The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia

• Published in: American journal of ophthalmology Vol. 195; pp. 161 - 170
• Main Authors: Khor, Wei-Boon, Prajna, Venkatesh N., Garg, Prashant, Mehta, Jodhbir S., Xie, Lixin, Liu, Zuguo, Padilla, Ma. Dominga B., Joo, Choun-Ki, Inoue, Yoshitsugu, Goseyarakwong, Panida, Hu, Fung-Rong, Nishida, Kohji, Kinoshita, Shigeru, Puangsricharern, Vilavun, Tan, Ai-Ling, Beuerman, Roger, Young, Alvin, Sharma, Namrata, Haaland, Benjamin, Mah, Francis S., Tu, Elmer Y., Stapleton, Fiona J., Abbott, Richard L., Tan, Donald Tiang-Hwee
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018; Elsevier Limited
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antifungal Agents - therapeutic use; Asia - epidemiology; Bacteria - isolation & purification; Child; Child, Preschool; Cornea; Corneal Ulcer - drug therapy; Corneal Ulcer - epidemiology; Corneal Ulcer - microbiology; Developing countries; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - epidemiology; Eye Infections, Bacterial - microbiology; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - epidemiology; Eye Infections, Fungal - microbiology; Female; Fungi - isolation & purification; Humans; Infant; Infant, Newborn; Infections; Intervention; LDCs; Male; Medical treatment; Middle Aged; Ophthalmology; Ophthalmology - organization & administration; Patients; Prospective Studies; Risk Factors; Sex Distribution; Societies, Medical - statistics & numerical data; Surgery; Transplants & implants; Visual Acuity - physiology; Visual impairment; Asia; South Korea; Singapore; Philippines; China; Japan; Taiwan; Thailand; India
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2018.07.040

To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia. Prospective, nonrandomized clinical study. Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection. A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%). Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.