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Clinical outcomes good in pediatric series of corneal ulcers
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PARIS — Infectious keratitis is a serious cause of ocular morbidity in children, potentially causing amblyopia and severe, permanent visual impairment.
With that in mind, Oriel Spierer, MD, and colleagues undertook a retrospective analysis of microbial ulcerative keratitis in pediatric cases at Bascom Palmer Eye Institute over a 24-year period. A total of 107 patients (108 eyes), mean age 13 years, with corneal ulcers were included.
Regarding risk factors, 77.6% of the patients were contact lens wearers, Spierer told colleagues at the World Society of Paediatric Ophthalmology and Strabismus Subspecialty Day preceding the European Society of Cataract and Refractive Surgeons meeting.
“The other risk factors were ocular trauma, corneal foreign body and systemic diseases,” Spierer said.
Cultures obtained from 89 of the eyes identified 17 microbial species, with the most common being Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Fusarium and Acanthamoeba.
A high antimicrobial susceptibility rate, 87.1% to 95.7%, was achieved with fluoroquinolones, aminoglycosides and third-generation cephalosporins. When children presented to the emergency department, in half of cases, they were treated empirically with combined fortified antibiotics, most often tobramycin against gram-negative bacteria and vancomycin against gram-positive bacteria, Spierer said. In 34.6% of cases, this treatment was changed after culture results were obtained.
Final visual acuity of 20/60 and better was achieved in 81.8% of cases, whereas 10% of cases had 20/200 or worse, he said.
“Mean visual acuity improved significantly from 20/160 on presentation to 20/50 at last follow-up. We saw that final visual acuity correlated with the presenting visual acuity and patient’s age, which means that as visual acuity at presentation was better and as the child was older, the final visual acuity was better,” Spierer said.
None of the patients underwent therapeutic corneal transplantation, and only two underwent an optical PK for visual rehabilitation due to residual cornea scar.
“We can conclude that overall patients had good clinical outcomes,” he said. – by Patricia Nale, ELS
Reference:
Spierer O. Clinical and microbial characteristics of paediatric infectious keratitis. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 13-18, 2019; Paris.
Disclosure: Spierer reports no relevant financial disclosures.