Microbial Keratitis and Ocular Surface Disease: A 5-Year Study of the Microbiology, Risk Factors and Clinical Outcomes in Sydney, Australia

Abstract Background: To compare the clinical characteristics and treatment outcomes of microbiologically-proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically-proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors and clinical characteristics, microbiological profiles, and treatment outcomes were compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. No significant differences were observed in mean age, sex, occupation, and baseline clinical characteristics between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048), identified fungal isolates (53.3% vs. 26.4%, p=0.014), and diagnosed by repeat microbiological tests (40.0% vs. 17.0%, p=0.020). Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.015). Regarding treatment outcomes, the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 5.95, p=0.003), prior topical steroid use (odds 3.45, p=0.034), and non-vegetable corneal trauma (odds 4.46, p=0.037). Conclusions: The PS group was more associated with previous ocular surface disease, and no significant differences were observed in the baseline clinical characteristics between the two groups. Diagnosis was more difficult and treatment results were worse in the PS group in this study. Repeat microbiological tests can be helpful in diagnosing fungal infections especially in the prior topical steroid used group. Keywords: Fungal ocular infection, Steroids, Ulcerative keratitis.

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Eye care in the intensive care unit

Journal of the Intensive Care Society ◽

10.1177/1751143718764529 ◽

2018 ◽

Vol 19 (4) ◽

pp. 345-350 ◽

Cited By ~ 13

Author(s):

Benjamin J Hearne ◽

Elewys G Hearne ◽

Hugh Montgomery ◽

Susan L Lightman

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Ocular Surface ◽

Ocular Surface Disease ◽

Evidence Based ◽

Eye Care ◽

Corneal Epithelial ◽

Intensive Care Patients ◽

Vulnerable Patients

Ocular surface disease is common in the intensive care population with 20–42% of patients developing corneal epithelial defects. The ocular surface is normally protected by the ability to produce tears, to blink and to close the eyes with rest or sleep. All of these mechanisms can be disrupted in the intensive care population, increasing the risk of developing ocular surface disease. Despite the scale of the problem, eye-care protocols are commonly not instigated and documentation of eye care is often poor. This review details the risk factors for developing ocular surface disease. It also provides evidence-based guidance on protecting the eyes in vulnerable patients, identifying diseases affecting the eye in intensive care patients and delivering the best treatment to the eye. There is growing evidence that adherence to a correctly performed eye-care guideline prevents the majority of corneal problems encountered in the intensive care unit.

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Microbial keratitis in Sydney, Australia: risk factors, patient outcomes, and seasonal variation

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-04681-0 ◽

2020 ◽

Vol 258 (8) ◽

pp. 1745-1755 ◽

Cited By ~ 2

Author(s):

Pauline Khoo ◽

Maria P. Cabrera-Aguas ◽

Vuong Nguyen ◽

Monica M. Lahra ◽

Stephanie L. Watson

Keyword(s):

Risk Factors ◽

Seasonal Variation ◽

Patient Outcomes ◽

Microbial Keratitis ◽

Sydney Australia

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Prevalence of ocular surface disease symptoms and risk factors in group of university students in Monterrey, Mexico

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-016-0114-z ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 4

Author(s):

Manuel Garza-León ◽

Miguel Valencia-Garza ◽

Bernardo Martínez-Leal ◽

Pablo Villarreal-Peña ◽

Hernán Gerardo Marcos-Abdala ◽

...

Keyword(s):

Risk Factors ◽

University Students ◽

Ocular Surface ◽

Ocular Surface Disease ◽

Disease Symptoms

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Dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis: clinical presentation, risk factors for development and outcomes of treatment with tacrolimus ointment

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315010 ◽

2019 ◽

Vol 104 (6) ◽

pp. 776-779 ◽

Cited By ~ 6

Author(s):

Yoav Nahum ◽

Michael Mimouni ◽

Eitan Livny ◽

Irit Bahar ◽

Emmilia Hodak ◽

...

