Background To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively). Methods Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p = 0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p = 0.048) and deep infiltration (53.3% vs. 32.1%, p = 0.057). Regarding treatment outcomes, final BCVA < 0.1 (60% vs. 44.2%, p = 0.133), the use of voriconazole (topical 10% vs. 0%, p = 0.044; systemic 23.3% vs. 1.9%, p = 0.003), surgical intervention (43.3% vs. 20.8%, p = 0.029), and treatment failure (46.7% vs. 22.6%, p = 0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p = 0.005) and deep infiltration (OR 4.38, p = 0.013). Conclusions Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.

BackgroundTo compare clinical characteristics and antibiotic susceptibilities in patients with Pseudomonas aeruginosa (PA) and P. putida (PP) keratitis at a tertiary referral center in South Korea.MethodsForty-nine cases of inpatients with culture-proven PA and PP keratitis were reviewed retrospectively between January 1998 and December 2017. We excluded cases of polymicrobial infection. Epidemiology, predisposing factors, clinical characteristics, antibiotic susceptibilities, and treatment outcomes were compared between the PA and PP groups. The risk factors for poor clinical outcome were evaluated on the basis of the total cohort and analyzed using multivariate logistic regression.ResultsA total of 33 eyes with PA keratitis and 16 eyes with PP keratitis were included. The mean age was 47.0 years in the PA group and 59.3 years in the PP group (p = 0.060). Differences were observed between the PA and PP groups in hypopyon (45.5% vs 6.3%, p = 0.006) and symptom duration (4.3 vs 9.5 days, p = 0.022). The most common predisposing factor for PA was wearing contact lenses (36.4%) and that for PP was corneal trauma (62.5%). No significant differences were observed in sex, previous topical steroid use, systemic disease, or duration of hospitalization between the two groups. The PA and PP groups both demonstrated good efficacy of colistin (both 100%), tobramycin (93.3%, 100%), ceftazidime (93.9%, 87.5%), and ciprofloxacin (96.6%, 87.5%). Imipenem (100% vs 81.3%, p = 0.030), piperacillin (96.6% vs 75%, p = 0.047), and ticarcillin (85% vs 0%, p < 0.001) showed significantly lower efficacy in the PP group than in the PA group. A poor clinical outcome was observed in 31.2% of the PA group and 37.5% of the PP group (p = 0.665). The risk factors for poor clinical outcome were previous ocular surface disease (odds ratio 10.79, p = 0.012) and hypopyon (odds ratio 9.02, p = 0.024).ConclusionsThe PA group was more closely associated with younger age, wearing contact lenses, shorter symptom duration, and hypopyon, whereas the PP group was more closely associated with elderly age, corneal trauma, and decreased efficacy of the beta-lactams. Clinical outcomes were not significantly different between the two groups. Previous ocular surface disease and hypopyon were the risk factors for poor clinical outcome.

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Background: To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. In those, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.103). No significant differences were observed in mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting BCVA between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048) and deep infiltration (53.3% vs. 32.1%, p=0.057). Regarding treatment outcomes, final BCVA <0.1 (60% vs. 44.2%, p=0.133), the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 6.01, p=0.005), deep infiltration (odds 4.38, p=0.013), prior topical steroid use (odds 2.79, p=0.091), and previous ocular surface disease (odds 2.82, p=0.093). Conclusions: The PS group was more associated with previous ocular surface disease and deep infiltration when compared with the NPS group. Treatment progresses and treatment results were worse in the PS group. Careful attention should be paid to the use of steroids in clinical practice.

Background: To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively) Methods: Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p=0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p=0.048) and deep infiltration (53.3% vs. 32.1%, p=0.057). Regarding treatment outcomes, final BCVA <0.1 (60% vs. 44.2%, p=0.133), the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029), and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p=0.005) and deep infiltration (OR 4.38, p=0.013). Conclusions: Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.

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Background: To compare the clinical characteristics and treatment outcomes of microbiologically-proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically-proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors and clinical characteristics, microbiological profiles, and treatment outcomes were compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. No significant differences were observed in mean age, sex, occupation, and baseline clinical characteristics between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048), identified fungal isolates (53.3% vs. 26.4%, p=0.014), and diagnosed by repeat microbiological tests (40.0% vs. 17.0%, p=0.020). Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.015). Regarding treatment outcomes, the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 5.95, p=0.003), prior topical steroid use (odds 3.45, p=0.034), and non-vegetable corneal trauma (odds 4.46, p=0.037). Conclusions: The PS group was more associated with previous ocular surface disease, and no significant differences were observed in the baseline clinical characteristics between the two groups. Diagnosis was more difficult and treatment results were worse in the PS group in this study. Repeat microbiological tests can be helpful in diagnosing fungal infections especially in the prior topical steroid used group. Keywords: Fungal ocular infection, Steroids, Ulcerative keratitis.

The purpose of this study was to evaluate the clinical aspects of inpatients with bacterial keratitis according to culture positivity. Methods: This was a retrospective review of 98 cases of inpatients with bacterial keratitis who were treated between January 2011 and December 2016 in Yeungnam University Hospital. Epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between culture positive (CP, 39 eyes) and culture negative (CN, 59 eyes) groups. Risk factors for poor clinical outcome were evaluated in the total cohort and analyzed using multivariate logistic regression. Results: Pseudomonas spp. (31%) and Staphylococcus spp. (24%) were common in the CP group. There were no significant differences in previous ocular surface disease, contact lens wear, or hypopyon between the two groups. Epithelial defect size ≥5 mm 2 (51%:31%, p = 0.04) and initial visual acuity <0.1 (Snellen) (51%:31%, p = 0.04) were significantly higher in the CP group than in the CN group. Epithelial healing time ≥14 days (18%:5%, p = 0.08) and poor clinical outcome (28%:20%, p = 0.37) were more common in the CP group than in the CN group. Risk factors for poor clinical outcome were previous ocular surface disease (odds ratio [OR] = 11.29, 95% confidence interval [CI] = 2.01-63.41, p = 0.006) and previous ocular surgery (OR = 6.98, 95% CI = 1.51-32.20, p = 0.01). Conclusions: The CP group showed relatively worse initial clinical characteristics than the CN group. Treatment outcomes were slightly worse in the CP group than in the CN group; however, this difference was not statistically significant. Previous ocular surface disease and previous ocular surgery were associated with poor clinical outcome.