Purpose: This study investigated the microbiological profile and clinical characteristics of culture positive (CP) contact lens-related bacterial keratitis (CLBK) and compared them to culture negative (CN) cases. Methods: We retrospectively analyzed 142 CLBK patients hospitalized between January 1998 and December 2022. The CP and CN groups consisted of 79 eyes (100 isolates) and 63 eyes, respectively. We investigated the microbiological profile in the CP group and compared the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes between the CP and CN groups. Poor treatment outcomes were defined as a final best-corrected visual acuity (BCVA) ≤ 0.5, worsened BCVA after treatment, or the need for surgical intervention. We evaluated the risk factors for poor treatment outcomes in the entire cohort through two-proportional Z-test analysis. Results: In CP group, gram-negative bacteria accounted for 85%, and common isolates were Pseudomonas (27%) and Serratia (26%) species. There were significant differences in mean age (27.0 years vs. 33.8 years, p = 0.009) and a history of therapeutic bandage contact lens wear (13.9% vs. 28.6%, p = 0.031) between the CP and CN groups. However, there were no significant differences in symptom duration, prior use of topical antibiotics, sleeping with wearing CL, epithelial defect size, hypopyon, and poor treatment outcomes. Significant risk factors for poor treatment outcomes in the entire group included deep infiltration (Z = 2.88), epithelial healing time ≥ 7 days (Z = 2.30), initial BCVA < 0.1 (Z = 2.20), over date use of contact lens (Z = 2.10), and epithelial defect size ≥ 5 mm2 (Z = 2.05). Conclusions There were no significant differences in clinical characteristics and treatment outcomes between the CP and CN groups. Poor initial clinical findings and over date use of contact lens were associated with poor treatment outcomes in both groups. J Korean

Purpose: To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis. Methods: A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed. Results: Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm2 (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12). Conclusions In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.

Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis. Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group. Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36). Conclusions Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. Conclusions In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. Conclusions In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

Purpose: To investigate the epidemiology, predisposing factors, clinical characteristics, and treatment results of Candida species keratitis. Methods: Eighteen eyes of 18 patients who were diagnosed with Candida species keratitis (C. albicans [CA], 9 eyes; non-CA [NCA], 9 eyes) via corneal culture and hospitalized at Yeungnam University Hospital were included. The epidemiology, predisposing factors, initial clinical characteristics, and treatment outcomes were analyzed retrospectively. Treatment success was defined as the successful healing of corneal lesions after medical intervention. Results: The mean age was 67.5 ± 15.4 years and polymicrobial infection was observed in seven eyes (39%). The mean duration of symptoms was 23.9 days. The common predisposing factors were previous ocular surface disease (8 eyes, 44%), corneal trauma (8 eyes, 44%), and previous topical steroid use (7 eyes, 39%). Common initial clinical characteristics were round infiltration (13 eyes, 72%), hypopyon (8 eyes, 44%), and an initial best corrected visual acuity (BCVA) of less than 0.1 (13 eyes, 72%).In terms of treatment outcomes, we recorded a mean corneal epithelial healing time of 23.5 ± 18.9 days, a final BCVA <0.1 in 12 eyes (75%), and treatment success in 6 eyes (35%). Surgical treatments were performed in 11 eyes (61%), five of which experienced evisceration or enucleation. There were no significant differences in clinical characteristics or treatment outcomes between the CA and NCA groups. In the treatment failure group, previous topical steroid use (64% vs. 0%, p = 0.04) was more common and symptom durations were relatively longer than in the treatment success group (31.3 vs. 13.5 days, p = 0.08). Conclusions Our results showed that Candida keratitis is associated with old age, previous ocular disease, and surgical treatment. Compared with the group in which successful outcomes were achieved, the treatment failure group was associated with previous topical steroid use and longer symptom duration.

PURPOSE: To analyze clinical aspects in a cohort of patients with Staphylococcus keratitis according to coagulase positivity (coagulase negative Staphylococcus [CNS], coagulase positive Staphylococcus [CPS]). METHODS: Epidemiology, predisposing factors, clinical characteristics, treatment outcomes, and antibiotic susceptibility were comparatively analyzed in 138 cases of culture-proven Staphylococcus keratitis (94 eyes with CNS and 44 eyes with CPS) over 20 years (1998–2017) at Yeungnam University Hospital. Poor clinical outcomes were defined as a final corrected visual acuity <0.1, a decreased visual acuity after treatment, complications, or surgical treatment. Risk factors for poor clinical outcomes were evaluated in the total cohort and analyzed using multivariate logistic regression. RESULTS: The most common predisposing factors were corneal trauma in the CNS group (47.9%) and previous ocular surface disease in the CPS group (31.8%). No significant differences were observed in mean age, sex, previous ocular surface disease, epithelial defect size, and hypopyon between the two groups. Methicillin susceptibility (39.4% vs. 72.7%, p < 0.001) was significantly lower in the CNS group, and poor clinical outcomes (28.0% vs. 43.9%, p = 0.076) were more common in the CPS group. The significant risk factors for poor clinical outcomes were initial best-corrected visual acuity <0.1, epithelial defect size ≥ 5 mm², symptom duration ≥10 days, and hypopyon. CONCLUSIONS: No significant differences were observed in epidemiological factors and initial clinical characteristics between the two study groups, but predisposing factors and methicillin susceptibility differed between the two groups. Treatment outcomes were relatively worse in the CPS group than in the CNS group, but the difference was not statistically significant. Poor clinical outcomes were more associated with long symptom duration and poor initial clinical characteristics than with coagulase positivity.
Causality ; Coagulase ; Cohort Studies ; Corneal Injuries ; Epidemiology ; Humans ; Keratitis ; Logistic Models ; Methicillin ; Risk Factors ; Staphylococcus ; Visual Acuity

