title: [Severe bacterial keratitis referred to ophthalmology emergency departments: a retrospective study of 268 cases].
abstract: OBJECTIVE
  To investigate epidemiological, microbiological and clinical aspects of severe bacterial keratitis, in order to update current understanding of risk factors (RF) and prognosis.
  
  
  METHODS
  We conducted a monocentric retrospective study from January 2005 to January 2011, identifying and collecting data from inpatients admitted for severe documented bacterial keratitis.
  
  
  RESULTS
  We found 268 unilateral corneal ulcers. At least one local or systemic risk factor was identified in 255/268 patients (95%). The leading risk factor was contact lens wear (129/268), followed by underlying corneal disease (50/268) and prior corneal surgery (47/268). Initial and final visual acuities were 0.06 and 0.2 (1.20 and 0.72 LogMAR) respectively. Contact lens wear was associated with better prognosis and shorter hospitalization (P<0.05). Corneal healing was obtained in 255/268 patients (95%), with adjuvant surgery for 33 patients. The most frequently isolated pathogens were Gram+ cocci, more commonly associated with degenerative keratopathy or prior corneal surgery, and Gram- bacilli, more commonly associated with contact lenses (P<0.05). Both demonstrated a similar prognosis.
  
  
  CONCLUSIONS
  Specific risk factors should be investigated in cases of severe bacterial keratitis. Contact lens wear is the most frequent risk factor, but with a better prognosis than underlying corneal disease, prior corneal surgery or systemic risk factors. The specific bacterial pathogen no longer appears to dramatically influence the outcome of severe corneal ulcers.
authors.affiliation: Unité d'ophtalmologie, pôle d'ophtalmologie et de chirurgie à dominante ambulatoire, Assistance publique-Hôpitaux de Paris, hôpital Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France. geoffrey.dethorey@gmail.com
authors.forename: G
authors.initials: G
authors.lastname: Dethorey
authors.forename: A
authors.initials: A
authors.lastname: Daruich
authors.forename: A
authors.initials: A
authors.lastname: Hay
authors.forename: G
authors.initials: G
authors.lastname: Renard
authors.forename: J-L
authors.initials: JL
authors.lastname: Bourges
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index