Age-related Clinical Analysis of Infectious Keratitis in Two Tertiary Centers

Jong Youn Kim; Kyung Chul Yoon; Yeoung Geol Park; Nam Chun Cho; In Cheon You

doi:10.3341/jkos.2010.51.7.927

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Kim, Yoon, Park, Cho, and You: Age-related Clinical Analysis of Infectious Keratitis in Two Tertiary Centers

Original Article

J Korean Ophthalmol Soc 2010;51(7):927-934.

Published online: 31 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.7.927

Age-related Clinical Analysis of Infectious Keratitis in Two Tertiary Centers

Jong Youn Kim, MD¹, Kyung Chul Yoon, MD², Yeoung Geol Park, MD², Nam Chun Cho, MD¹, In Cheon You, MD¹

¹Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

²Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

Address reprint requests to In Cheon You, MD, Department of Ophthalmology, Chonbuk National University Hospital #634-18 Geumam-dong, Dukjin-gu, Jeonju 560-182, Korea Tel: 82-63-250-2581, Fax: 82-63-250-1960, E-mail: you2ic@paran.com

Received 19 October 2009 Accepted 18 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the age-related risk factors, clinical manifestations, and prognosis in infectious keratitis.

Methods

Records of patients with infectious keratitis who visited one of the two tertiary medical centers at Jeolla-do from January 2000 to December 2007 were reviewed. Risk factors depending on patient age distribution standardized over and under the age of 60 were reviewed retrospectively by analyzing sex, age, previous history of trauma, systemic disease, previous ocular disease, causative organism and treatment.

Results

A total of 757 patients (757 eyes) visited either one of the two tertiary medical centers. The mean age was 58.2±18.0 (4 to 93) years, and patients included 437 males (57.7%), and 320 females (42.3%). The most common risk factor among all age groups was trauma, especially due to vegetable matter. The second most frequent risk factor among the younger patients was contact lens use (19.2%), and common risk factors among the elderly were previous ocular disease (20.0%), systemic disease (15.5%), and ocular surgery (9.7%). The most prevalent causative organisms among all age groups were Gram-positive bacteria, in particular Staphylococcus epidermidis. Elderly patients had a higher frequency of corneal perforation than did younger patients. In addition, elderly patients had a worse prognosis and more often required surgical treatment.

Conclusions

Infectious keratitis has more severe clinical manifestations and complications and a worse prognosis in elderly than in younger patients. Elderly patients have more diverse risk factors. Prevention should aim at avoiding ocular trauma, especially by vegetable matter, and at controlling ocular surface diseases, such as exposure keratitis and bullous keratopathy.

Keywords: Age group, Infectious keratitis, Prognosis, Risk factor

References

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Table 1.

Demographic characterisitics of infectious keratitis seen at two tertiary medical centers

Variable	CUH^* patients	CNUH^† patients	Younger patients (<60 years)	Elderly patients (≥60 years)
No. of visited patients (%)	318 (42.0)	439 (58.0)	313 (41.3)	444 (58.7)
Age (years)
Mean± SD^‡	58.2±18.3	58.2±17.4	41.5±14.6	70.2±7.1
Range	(7-89)	(4-93)	(4-59)	(60-93)
Sex
Male	182 (57.2)	255 (58.1)	197 (62.9)	240 (54.1)
Female	136 (42.8)	184 (41.9)	116 (37.1)	204 (45.9)

^* CUH=Chonbuk National University Hospital

^† CNUH=Chonnam National University Hospital

^‡ SD=standard deviation.

Table 2.

Predisposing factors in patients with infectious keratitis at two tertiary medical centers

Predisposing factors	Younger patients (<60 years) [n (%)]	Elderly patients (≥60 years) [n (%)]	P value
Trauma	128 (40.9)	189 (42.6)	0.945
Vegetable matter	47 (15.0)	103 (23.2)	0.005
Sand/soil/stone/dust	24 (7.7)	31 (7.0)	0.720
Metallic foreign body	12 (3.8)	14 (3.2)	0.613
Miscellaneous items	45 (14.4)	41 (9.2)	0.028
Preexisting ocular disease	46 (14.7)	89 (20.0)	0.095
Systemic disease	33 (10.5)	69 (15.5)	0.073
Contact lens wear	60 (19.2)	2 (0.5)	<0.001
Prior ocular surgery	10 (3.2)	43 (9.7)	0.001
None or unknown	61 (19.5)	103 (23.2)	0.332

Table 3.

Preexisting ocular diseases in patients with infectious keratitis at two tertiary medical centers

Preexisting ocular diseases	Younger patients (<60 years) [n (%)]	Elderly patients (≥60 years) [n (%)]	P value
Lagophthalmos (exposure keratitis)	9 (2.9)	22 (5.0)	0.003
Bullous keratopathy	5 (1.6)	20 (4.5)	0.028
Previous keratitis	11 (3.5)	14 (3.2)	0.784
Herpetic keratitis	10 (3.2)	14 (3.2)	0.974
Trichiasis	5 (1.6)	4 (0.9)	0.384
Conjunctivitis	4 (1.3)	0 (0.0)	N-S^*
Dry eye syndrome	0 (0.0)	2 (0.5)	N-S^*
Blepharitis	0 (0.0)	2 (0.5)	N-S^*
Stevens-Johnson syndrome	2 (0.6)	0 (0.0)	N-S^*
Dacryocystitis	0 (0.0)	1 (0.2)	N-S^*
Other	0 (0.0)	11 (2.5)	N-S^*

^* N-S=not significant.

