title: [Microbial keratitis: a 4 year study of risk factors and traditional/complementary medicine in Oman].
abstract: OBJECTIVE
  To determine the risk factors and the influence of complementary/alternative medicines (CAM) for infectious keratitis in a monsoon-free region of the Sultanate of Oman.
  
  
  METHODS
  Retrospective single center cohort study.
  
  
  METHODS
  Demographic data, risk factors, and pathogens.
  
  
  METHODS
  Patients with purulent stromal keratitis admitted from 2001-2004 were evaluated for clinical and microbiological data, CAM use, duration of hospitalization, and outcome of treatment.
  
  
  METHODS
  chi(2)-test, Z-test.
  
  
  RESULTS
  A total of 320 patients (326 eyes) out of 7,524 admissions had severe infectious stromal keratitis requiring inpatient treatment. The average age was 35.1+/-2.5 years (range 1.5-63 years), the male:female ratio was 2:3 in the age group >or=13 years and 2:1 in the age group <or=12 years. Unsuccessful treatment by traditional healers prior to presentation was recorded for 203 patients (62.3%). Ocular risk factors included severe trachomatous dry eye conditions, meibomianitis and soft contact lens overwear. Systemic compromising risk factors were diabetes mellitus and medical immunosuppression. A total of 215 patient eyes (66%) had delayed or no healing (therapy drop-outs), and hospitalization (45 days) was significantly prolonged compared to the 111 antibiotic responders (26 days) (p<0.001). All eyes of patients with prior CAM had worse vision at admission and after therapy (p<0.001), and 97 eyes of patients with uncontrolled diabetes (p<0.001) and 68 eyes of patients with immunosuppression (p<0.001) had a poor visual outcome (vision <0.1). Thirteen eyes perforated. A negative microbiological result correlated with worse final vision (p<0.05). All 13 perforated eyes had received prior CAM (p<0.001).
  
  
  CONCLUSIONS
  Trachoma, trauma and contact lens overwear are significant risk factors for infectious keratitis in Oman and correlate with specific age groups. Delay in treatment due to the first-line utilization of CAM showed a significant adverse impact on outcome.
authors.affiliation: Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, 123 , Al Khod/Muscat, Oman. alexander@squ.edu.om
authors.forename: A
authors.initials: A
authors.lastname: Bialasiewicz
authors.forename: R
authors.initials: R
authors.lastname: Shenoy
authors.forename: A
authors.initials: A
authors.lastname: Thakral
authors.forename: A A
authors.initials: AA
authors.lastname: Al-Muniri
authors.forename: U
authors.initials: U
authors.lastname: Shenoy
authors.forename: Z
authors.initials: Z
authors.lastname: Al-Mughairi
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007634:Keratitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009850:Oman / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome