Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

Abstract

Aim: To determine whether topical antifungal prophylaxis distributed by paid village health workers (VHWs) in south India is necessary after corneal abrasion to prevent fungal keratitis in a population where half of the ulcers are fungal. Methods: Two panchayaths (village administrative units in Madurai district with a combined population of 48 039 were followed prospectively for 18 months by 15 VHWs who were trained to identify posttraumatic corneal abrasions. Patients fulfilling the eligibility criteria were randomised into two groups and treated with either 1% chloramphenicol and 1% clotrimazole ointment or 1% chloramphenicol and a placebo ointment three times a day for 3 days. Patients, doctors and VHWs were blinded to treatment. Results: During the 18-month period, 1365 people reported to VHWs with ocular injuries, of whom 374 with corneal abrasions were eligible for treatment. Of these, 368 (98.5%) abrasions healed without complications. Two patients had mild localised allergic reactions to the ointment, two dropped out and two patients in the placebo group developed microscopic culture-negative corneal stromal infiltrates that healed in 1 week with natamycin drops. Conclusions: Both fungal and bacterial ulcers that occur after traumatic corneal abrasions seem to be effectively prevented in a village setting using only antibiotic prophylaxis.

Microbial Keratitis in East Africa: Why are the Outcomes so Poor?

“…Moreover, several studies in Asia have now demonstrated that prompt prophylactic treatment of corneal abrasions with topical chloramphenicol is very effective in preventing the development of microbial keratitis. 5,26 However, this is probably not widely practiced in this region.…”

A Case of Alternaria Alternata Keratitis

“…8 Mantar keratitleri için en önemli risk faktörü, bitkisel materyallerle direkt travma olup, sunulan olguda da benzer bir travma öyküsü mevcuttur. 9 Bunun dışında azalan oranlarda geçi-rilmiş oküler cerrahi ve kontakt lens kullanımı da risk faktörleri arasındadır.…”

Microbial Keratitis in the Developing World: Does Prevention Work?

“…They were treated empirically with 5% Natamycin for 1 week because of the risk of developing a fungal ulceration and both healed without sequelae. 11 …”

“…In an adjacent untreated large village of 4000, the corneal ulcer rate during the same period was 165 per 100,000 annually, and in the study area of 48,039, 8 patients with corneal ulcers (11 per 100,000) were seen in the 18-month period who had not reported to have their abrasions treated. 11 At the end of 18 months, there were 374 patients with documented corneal abrasions that had been randomized to 1 of the 2 treatment groups. Two patients dropped out of the study for personal reasons, 2 had mild allergic reactions to the placebo ointment, and 368 of the abrasions (98.5%) healed without complications.…”

“…Anecdotal evidence from clinicians at Aravind Eye Hospital suggested that ''corneal abrasions treated with Chloramphenicol ointment almost never develop either bacterial or fungal keratitis'' also raised this interesting question. In Madurai, 11 15 VHWs employed by Aravind Eye Hospital were trained to follow a population of 48,039 in 2 panchayaths for 18 months (a panchayath is approximately 25,000 individuals and comprises a number of different villages). Patients with corneal abrasions were randomized into 2 groups.…”