The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia

Am J Ophthalmol. 2018 Nov;195:161-170. doi: 10.1016/j.ajo.2018.07.040. Epub 2018 Aug 9.

Abstract

Purpose: To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia.

Design: Prospective, nonrandomized clinical study.

Methods: Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection.

Results: A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%).

Conclusion: Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Antifungal Agents / therapeutic use
  • Asia / epidemiology
  • Bacteria / isolation & purification
  • Child
  • Child, Preschool
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / epidemiology*
  • Corneal Ulcer / microbiology
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / epidemiology*
  • Eye Infections, Fungal / microbiology
  • Female
  • Fungi / isolation & purification
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Ophthalmology / organization & administration
  • Prospective Studies
  • Risk Factors
  • Sex Distribution
  • Societies, Medical / statistics & numerical data
  • Visual Acuity / physiology

Substances

  • Anti-Bacterial Agents
  • Antifungal Agents