Prospective Evaluation of the Clinical Profile, Treatment Outcomes and the Demand for Corneal Transplantation in Microbial Keratitis: A Single Center Analysis.

ABSTRACT

Aim: The aim was to study the clinical profile, treatment outcomes, and the magnitude of corneal donor requirement secondary to corneal ulcers in our institute. Materials and Methods: A prospective case series study was carried out on 134 eyes of 134 consecutive patients presenting with corneal ulcers from January 2010 to December 2013 at our tertiary eye care center. Information was recorded about the patient’s age and gender, risk factors, prior therapy, clinical presentation, microbiological work-up, management and its outcome. Results: Majority of the corneal ulcers (46.2%) were seen in patients in the productive age-group (21 and 50 years), with 83% male preponderance. Ocular trauma (47%) with vegetative matter was the main predisposing factor. Of the corneal ulcers, 52.9% were of fungal, followed by viral, bacterial and neurotrophic etiology. At presentation, 11.1% were on topical steroid therapy. Only 41% had microbiological confirmation. About 47.7% healed with significant scarring, 41.7% with minimal scarring and 10.4% progressed to complications. Of the 10% eyes with complications, emergency keratoplasty was done in 4% and evisceration in 2%. 17% of eyes responded to antimicrobial therapy; 60% eyes needed therapeutic keratoplasty. Conclusion: Despite an early and aggressive management, we found that 89% of ulcers healed with corneal scarring and poor visual outcome and 60% eyes needed keratoplasty for visual rehabilitation. Hence, combined public health initiatives, overall improvement in medical care and adopting successful eye bank development models is important to meet the increasing demand for keratoplasty.