MICROBIAL KERATITIS IN CHILDREN

Objective: Microbial keratitis is a major cause of corneal blindness w orldwide. This problem is particularly relevant to children, because m ost of their visual life is ahead of them, and they are uniquely at ri sk for irreversible ocular deficits, such as those resulting from ambl yopia. The objective of this study was to determine the etiologic agen ts and predisposing factors in childhood infectious keratitis and to e xamine the outcome of treatment in terms of structure and visual acuit y. Design: The study design was a retrospective case series. Participa nts: The authors studied 113 eyes in 107 children 16 years of age and younger who were treated for (nonviral) microbial keratitis at the LV Prasad Eye Institute in Hyderabad, India, during the 4.5-year period b etween February 1, 1991, and June 30, 1995. Intervention: The patients who met the following criteria were included in the study: (1) cornea l stromal infiltrate was present on slit-lamp examination; and (2) a c orneal scraping was taken at the time of examination for suspected mic robial keratitis. Main Outcome Measures: Etiologic micro-organisms, pr edisposing factors, treatment method, structural treatment outcome, an d visual acuity treatment outcome of the infectious keratitis episode were measured. Results: The principal predisposing factors identified in this study were trauma (21.2%), ocular disease (17.7%), systemic di sease (15.9%), and prior penetrating keratoplasty in the same eye (8.8 %). Vitamin A deficiency was an important factor within the category o f severe systemic disease, and contact lens wear was not involved in a ny of the cases. A total of 85 organisms were isolated in cultures of corneal scrapings from 64 (56.6%) of the 113 cases. Staphylococcus spe cies (43.7%), Streptococcus pneumoniae (18.8%), and fungi (17.2%) were the most common isolates. Eighteen eyes (15.9%) required surgery, and 28 (36.4%) of the 77 patients on whom visual acuity was assessed at l ast follow-up achieved an unaided visual acuity of 20/60 or better at last follow-up. Conclusion: This work represents the largest recent st udy on childhood (nonviral) microbial keratitis, its management, and t reatment outcomes. In this study, amblyopia is highlighted as a potent ially significant sequela of childhood microbial keratitis. Identifica tion of the appropriate predisposing factors, etiologic microbial orga nisms, and treatment outcome from this study may aid in early recognit ion and treatment of microbial keratitis in children.