Keyword(s):

Risk Factors ◽

Atopic Dermatitis ◽

Dry Eye ◽

Ocular Surface ◽

Medical Center ◽

Signs And Symptoms ◽

Adult Patients ◽

Ocular Surface Disease ◽

Tacrolimus Ointment ◽

Severity Scores

AimTo identify risk factors for the development of dupilumab-induced ocular surface disease (DIOSD) in adult patients with atopic dermatitis (AD) and describe outcomes of treatment.MethodsA retrospective institutional cohort study performed at the Rabin Medical Center, Petach Tikva, Israel. Adult patients with AD who received dupilumab from March 2018 to June 2019 were included. Demographics, AD severity scores, blood IgE levels, previous atopic keratoconjunctivitis (AKC), dermatological response to dupilumab, ophthalmological evaluation and treatment were noted. Univariate and multivariate analyses were used to identify risk factors for DIOSD.ResultsSixteen of 37 patients who were included in the study (43%) had new or exacerbated symptoms of ocular surface disease starting at 2 weeks following the first treatment. Three patients reported transient dry eye sensation which lasted 2 weeks; nine patients reported chronic dry eye sensation, and four patients (25%) had marked blepharoconjunctivitis. The presence of severe AD was the strongest predictor of DIOSD. Not a single patient with moderate AD had DIOSD. In multivariate analysis, prior AKC was a risk factor for DIOSD (R2=15.78, OR=23.28, p=0.005) while a family history of atopy was protective of DIOSD (R2=6.22, OR=0.13, p=0.05). All four patients with blepharoconjunctivitis had resolution of signs, and symptoms within days of starting periocular 0.03%–0.1% tacrolimus ointment.ConclusionsDIOSD is common in patients with AD receiving dupilumab. While most cases are mild, some patients can develop blepharoconjunctivitis which responds well to tacrolimus ointment. AD severity, and previous AKC are risk factors for DIOSD.

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Risk Factors to Develop Ocular Surface Disease in Treated Glaucoma or Ocular Hypertension Patients

European Journal of Ophthalmology ◽

10.5301/ejo.5000220 ◽

2012 ◽

Vol 23 (3) ◽

pp. 296-302 ◽

Cited By ~ 35

Author(s):

Gemma Caterina Maria Rossi ◽

Gian Maria Pasinetti ◽

Luigia Scudeller ◽

Marta Raimondi ◽

Sara Lanteri ◽

...

Keyword(s):

Risk Factors ◽

Ocular Hypertension ◽

Ocular Surface ◽

Ocular Surface Disease

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Risk factors for ocular surface disease in Tunisian users of preserved antiglaucomatous eye drops

Journal of Current Ophthalmology ◽

10.4103/joco.joco_226_20 ◽

2021 ◽

Vol 33 (2) ◽

pp. 128

Author(s):

Houda Lajmi ◽

Wassim Hmaied ◽

BesmaBen Achour ◽

Amin Zahaf

Keyword(s):

Risk Factors ◽

Ocular Surface ◽

Ocular Surface Disease ◽

Eye Drops

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Ocular Surface Disease: An Integral Part of Glaucoma Management

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1064 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Aysha Salam

Keyword(s):

Risk Factors ◽

Adverse Effects ◽

Active Ingredient ◽

Ocular Surface ◽

Ocular Surface Disease ◽

Patient Acceptance ◽

Loss Of Vision ◽

Poor Tolerance ◽

Common Risk Factors ◽

The Common

Glaucoma has been a silent and symptomless disease-causing relentless loss of vision requiring lifelong treatment. It is often hard to gain patient acceptance for a condition, the treatment for which does not manifest in the form of any direct visual gains. This is in turn is compounded by the adverse effects of medication. These are most commonly poor tolerance and preservative toxicity in addition to the active ingredient which in itself can compromise a vulnerable ocular surface.1,2 Glaucoma patients are presumably at a much higher risk of developing ocular surface disease and one of the commonest reasons for that is being treated with reservative-containing medications over a prolonged period.1,2 This editorial will highlight some of the common risk factors and possible remedies in glaucoma patients manifesting with ocular surface disease.

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