Posters

The role of corneal scraping in the management of infectious keratitis

Poster Details

First Author: A.Volinia ITALY

Co Author(s):    L. Avoni   A. Saitta   A. Bratu   D. D'eliseo           

Abstract Details

Purpose:

A clinical diagnosis of corneal infection does not give an unequivocal indication of the causative organism because a wide range of organisms can produce a similar clinical picture. The identification of organisms responsible for microbial keratitisis desirable because a positive result indicates the appropriate class of antimicrobial agent to use. The aim of our study is to show the role of routine smears, cultures and antibiotic sensitivity testing in the treatment of suspected infectious Keratitis.

Setting:

“Santa Maria delle Croci” Hospital of Ravenna, Italy

Methods:

A retrospective chart and laboratory data review was performed for 34 consecutive patients seen between January 2016 and December 2017 with a primary diagnosis of infectious Keratitis. No patients were treated with antibiotics before evaluation in the authors’ department and all under went corneal scrapings for gram-stain and bacterial, fungal and mycobacterium cultures. All patients initially were treated with a topical fluoroquinolone antibiotics, because fluoroquinolone antibiotic drops are easily available, present a broad spectrum of activity and an apparent lack of toxicity. Then, on the basis of sensitivity testing the treatment modification could be made in an informed manner.

Results:

Of 34 corneal scrapings performed, all tested positive for sensitivity testing. 22 were bacterial keratitis (18 Gram positive and 4 Gram negative organisms), 10 were fungal ulcers, while acanthamoeba infection was suggested in two patients. Gram positive bacterial keratitis were treated with Cefazolin 5%, that cover the Gram positive cocci. The triazolefluconazole 0.2% in combination with voriconazole 2% were used for filamentous fungal keratitis. While topical amphotericin B 0.15% was the preferred initial agent for patients with yeast infection. Finally, the two patients with acanthamoeba infection were treated with a combination of propamidineisethionate 0.1% (Brolene) and polyhexamethylenebiguanide 0.02% (PHMB).

Conclusions:

The identification of organisms responsible for microbial keratitisis desirable because a positive result indicates the appropriate class of antimicrobial agent to use. Knowing the causative organism also gives the treating clinician confidence to pursue a particular line of therapy and avoids the unnecessary use of ineffective and potentially toxic drugs. Of our 34 patients, 11 patients recovered only with medical treatment, while the others 23 have required also surgery (17 DALK and 6 PK) because after recovery persisted a corneal scar.

Financial Disclosure:

None