Optometry: Open Access
Open Access

Abstract

Purpose: To apply a step wise evaluation and a treatment plan for patients with resistant keratitis. Patients & Methods: In this prospective study, laboratory diagnosis and treatment outcome were assessed in 40 patients with clinical diagnosis of resistant keratitis that failed to improve by conventional medical treatment. Each patient was evaluated by clinical examination, ultrasound as well as specimen collection from the affected eye for laboratory evaluation. Sterile swabs, scraping, biopsy or contact lens, specimens were inoculated directly onto blood agar, chocolate agar and Sabouraud dextrose agar (SDA) and smeared onto two slides-one for Gram stain and the other for 10% KOH wet preparation. Direct microscopy and culture methods were used for diagnosis of bacterial and fungal keratitis. Results: 14/40 was diagnosed as bacterial keratitis, 16 patients were diagnosed as fungal keratitis with (fungal/bacterial ratio was 1.14/1). Six patients had mixed bacterial and fungal infection. Trauma was the most important predisposing factor (42.5%). Pseudomonas was the most frequent bacterial isolate (20%) while Aspergillus was the most frequent fungal isolate (31.8%). Medical therapy failed in 16% of cases that necessitated surgical intervention. Keratitis healed without complications in 87.5%; however, complications occurred in 12.5% of cases. No statistically significant difference was observed when we compared occurrence of complications between fungal keratitis and bacterial keratitis cases (p>0.05).There was an overall success rate without complications in 84% of cases treated medically and 93.3% of cases treated by combined medical and surgical treatment. Conclusions: Understanding the cause of resistant keratitis and using a planned protocol for management improves the outcome and decrease the need for urgent penetrating keratoplasty.

Biography

Hala El Mofty is working as a Professor of Ophthalmology, Faculty of Medicine, Cairo University. Born in Cairo, Egypt. Joined Cairo University Faculty of medicine in 1977 and graduated with an excellent degree with honour and  got residency in Cairo University hospitals (about 6000 beds). Ophthalmology department in Cairo university hospitals is considered as a referral center from all over Egypt. Thus, practicing ophthalmology since 1985. Head of ophthalmology department Misr University for science and Technology since 2015 with main interest in corneal infections and ophthalmology ultrasound. Education and teaching undergraduate and postgraduates is my hobby. Moreover  interested in Research work and published a lot of  national and international papers. Through my research achieved the patency of new topical drug for treating fungal and acanthamoeba keratitis  from Academy of Scientific Research in Cairo August 2005.