MICROBIAL KERATITIS RESULTING IN LOSS OF THE EYE

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the clinical characteristics of infected corneal ulcers resulting in l oss of the eye. PATIENTS AND METHODS: The authors conducted a retrospe ctive study of all cases requiring evisceration or enucleation due to microbial keratitis at Wills Eye Hospital between January 1, 1989, and December 31, 1995. Medical records were reviewed to determine the pas t medical and ophthalmic history, duration of symptoms and treatment p rior to referral, and the size of the ulcer at time of presentation. T reatment, culture results, and clinical course were also analyzed. RES ULTS: During the study period, 1.8% (17 of 965) of the patients with c orneal ulcers admitted to Wills Eye Hospital underwent evisceration or enucleation for microbial keratitis. The median age of the patients w as 67 years (+/- 20.1 years). A majority of the patients (82%, 14 of 1 7) had a history of preexisting ocular disease resulting in poor visua l acuity. The median duration of symptoms prior to presentation to Wil ls Eye Hospital was 11.4 days (+/- 13.3 days). The average size of the corneal infiltrate was 40.8 mm(2) (+/- 38.7 mm(2)). The most common p athogens were Pseudomonas (7 cases) and Streptococcus (3 cases). Patie nts required evisceration (14 cases) or enucleation (3 cases) due to u ncontrolled infection. CONCLUSIONS: Microbial keratitis resulting in l oss of the eye occurred typically in patients who were elderly with pr eexisting poor visual acuity, who presented with severe infections due to virulent organisms or delayed treatment.