Patients with treatment failure were more prone to have polymicrobial, P. aeruginosa (shown here) or fungal infections.

Patients with treatment failure were more prone to have polymicrobial, P. aeruginosa (shown here) or fungal infections. Photo: Christine Sindt, OD. Click image to enlarge.

At ARVO 2023 in New Orleans, new research was presented based on a retrospective study at the University of Rochester. The researchers examined patient demographics, systemic and ocular comorbidities and microbial data to determine which factors, if any, are associated with infectious keratitis.

The study included 407 patients with infectious keratitis who had clinical follow-up documentation of at least two weeks after diagnosis. Treatment failure was defined as having no clinical improvement within two weeks of initial presentation and/or needing surgical intervention of corneal gluing, patch grafts, transplants or evisceration of the eye.

A small proportion (15.2%) of the 407 participants experienced treatment failure. However, of this group, 58.1% needed surgical intervention. After looking at the different data, researchers found higher rates of Pseudomonas aeruginosa, fungi and polymicrobial cultures. Other risk factors associated with treatment failure were age greater than 65, systemic immunosuppression and history of smoking.

Ocular history associated with treatment failure included previous corneal transplant, previous transplant rejection, topical steroid use, intraocular surgery history and a visual acuity of 20/250 or worse. Higher rates of prescribed fortified antibiotics were given, and more bandage contact lenses were used in patients with treatment failure during the course of treatment.

As such, the authors noted that many different ocular and other factors put patients at risk of treatment rejection for infectious keratitis. They believe that “this study improves our understanding of infectious keratitis by identifying key prognostic indicators of treatment failure for this blinding disease,” according to their ARVO abstract.

Original abstract content © Association for Research in Vision and Ophthalmology 2023.

Maretz C, Atlas J, Shah S, Wozniak R. Infectious keratitis treatment failure—a study of patient and microbial characteristics in Rochester, NY. ARVO 2023 annual meeting.