ISSN: 1300-0365
Dil: Türkçe
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Our Clinical Experience With Bacterial Keratitis
Murat DOĞRU*, Mehmet BAYKARA**, Feray AYGÜL***, Ahmet ÖZMEN****,Haluk ERTÜRK****, Hikmet ÖZÇETİN****
* Yrd.Doç.Dr., Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları AD,** Uz.Dr., Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları AD,*** Arş.Gör.Dr., Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları AD,**** Prof.Dr., Uludağ Üniversitesi Tıp Fakültesi Göz Hastalıkları AD, BURSA
Objective: To investigate the factors which might have influenced progressive keratolysis in corneal ulcer cases due to bacterial keratitis in which desmatocele corneal perforation developed.
Materials and Methods: Clinical records on 35 eyes of 35 patients were examined retrospectively. Data on systemic and ocular disease history, visual acuity, revealing ulcer size, depth, location and corneal complications were recorded in details. Corneal scraping and culture specimens were sent for microbiologic investigation. Topical fortified gentamycin and cephazolin or topical fluoroquinolone monotherapy were instituted in all patients. Topical fortified vancomycin and fucidic acid were started in cases with inadequate response according to antibiogram sensitivity. Cases responsive to medical treatment with progressive keratolysis also underwent tarsorraphy, amniotic membrane transplantation or penetrating keratoplasty. Patients were divided into 2 groups according to the presence of keratolysis related complications and the differences between these groups were investigated.
Results: The most common cause of bacterial keratitis was contact lens use in 13 cases (37%) Microorganisms were identified in 17 cases (48.5%) of the patients.The most frequent isolates in 12 cases with bacterial multiplication were S.aereus, S.epidermidis and Pseudomonas. Central leucoma encountered in 9 patients was the most frequent complication. 4 patients developed descemetocele secondary to progressive keratolysis and 4 patients had corneal perforation. One or more risk factors such as systemic and ocular disease, advanced age and central ulcer location were present in the before mentioned cases.
Conclusion: The constitution of a relationship between patient history, corneal findings and infectious agent, implementation of bacterial isolation with effective methods, institution of antibiotic therapy according to antibiogram sensitivity are important steps in the control of infectious process in bacterial keratitis. Caution should be exercised in bacterial keratitis patients under fluoroquinolone monotherapy with systemic and ocular diseases, advanced age, and central corneal ulcers regarding keratolysis related complications.Keywords: Bacterial keratitis, Keratolysis, Corneal ulcer,Contact lensTürkiye Klinikleri J Oftalmoloji 2003, 12:208-214
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