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Risk factors, management, and outcomes of keratitis: A retrospective analysis of 110 cases. | LitMetric

Risk factors, management, and outcomes of keratitis: A retrospective analysis of 110 cases.

Am J Ophthalmol Case Rep

Department of Ophthalmology and Visual Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.

Published: March 2022

AI Article Synopsis

  • The study aimed to assess risk factors, treatment methods, and visual outcomes for patients with keratitis (AK) over a 16-year span at the University of Iowa, focusing on risk factors, diagnosis timelines, and treatment failures.
  • Contact lens wear was identified as the main risk factor for AK, with 40% of patients experiencing failure of medical therapy, and those who received successful treatment had significantly better vision outcomes compared to those needing surgical intervention.
  • The use of corticosteroids prior to an AK diagnosis was linked to longer diagnosis times, worse final vision, and a higher likelihood of requiring surgical treatment, highlighting the importance of caution with steroid use in contact lens-related keratitis cases.

Article Abstract

Purpose: To evaluate the risk factors, medical and surgical management, and visual outcomes of patients affected by keratitis (AK) over a 16-year period.

Observations: Records were reviewed retrospectively for all AK patients treated at University of Iowa between 2002 and 2017. Main outcomes measured were risk factors, time to diagnosis, coinfection types, initial and final visual acuities, and treatment outcomes, with failure of medical therapy defined as need for therapeutic keratoplasty (TK). Effects of steroid use on these outcomes were determined. Among all AK cases occurring during the study period (N = 110), the median age of the AK cohort was 31 years (range 8-80 years), and 49.1% were men. Contact lens wear was the primary risk factor for AK (95/100, 86.4%), and the median time to diagnosis was 0.70 (0.23-1.23) months. Forty-four AK patients (40%) failed medical therapy. Vision outcomes were better for AK patients with successful medical therapy compared to those requiring TK (LogMAR 0.00 v. 0.30; p < 0.0001). Corticosteroid use was associated with increased time to diagnosis (1.00 v. 0.50 months; p = 0.002), decreased final vision (LogMAR 0.10 v. 0.00; p < 0.05) and increased need for TK (40/77 v. 4/33; p < 0.001).

Conclusions And Importance: keratitis cases have increased over the past two decades at our institution. In this large retrospective study, AK was commonly misdiagnosed with delayed diagnosis and high rates of failed medical therapy. Corticosteroid use before AK diagnosis led to poorer outcomes. Our findings underscore the need for ophthalmologists to suspect in the setting of contact lens-associated keratitis before topical steroids are initiated.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842025PMC
http://dx.doi.org/10.1016/j.ajoc.2022.101372DOI Listing

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