ULCERATIVE KERATITIS IN BULLOUS KERATOPATHY

Purpose: The authors review a large series of patients with bullous ke ratopathy (BK) to analyze the frequency of ulcerative keratitis, and d etermine the contributory roles of bullae, bandage soft contact lenses , steroids, and prophylactic antibiotics. Methods: A retrospective rev iew of all cases of pseudophakic or aphakic bullous keratopathy presen ting to the cornea service between January 1, 1986 and September 1, 19 95 was performed. The influence of time, bullae, bandage contact lense s, steroids, and prophylactic antibiotics was evaluated by actuarial m ethods and multivariate analysis. Results: Nine hundred eighteen patie nts were included in this study, 44 (4.7%) of whom had infectious or i nflammatory complications; 813 cases were available for statistical an alysis. Steroids (P < 0.0001), bandage soft contact lens use (P = 0.00 4), and bullae (P = 0.01) had statistically significant independent ef fects on the risk of developing ulcerative keratitis, and the combinat ion of steroids and bandage lenses yielded the highest risk (P < 0.001 ). Prophylactic antibiotic use paradoxically had a statistically signi ficant association with ulcerative keratitis in these patients (P = 0. 01). Increasing BK time was also associated with ulcer development, an d the risk remained relatively constant over the 60 months of the stud y. Streptococcus was the most frequent organism cultured. Conclusions: Ulcerative keratitis developed in 4.7% of patients with bullous kerat opathy. Prolonged BK time alone was a risk factor for infection. The s trongest single additional risk factor for ulcer development was stero id use, followed by bandage soft contact lens use, and their simultane ous use had the greatest effect. The presence of bullae was also a ris k factor for infection, and prophylactic antibiotic use did not preven t ulcer development.