THE UTILITY OF CULTURING CORNEAL ULCERS IN A TERTIARY REFERRAL CENTERVERSUS A GENERAL OPHTHALMOLOGY CLINIC

Objective: The purpose of the study is to compare the utility of cultu ring corneal ulcers in a tertiary referral clinic and a general ophtha lmology clinic, Design: A retrospective review elf medical and microbi ologic records was performed, Participants: One hundred fifty-seven pa tients with corneal ulcers were included in the study, Eighty-two ulce rs were treated in the referral clinic and 75 ulcers were treated in t he general ophthalmology clinic. Main Outcome Measures: The authors de termined the percentage of corneal ulcers in each clinical setting tha t failed to respond to empiric therapy and required a culture-directed change in treatment. Results: One hundred fifty-seven ulcers were inc luded. Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results. All 75 pa tients in the general clinic responded to empiric antibiotics, such th at culture data never were required for modification of therapy (0%, P = 0.007), In contrast to patients treated in the Cornea Clinic, patie nts treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulce ration other than contact lens wear. Conclusions: Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers. However, it appears reasonable for general ophthalmol ogists to use culturing more judiciously, Patients with significant co rneal ulcers should be cultured regardless of the clinic to which they present. However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics. Close followup is mandatory to di scover the rare patient who will not respond to empiric therapy.