The impact of the COVID-19 pandemic on microbial keratitis presentation patterns

Abstract

Background Microbial keratitis (MK) is the most common non-surgical ophthalmic emergency, and can rapidly progress, causing irreversible sight-loss. This study explored whether the COVID-19 (C19) national lockdown impacted upon the clinical presentation and outcomes of MK at a UK tertiary-care centre. Methods Medical records were retrospectively reviewed for all patients with presumed MK requiring corneal scrapes, presenting between 23rd March and 30th June in 2020 (Y2020), and the equivalent time windows in 2017, 2018 and 2019 (pre-C19). Results In total, 181 and 49 patients presented during the pre-C19 and Y2020 periods, respectively. In Y2020, concurrent ocular trauma (16.3% vs. 5.5%, p = 0.030) and immunosuppression use (12.2% vs 1.7%, p = 0.004) were more prevalent. Despite proportionately fewer ward admissions during the pandemic (8.2% vs 32.6%, p<0.001), no differences were observed in baseline demographics; presenting visual acuity (VA; median 0.6 vs 0.6 LogMAR, p = 0.785); ulcer area (4.0 vs 3.0mm2, p = 0.520); or final VA (0.30 vs 0.30 LogMAR, p = 0.990). Whilst the overall rates of culture positivity were similar in Y2020 and pre-C19 (49.0% vs. 54.7%, p = 0.520), there were differences in the cultures isolated, with a lower rate of poly-microbial cultures in Y2020 (8.3% vs. 31.3%, p = 0.022). Conclusions Patient characteristics, MK severity and final visual outcomes did not appear to be affected in the first UK lockdown, despite fewer patients being admitted for care. Concurrent trauma and systemic immunosuppression use were greater than in previous years. The difference in spectra of isolated organisms may relate to behavioural changes, such as increased hand hygiene.

Challenges in the diagnosis and management of atypical fungal keratitis during the COVID-19 pandemic: a case series

“…Butt et al . [ 47 ] also concur that there were no significant differences in the treatment outcomes of admitted and self-medicating microbial keratitis patients.…”

“…In this case series, the central ulcers (noted in cases 1 and 2) and hypopyon (noted in case 3) could be successfully managed without admitting the patients, despite COVID-19-related constraints. Butt et al [47] also concur that there were no significant differences in the treatment outcomes of admitted and self-medicating microbial keratitis patients.…”

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study

“…[ 28 ] The study conducted in the UK during the first wave of COVID-19 in the year 2020 showed a decline in culture positivity rate from 55% to 49%. [ 29 ] Our study had a culture positivity rate of 28.28%. The low culture positivity rate could be attributed to delayed presentation due to nationwide lockdown, delayed examination of the samples owing to increased workload in terms of increased demand for COVID-19 polymerase chain reaction sampling of nasal and throat swabs, and prior use of antimicrobials prescribed by local practitioners.…”

“…Table 5 summarizes various comparative and noncomparative studies on microbiological and demographic profile of corneal ulcers during COVID-19. [ 29 30 31 32 33 ] The current study is the only prospective study on demographic and microbiological profile of corneal ulcers during COVID-19 era.…”

Enhancing Clinical Decision-Making in Complex Corneal Disorders: The Role of In-Vivo Confocal Microscopy

“…Additionally, it offers seven-days-a-week Eye Casualty services for adults and children with acute sight threatening eye disease. Previous data obtained from 2015–2016 [ 8 ] reported that BMEC recorded approximately 120 attendances per day with up to 112.5 admissions per year due to MK with direct costs of admission of £3681 per patient. Consequently, it is evident that complex corneal disorders can negatively impact on the NHS, economy and also on patients’ quality of life [ 9 ].…”