PURPOSE: 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 mm² (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.
Bacterial Infections ; Causality ; Cohort Studies ; Corneal Ulcer ; Epidemiology ; Humans ; Inpatients ; Keratitis ; Logistic Models ; Pseudomonas ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Visual Acuity

PURPOSE: To report a case of isolated conjunctival lymphangioma mimicking a recurrent conjunctival cyst. CASE SUMMARY: A 39-year-old male with a conjunctival cyst in the right eye lasted for 1 month visited our hospital. He had previously undergone aspiration of the cyst at another hospital 1 week before visiting our hospital. However, the cyst recurred, and he was referred to our hospital. On slit lamp biomicroscopy, yellow-colored turbid fluid and a hemorrhage were observed in the conjunctival cyst, but no specific finding was found in the fundus photography. The patient was initially treated with topical antibiotics and steroids. Three weeks later, absorption of the hemorrhage was noted, but there was no change in the size of the cyst. Therefore, surgical removal and histological examination of the cyst were performed. The histological examination revealed that the lesion was positive for CD 31 and D2-40, and the cyst was diagnosed as a cystic conjunctival lymphangioma. Thereafter, brain magnetic resonance imaging was performed to screen for orbital lymphangioma and systemic disease that could accompany a conjunctival lymphangioma. However, no specific findings were observed. There was no recurrence of the conjunctival cyst at 1 year and 6 months after surgical removal, and no other ophthalmic or systemic complication was observed. CONCLUSIONS: An isolated conjunctival lymphangioma is a rare lesion. In the diagnosis of lymphangioma, systemic examination is recommended for the identification of comorbid diseases, such as orbital lymphangioma.
Absorption ; Adult ; Anti-Bacterial Agents ; Brain ; Diagnosis ; Hemorrhage ; Humans ; Lymphangioma ; Magnetic Resonance Imaging ; Male ; Orbit ; Photography ; Recurrence ; Slit Lamp ; Steroids

PURPOSE: This study analyzed clinical characteristics of Staphylococcus aureus keratitis according to methicillin-resistance. METHODS: The authors performed a retrospective chart review of 46 isolates in 46 eyes with Staphylococcus aureus keratitis that were followed up for more than 2 months between January 1998 and December 2014. Comparative analyses of the epidemiology, predisposing factors, initial clinical manifestations, antibiotics susceptibility and clinical outcome between methicillin-resistant Staphylococcus aureus (MRSA) keratitis and methicillin-sensitive Staphylococcus aureus (MSSA) keratitis were performed. Risk factors of poor visual outcome were analyzed using logistic regression analysis. RESULTS: Among 46 eyes, MRSA was present in 15 eyes (33%) and MSSA in 31 eyes (67%). Male (61%) and older than 60 year-old group (48%) were common. Ocular surface disease/ocular surgery history and trauma were more common as a predisposing factor. Vancomycin was 100% sensitive to both the MRSA and MSSA groups. Antibiotics susceptibility to MRSA was significantly low in the oxacillin (0%), gentamicin (13.3%) and trimethoprim/sulfamethoxazole (53.3%) groups. Sensitivity to fluoroquinolone was 81.3% (MRSA 64.3% vs. MSSA 94.4%; p = 0.064). There were no differences in early corneal findings between the groups. The ratio of BCVA 0.5 or more was 24.4% initially and increased to 44.4% after treatment among all eyes (p = 0.046). Risk factors for poor visual outcomes included a BCVA less than 0.1 at initial evaluation (p = 0.033). CONCLUSIONS: Among eyes with Staphylococcus aureus keratitis, 33% were MRSA. The ratio of BCVA 0.5 or more increased after treatment among all eyes. There were no differences between MRSA and MSSA eyes in terms of epidemiology, predisposing factors, initial clinical manifestations or clinical outcome, except for antibiotic susceptibility. For positive patient outcomes, a treatment approach considering methicillin-resistance as well as various factors affecting clinical course is recommended.
Anti-Bacterial Agents ; Causality ; Epidemiology ; Gentamicins ; Humans ; Keratitis* ; Logistic Models ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Retrospective Studies ; Risk Factors ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin