title: Corneal ulcers and the use of topical fluoroquinolones.
abstract: OBJECTIVE
  To determine whether the widespread use of topical fluoroquinolones has changed the spectrum of ulcerative keratitis, and to determine how it has affected practice patterns in the treatment of corneal ulcers.
  
  
  METHODS
  We retrospectively reviewed the charts of 48 consecutive patients with infectious corneal ulcers from 7/1/91 to 12/31/91 and 47 consecutive patients from 7/1/94 to 12/31/94. Patients were treated with intensive topical antibiotics (either standard fortified antibiotics or topical fluoroquinolones) at a frequency of at least every hour while awake. Some patients were admitted to the hospital, and some underwent scraping for smears and cultures.
  
  
  RESULTS
  Ulcers which were seen in 1994 appear to have been more severe than those seen in 1991 as judged by the presence of more ulcers associated with hypopyons, (P< 0.05) but not with regard to the size of the infiltrate or epithelial defect. More ulcers in 1994 were treated on an outpatient basis (P< 0.02) and fewer ulcers were scraped and cultured than in 1991 (P< 0.001). Culture results from the 1991 and 1994 groups were similar. The most frequently isolated organisms were coagulase-negative Staphylococcus, Pseudomonas, Staphylococcus aureus, and Streptococcus spp.
  
  
  CONCLUSIONS
  The spectrum of ulcerative keratitis at a tertiary referral center may be showing a trend towards more severe ulcers, but the causative agents responsible for the infection are unchanged.
authors.affiliation: Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Honig
authors.forename: E J
authors.initials: EJ
authors.lastname: Cohen
authors.forename: C J
authors.initials: CJ
authors.lastname: Rapuano
authors.forename: P R
authors.initials: PR
authors.lastname: Laibson
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000867:Anterior Chamber; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003320:Corneal Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D011549:Pseudomonas / Q000302:isolation & purification; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D013492:Suppuration / Q000150:complications
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones