Various factors affecting the bacterial corneal ulcer healing: a 4-years study in referral tertiary eye hospital in Indonesia

  • Muhammad Asroruddin Department of Ophthalmology, Faculty of Medicine, University of Tanjungpura, Tanjungpura University Hospital, Pontianak
  • Rina L.D. Nora Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Lukman Edwar Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Soedarman Sjamsoe Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Made Susiyanti Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
Keywords: bacterial corneal ulcer, fluoroquinolone, Pseudomonas sp.
Abstract viewed: 2158 times
PDF downloaded: 2051 times

Abstract

Background: Corneal ulcer is one of the most common causes of visual acuity impairment and blindness all over the world. The aim of the study was to evaluate various factors affecting the bacterial corneal ulcers healing, including the predisposing factors, causative organisms, antibiotic sensitivity, as well as the treatment outcomes.

Methods: All data were taken retrospectively from medical records of patients who underwent corneal scraping for Gram examination and/or culture over a-4-year period (2008-2011) at the Cipto Mangunkusumo Hospital Jakarta. Treatment outcome were analyzed using Chi-square test, one-way ANOVA, and post-hoc analysis. Mean time required for complete epithelial healing was also investigated.

Results: 220 cases of bacterial corneal ulcers in 216 patients were included. The most common risk factors were ocular trauma (45.8%). Gram-positive coccus were found in 65.7% cases other than other microbes. Pseudomonas sp. (25,0%) and Staphylococcus epidermidis (18.4%) were the most common isolates, sensitive to almost all kinds of antibiotics. About 83.0% (106 cases) were improved with antibiotics only, the rest were not improved and worsened. Mean time for complete epithelial healing was 17.5 ± 8.9 days with mild ulcer had the most rapid recovery. Eyes treated with fluoroquinolone eyedrops were healed in 14 days, faster than other regiments.

Conclusion: Ocular trauma was the most common risk factor for corneal ulcer, and the most commonly isolated organism was Pseudomonas sp. Most cases were improved with antibiotics, and fluoroquinolone showed faster healing. Complete epithelial healing occurred in about 17.5 days.

References

  1. Weisenthal RW. 2013-2014 Basic and clinical science course, section 8: external disease and cornea. American Academy of Ophthalmology; San Fransisco, 2010. p. 22-30.

  2. Garg Prashant, rao GN. Corneal ulcers: diagnosis and management. Community Eye Health. 1999;12(30):21-3.

  3. aao.org [internet]. San Fransisco: Cornea/external disease panel members. Preferred practice pattern guidelines. Bacterial keratitis. [Update Sept 2012; Cited 2012 Dec]. Available from: www.aao.org

  4. World Health Organization. Guidelines for the management of corneal ulcer at primary, secondary, and tertiary care health facilities in the South-East Asia Region. WHO Regional Office for South East Asia; 2004.

  5. Damayanti Y, Sitompul R. Karakteristik klinis dan hasil terapi ulkus kornea bakteri di Poliklinik Mata Rumah Sakit Dr. Cipto Mangunkusumo Periode 1 Juli 2005 - 30 Juni 2007. Thesis. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2008. Indonesian.

  6. Wirastana. Karakteristik ulkus kornea jamur di Divisi Infeksi dan Imunologi Polimata RSCM tahun 2007-2009. Thesis. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2010.

  7. Sirikul T, Prabriputaloong T, Smathivat A, Chuck RS, Vongthongsri A. Predisposing factors and etiologic diagnosis of ulcerative keratitis. Cornea. 2008;27(3):283-7. http://dx.doi.org/10.1097/ICO.0b013e31815ca0bb

  8. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivkumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol. 2007;14(2):61-9. http://dx.doi.org/10.1080/09286580601001347

  9. Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol. 1997;81(11):965-71. http://dx.doi.org/10.1136/bjo.81.11.965

  10. Sitompul R, Asyari F, Sjamsoe S, Marsetio M. Perbandingan efektifitas dibekasin dan gentamisin sebagai terapi pada ulkus kornea bakteri. Ophthalmologica Indonesiana. 1997;17:47-52. Indonesian.

  11. Rahmadhani SFS. Peranan kultur dan uji kepekaan dalam penalaksanaan ulkus kornea bakteri di Sub Bagian Infeksi dan Imunologi Ilmu Penyakit Mata RS Cipto Mangunkusumo 1995-1998. Thesis. Jakarta: Fakultas Kedokteran Universitas Indonesia; 1999. Indonesian.

  12. Green M, Apel A, Stapleton F. Risk factors and causative organisms in microbial keratitis. Cornea. 2008;27(1):22-7. http://dx.doi.org/10.1097/ICO.0b013e318156caf2

  13. Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in contact lens-related corneal ulcers. Cornea. 2005;24(1):51-8. http://dx.doi.org/10.1097/01.ico.0000138839.29823.57

  14. Jones DB. Decision-making in the management of microbial keratitis. Ophthalmology. 1981;88(8):814-20. http://dx.doi.org/10.1016/S0161-6420(81)34943-4

  15. Fong CF, Tseng CH, Hu FR, Wang IJ, Chen WL, Hou YC. Clinical characteristic of microbial keratitis in a university hospital in Taiwan. Am J Ophthalmol. 2004;137(2):329-36. http://dx.doi.org/10.1016/j.ajo.2003.09.001

  16. Marangon FB, Miller D, Alfonso EC. Impact of prior therapy on the recovery and frequency of corneal pathogens. Cornea. 2004;23(2):158-64. http://dx.doi.org/10.1097/00003226-200403000-00009

  17. Shalchi Z, Gurbaxani A, Baker M, Nash J. Antibiotic resistance in microbial keratitis: ten-year experience of corneal scrapes in the United Kingdom. Ophthalmology. 2011;118(11):2161-5. http://dx.doi.org/10.1016/j.ophtha.2011.04.021

  18. Narsani AK, Jatoi SM, Lohana MK, Dabir SA, Gul S, Khanzada MA. Hospital -base epidemiology, risk factors and microbiological diagnosis of bacterial corneal ulcer. Int J Ophthalmol. 2009;2(4):362-6.

  19. Keay L, Edwards K, Naduvilath T, Taylor HR, Snibson GR, Forde K, et al. Microbial keratitis, predisposing factors and morbidity. Ophthalmology. 2006;113(1):109-16. http://dx.doi.org/10.1016/j.ophtha.2005.08.013

  20. Bourcier T, Thomas F, Borderie V, Chaumeil C, Laroche L. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 2003;87(7):834-8. http://dx.doi.org/10.1136/bjo.87.7.834

  21. Chawla B, Agarwal P, Tandon R, Titiyal JS, Sharma N, Agarwal T, et al. In vitro susceptibility of bacterial keratitis isolates to fourth-generation fluoroquinolones. Eur J Ophthalmol. 2010;20(2):300-5.

  22. N, T. (2017). Mau nanya dong dok. [online] Mau nanya dong dok. Available at: https://nanyadongdok.blogspot.com [Accessed 2 Jul. 2014].

  23. Hussain I, Khan BS, Soni M, Iqbal M, Habibullah. Non-viral microbial keratitis: etiology, clinical features and visual outcome. J Coll Physicians Surg Pak. 2012;22(3):151-4.

  24. Shah VM, Tandon R, Satpathy G, Nayak N, Chawla B, Agarwal T, et al. Randomized clinical study for comparative evaluation of fourth-generation fluoroquinolones with the combination of fortified antibiotics in the treatment of bacterial corneal ulcers. Cornea. 2010;29(7):751-7. http://dx.doi.org/10.1097/ico.0b013e3181ca2ba3

  25. Kowalski RP, Dhaliwal DK, Karenchak LM, Romanowski EG, Mah FS, Ritterband DC, et al. Gatifloxacin and moxifloxacin: an in vitro susceptibility comparison to levofloxacin, ciprofloxacin, and ofloxacin using bacterial keratitis isolates. Am J Ophthalmol. 2003;136(3):500-5. http://dx.doi.org/10.1016/S0002-9394(03)00294-0

  26. Khokhar S, Sindhu N, Mirdha BR. Comparison of topical 0.3% ofloxacin to fortified tobramycin-cefazolin in the therapy of bacterial keratitis. Infection. 2000;28(3):149-52. http://dx.doi.org/10.1007/s150100050068

  27. Panda A, Ahuja R, Sastry SS. Comparison of topical 0.3% ofloxacin with fortified tobramycin plus cefazolin in the treatment of bacterial keratitis. Eye (Lond). 1999;13(Pt 6):744-7. http://dx.doi.org/10.1038/eye.1999.220

  28. Constantinou M, Daniell M, Snibson GR, Vu HT, Taylor HR. Clinical efficacy of moxifloxacin in the treatment of bacterial keratitis: a randomized clinical trial. Ophthalmology. 2007;114(9):1622-9. http://dx.doi.org/10.1016/j.ophtha.2006.12.011

Published
2015-11-09
How to Cite
1.
Asroruddin M, Nora RL, Edwar L, Sjamsoe S, Susiyanti M. Various factors affecting the bacterial corneal ulcer healing: a 4-years study in referral tertiary eye hospital in Indonesia. Med J Indones [Internet]. 2015Nov.9 [cited 2019Dec.15];24(3):150-5. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1044
Section
Clinical Research