Title: Clinical and Microbiological Profile of Bacterial and Fungal Corneal Ulcers

Authors: Dr Manjusha N.S. Dr Manoj Venugopal

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i2.148

Abstract

The study was done to determine the predisposing factors, specific pathogenic organisms and visual outcome in patients presenting with corneal ulcers in Department of Ophthalmology, TDMCH, Alappuzha. Patients above the age of 12 years with bacterial or fungal corneal ulcer as confirmed by staining, from 1 January 2012 to 30 June 2013 were included in the study. The patients were examined and corneal scrapings were taken. A history of previous corneal injury with vegetative matter was present in 34% of subjects. Staining reports showed 76% of cases were fungal infection and 24% cases were bacterial infection. Culture positivity was obtained in 88% cases and 12 % were culture negative. Of those with positive culture 66% had fungal infection and 22% had bacterial infection. Among the bacteria isolated 20% were Staphylococcus aureus and among the fungi isolated 56% were Fusarium species. The best corrected visual acuity was recorded using Snellen’s chart at the end of 3 months. 28% had vision in the range of 6/24 - 6/60. This study concludes that corneal ulceration most often occurs after a corneal injury with organic material, with fungal infections showing a marked preponderance over bacterial infection. Fusarium species in fungal infections and Staphylococcus aureus in bacterial infections were mostly isolated. The final visual outcome is  good with early diagnosis and prompt treatment. These findings show the importance of early identification as well as treatment of corneal ulceration in the prevention of corneal ulceration in a developing world.

Keywords: corneal ulcer, bacteria; fungi; visual outcome.

References

1.      Garg P, Krishna PV, Stratis AK, Gopinathan U. The value of corneal transplantation in reducing blindness. Eye (Lond) 2005;19:1106-14.

2.      National Programme for Control of Blindness. Report of National Programme for Control of Blindness, India and World Health Organization; 1986-89

3.      Dandona R, Dandona L. Corneal blindness in a southern Indian population: Need for health promotion strategies. Br J Ophthalmol 2003;87:133-41.

4.      National Programme for Control of Blindness. Available from: http://pbhealth.gov.in/pdf/Blindness.pdf.

Eye Donation. NPCB India Newsletter; Jul-Sep 2010. Available from: http://npcb.nic.in/writereaddata/mainlinkfile/File200.pdf.

5.      Dandona L, Dandona R, John RK. Estimation of blindness in India from 2000 through 2020: Implications for the blindness control policy. Natl Med J India 2001;14:327-34. 

6.      Whitcher JP, Srinivasan M: Corneal ulceration in the developing world – a silent epidemic. Br J Ophthalmol 1997; 81:622-623.

7.      Thygeson P, Acute Central[Hypopyon] Ulcers Of Cornea, Calif Med 1948;69:18

8.      Srinivasan, Gonzales et al, Epidemiology And Aetiological Diagnosis Of Corneal Ulceration In Maurai South India BJO 1997;81:965-971

9.      Upadhyay MP et al, Epidemiologic charecteristics, predisposing factors and etiologic diagnosis of corneal ulceration in Nepal, Am.J.ophthal, 1991;111:92

10.  Benson WH and Lanier JD, Comparison of techniques for culturing corneal ulcers. Ophthalmology 1992, 9:800

11.  McClellan KA, Bernad PJ, Billson FA, Microbial investigations in keratitis at Sydney Eye Hospital Aust NZ J Ophthalmol 1989, 17:413 -6

12.  Gopinathan U, Garg P, Fernandez M. The epidemiological features and laboratory results of fungal keratitis: a ten year review at a referral eye center in South India.Cornea 2002;21[6]:555 - 59

13.  Srinivas M: Fungal Keratitis. Current OpinOphthalmol 2004;15:321-327

14.  Bharathi MJ, Ramakrishnan R, Vasu S, et al: Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol 2003; 51:315-321

15.  Guidelines for management of corneal ulcer at primary, secondary and tertiary health care facilities in SEAR 2004: SEA/ophthal/126

16.  Tewari A, Sood N, Vegad MM, Mehta DC. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J Ophthalmol 2012;60:267-72.

17.  Nath R, Baruah S, Saikia L, Devi B, Borthakur A K, Mahanta J. Mycotic corneal ulcers in upper Assam. Indian J Ophthalmol 2011;59:367-71.

18.  Kashinatha Shenoy. Epidemiological pattern and risk factors of corneal ulcer in Malabar region of coastal Kerala. Res. J. Pharm. Biol. Chem. Sci. April – june 2013;4(2):1479 – 88.

19.  Narsani AK, Jatoi SM, Lohana MK, Dabir SA, Gul S, Khanzade MA. Hospital based epidemiology, risk factors and microbiological diagnosis of bacterial corneal ulcer. Int J Ophthalmol 2009; 2(4): 362:366.

20.  Thylefors B. Present challenges in global prevention of blindness. Aust NZ J Ophthalmol 1992;20:89 -94.

Corresponding Author

Dr Manjusha N.S.

C/o Dr. M. Rajan, NMC 13/102, Railway station Road, Neyyattinkara, 695121

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