Table 4.

Prevalence of prognostic factors for infectious keratitis in younger and elderly patients

Prognostic factors	Younger patients (<60 years) [n (%)]	Elderly patients (≥60 years) [n (%)]	P value
Location of ulcer
Central	110 (35.1)	186 (41.9)	0.066
Paracentral	126 (40.3)	176 (39.6)
Peripheral	77 (24.6)	82 (18.5)
Size of ulcer (mm²)
≤5.0	220 (70.3)	216 (48.6)	<0.001
>5.0	93 (29.7)	228 (51.4)
Hypopyon
Present	88 (28.1)	214 (48.2)	<0.001
Absent	225 (71.9)	230 (51.8)
Infiltration
Superficial	186 (59.4)	172 (38.7)	<0.001
Deep	127 (40.6)	272 (61.3)

Table 5.

Identified causative organisms in patients with infectious keratitis at two tertiary medical centers

Organisms	Younger patients (<60 years) [n (%)]	Elderly patients (≥60 years) [n (%)]	] P value
Gram (+) bacteria	163 (60.1)	258 (61.7)	0.100
Gram (+) cocci
Staphylococcus species	63 (23.2)	70 (16.7)	0.013
Staphylococcus aureus	11 (4.1)	14 (3.3)	0.576
Staphylococcus epidermidis	29 (10.7)	34 (8.1)	0.196
Other coagulase negative staphylococc	ci 23 (8.5)	22 (5.3)	0.071
Streptococcus species	16 (5.9)	39 (9.3)	0.116
Viridans streptococcus	7 (2.6)	17 (4.1)	0.011
Streptococcus pneumoniae	5 (1.8)	19 (4.5)	0.064
Other streptococcus	4 (1.5)	3 (0.7)	0.313
Enterococcus faecalis	0 (0.0)	2 (0.5)	N-S^*
Gram (+) bacilli
Bacillus species	1 (0.4)	3 (0.7)	0.571
Corynebacterium species	1 (0.4)	1 (0.2)	0.743
Other	3 (1.1)	14 (3.3)	0.069
Gram (−) bacteria	33 (12.2)	41 (9.8)	0.550
Gram (−) rod
Pseudomonas species	11 (4.1)	14 (3.3)	0.941
Serratia marcescens	8 (3.0)	0 (0.0)	0.001
Burkholderia cepacia	3 (1.1)	4 (1.0)	0.923
Klebsiella species	1 (0.4)	6 (1.4)	0.090
Enterobacter cloacae	1 (0.4)	4 (1.0)	0.252
Stenotrophomonas maltophilia	1 (0.4)	5 (1.2)	0.151
Proteus mirabilis	0 (0.0)	2 (0.5)	N-S^*
Moraxella lacunata	0 (0.0)	2 (0.5)	N-S^*
Other	8 (3.0)	4 (1.0)	0.093
Fungus	74 (27.3)	119 (28.5)	0.326
Nonpigmented (Hyaline) filamentous fungi	26 (9.6)	40 (9.6)	0.828
Fusarium species	16 (5.9)	29 (6.9)	0.661
Aspergillus species	9 (3.3)	7 (1.7)	0.124
Penicillium species	1 (0.4)	3 (0.7)	0.579
Beauveria species	0 (0.0)	1 (0.2)	N-S^*
Pigmented (Dematiacious) filamentous fungi	2 (0.8)	14 (3.3)	0.067
Alternaria species	0 (0.0)	11 (2.6)	0.007
Cladosporium species	1 (0.4)	3 (0.7)	0.579
Curvularia species	1 (0.4)	0 (0.0)	N-S^*
Other mold-like fungi	12 (4.4)	9 (2.2)	0.071
Yeast	4 (1.5)	8 (1.9)	0.713
Candida species	3 (1.1)	4 (1.0)	0.802
Trichosporon species	0 (0.0)	3 (0.7)	N-S^*
Rhodotorula species	1 (0.4)	1 (0.2)	0.733
Acanthamoeba	1 (0.4)	0 (0.0)	N-S^*
Total	271	418

^* N-S=not significant.

Table 6.

Surgical interventions in patients with infectious keratitis at two tertiary medical centers

Surgical interventions	Younger patients (<60 years) [n (%)]	Elderly patients (≥60 years) [n (%)]	P value
Amniotic membrane transplantation	38 (12.1)	94 (21.2)	0.001
Evisceration or enucleation	11 (3.5)	47 (10.6)	0.006
Penetrating keratoplasty	21 (6.7)	22 (5.0)	0.304
Partial or complete conjunctival flap	0 (3.2)	11 (2.5)	0.005
Scleral graft	1 (0.3)	10 (2.3)	0.029
Application of histoacryl glue	4 (1.3)	5 (1.1)	0.849
Tarsorrhaphy	1 (0.3)	7 (1.6)	0.096
Lamellar keratoplasty	0 (0.0)	5 (1.1)	0.066
Anterior chamber irrigation	1 (0.3)	1 (0.2)	0.109
Dacryocystorhinostomy	0 (0.0)	1 (0.2)	N-S^*

^* N-S=not significant.

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