics exhibited stable susceptibility over decades, this study reinforced that fluoroquinolones and fortified vancomycin continue to be good empiric therapies for treating bacterial keratitis in Taiwan.

Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital

AIM

To report the etiologies, risk factors, treatments, and outcomes of infectious keratitis (IK) at a major Vietnamese eye hospital.

METHODS

This is a retrospective review of all cases of IK at Vietnam National Eye Hospital (VNEH) in Hanoi, Vietnam. Medical histories, demographics, clinical features, microbiological results, and treatment outcomes were reviewed.

RESULTS

IK was diagnosed in 1974 eyes of 1952 patients, with ocular trauma being the greatest risk factor for IK (34.2%), frequently resulting from an agriculture-related injury (53.3%). The mean duration between symptom onset and presentation to VNEH was 19.3±14.4d, and 98.7% of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH. Based on smear results of 1706 samples, the most common organisms identified were bacteria (n=1107, 64.9%) and fungi (n=1092, 64.0%), with identification of both bacteria and fungi in 614 (36.0%) eyes. Fifty-five of 374 bacterial cultures (14.7%) and 426 of 838 fungal cultures (50.8%) were positive, with the most commonly cultured pathogens being Pseudomonas aeruginosa, Streptococcus pneumonia, Fusarium spp., and Aspergillus spp. Corneal perforation and descemetocele developed in 391 (19.8%) and 93 (4.7%) eyes, respectively. Medical treatment was successful in resolving IK in 50.4% eyes, while 337 (17.1%) eyes underwent penetrating or anterior lamellar keratoplasty. Evisceration was performed in 7.1% of eyes, most commonly in the setting of fungal keratitis.

CONCLUSION

Ocular trauma is a major risk factor for IK in Vietnam, which is diagnosed in almost 400 patients each year at VNEH. Given this, and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration, greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.

Fungal Keratitis in a Tertiary Hospital in Malaysia

Background

Fungal keratitis is one of the commonest causes of corneal blindness in developing countries including Malaysia. We aim to evaluate the sociodemographic background, clinical features, predisposing factors, laboratory findings, management, complications, and visual outcome of patients with fungal keratitis in a tertiary hospital in Malaysia.

Methods

A retrospective review of medical and microbiology records of all patients treated for corneal ulcer from 2015 to 2019 at Hospital Sultanah Bahiyah was performed. Sociodemography, predisposing risk factors, clinical characteristics, causative organisms, and final visual outcome were analyzed.

Results

We identified 103 patients with a diagnosis of fungal keratitis. The majority of the patients were of Malay ethnicity (85.4%) and male gender (81.6%), with an age range of 21 to 60 years (94.1%). Ocular trauma was the main predisposing factor in 82 (79.6%) patients. Poor visual improvement was observed in groups with ulcer more than 4mm (67.5%), presence of hypopyon (50.9%), and high intraocular pressure (75.0%) upon presentation. Fusarium spp. (19.4%) was the commonest fungus isolated followed by Aspergillus spp. (5.8%). All patients were prescribed either topical, oral, intracameral, or combined therapy, whereas 20 (19.4%) patients required surgical intervention, of which 16 (15.5%) underwent penetrating keratoplasty and three (2.9%) required evisceration.

Conclusion

The epidemiological, socioeconomic, and predisposing factors may facilitate timely diagnosis and prompt treatment to achieve a better visual outcome and minimize complications including corneal blindness.