[Severe microbial keratitis: report of 100 cases].
OBJECTIVE
To study predisposing factors, clinical aspects, and microbiological diagnosis in severe microbial keratitis, and to discuss the therapy and visual outcome.


METHODS
and methods: A prospective and retrospective study concerning patients presenting microbial keratitis hospitalized in department B of the Hedi Raies Ophthalmology Institute (Tunis, Tunisia), from August 1996 to November 2004.


RESULTS
One hundred patients with microbial keratitis were hospitalized (45 females and 55 males; ranging in age from 11 to 87 years). The principal predisposing factors were ocular surface pathology (30%), ocular trauma (28%), prior ocular surgery (17%), and contact lens wear (8%). The corneal scraping culture was positive in 42% of cases, isolating Gram-positive bacteria (48.6%), Gram-negative bacteria (29.7%), and fungi (21.6%). The majority of our patients (93%) had broad-spectrum topical antibiotics with therapeutic success in 53.8% of cases. Systemic antifungal agents were indicated in 17 cases. Surgery was necessary in 25.8% of cases: therapeutic keratoplasty in five cases and deleted keratoplasty in nine cases. Final visual acuity was equal to or better than at admission in 81% of cases. Anatomic loss of the eye was observed in eight cases (evisceration, six cases; enucleation, two cases).


CONCLUSIONS
microbial keratitis is a frequent and severe pathology that can lead to blindness. Only early and adapted management can improve the prognosis of severe microbial keratitis.
Limaiem
R
R
Service B, Institut Hedi Rais d'Ophtalmologie, Tunis, Tunisia. rlimaiem@yahoo.fr
Mghaieth
F
F
Merdassi
A
A
Mghaieth
K
K
Aissaoui
A
A
El Matri
L
L
D000038:Abscess / Q000382:microbiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D016039:Corneal Transplantation; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D000890:Anti-Infective Agents; D000935:Antifungal Agents