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A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital

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A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital Acta Scientific Ophthalmology (ISSN: 2582-3191) Volume 3 Issue 7 July 2020 Research Article A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital Avinash Poka, Mohan Das T* and Narayan M Received: Department of Ophthalmology, PES Institute of Medical Sciences and Research, Published: February 25, 2020 Kuppam, AP, India Mohan Das T., *Corresponding Author: June 02, 2020 et al. © All rights are reserved by Mohan Das T, Junior Resident, Department of Ophthalmology, PES Institute of Medical Sciences and Research, Kuppam, AP, India. Abstract Introduction: Cornea is responsible for three quarters of dioptric power of the eye and hence any injury to it can cause considerable - visual disturbances. Avascularity, while absolutely essential for optical purposes is boon to multiplying organisms. In India there are about 18.7 million blind people. The incidence of corneal blindness is 15.4%, the corneal ulcer contributing (9.34%), corneal dys trophy (0.49%), keratomalacia (1.68%), corneal opacity (3.67%) and others like keratoconus (0.09%) of this. Corneal blindness is a major problem in India, which adds a substantial burden to the community in general and health care resources all over the world. Further, individuals with corneal blindness are usually of a younger age group compared with those suffering from cataract. Hence, inObjectives terms blind: years the impact of corneal blindness is greater. 1. To study the clinical features, etiology and microbiological profile of suppurative keratitis. - 2. To study the course, final visual and therapeutic outcome of the cases. 3. To study the various factors affecting the outcomes and their relationship with the micro biological profile and clinical appear ance. 4.Materials To identify and Methodsthe signs: and symptoms (which carry a poorer prognosis or may indicate a fulminant course). - A prospective observational study was conducted at Department of Ophthalmic, PES Institute of Medical Sciences and Research, Kuppam study period between Jan 2018 - 2019. A total 80 subjects who diagnosed has corneal ulcer at tending in department of ophthalmology, PESIMSR. The following inclusion and exclusion criteria was used to conduct the research programme inclusion criteria: All cases of suspected Microbial keratitis visiting cornea clinic between January 2018 to June 2019. Exclusion criteria: All cases of clinically suspected non-bacterial and non-fungal keratitis, known cases of degeneration ulcer like Results: Moorens ulcer and Terriens. Patients below 18 years of age and patients unable to give valid consent and one eyed patients. Total 85 cases was considered for the study group. Out of which male comprises 52 (61.18%) and female was 33 (38.82%) with sex ratio 1:2. The significance was tested based on the logistic regression analysis. Irrespective of gender it was found that incidence and exposure of culture organisms was statistically significant (p < 0.01). The laterality was Correlated between Culture Fusarium Bacillus Aspergillums fumigates organisms, the analysis was done multivariate logistic regression method. As per the resulted findings, the most occurrences of the Strep. epidermidis Staph aureus Aspergillums flavus organisms was 23 (27.06%) (p < 0.01) followed by species 14 (16.47%) (p < 0.01), 12 Strep. pneumococcus (14.12%) (p < 0.01), 13 (15.29%) (p < 0.01), 11 (12.94%) (p < 0.01), 8 (9.41%) (p < 0.01) and fewer number of organisms are showed to be 4 (4.71%) (p < 0.01). The occurrence of the organisms Conclusion: when compared with laterality and other associated factors is found to be statistically significant. The definitive diagnosis of ulcers caused by multiple organisms can only be arrived at by microbiological evaluation. Accurate diagnostic tests not only play a key role in patient management but also reduce the risk of the patient developing long-term Keywords: complications. Organisms; Cornea; Incidence; Culture Organisms; Prevalence Citation: et al. Acta Scientific Ophthalmology Mohan Das T., “A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital”. 3.7 (2020): 02-12. A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital 03 Introduction to current anti-fungal which are fungistatic is a major cause for - Cornea is responsible for three quarters of dioptric power of the poor response to fungal keratitis, which may lead to perforation - - eye and hence any injury to it can cause considerable visual distur or panophthalmitis. Corneal ulcers by fusarium species. one of the bances. Avascularity, while absolutely essential for optical purpos most virulent ocular pathogens underscores the need for more ef - es is boon to multiplying organisms. In India there are about 18.7 fective methods of diagnosis and treatment to decrease the burden million blind people. The incidence of corneal blindness is 15.4%, of avoidable blindness. The cornel stroma is approximately 500mi the corneal ulcer contributing (9.34%), corneal dystrophy (0.49%), crometer thick and comprises 90% thickness of the cornea and is - keratomalacia (1.68%), corneal opacity (3.67%) and others like located between the bowmanns layer and descemets membrane. It keratoconus (0.09%) of this. Corneal blindness is a major prob is composed of lamellae formed from flattened bundles of collagen, - lem in India, which adds a substantial burden to the community in stromal keratocytes and ground substances like keratan sulphate. - general and health care resources all over the world. Further, indi Collagen is the major structural component of corneal stroma. viduals with corneal blindness are usually of a younger age group There are 200 to 250 bundles of collagen fibrils. Each bundle ex compared with those suffering from cataract. Hence, in terms blind tends the width of the cornea and is 2 nm thick 9 to 260 nm wide. - years the impact of corneal blindness is greater. The collagen fibrils are arranged in a regular manner, parallel to - the corneal surface. Such arrangements and equal spacing of col The commonest cause of corneal blindness is infection made lagen fibers creates a lattice or three-dimensional diffracting grat worse by malnutrition due to poverty and ignorance. Bacterial ing, which is responsible for the ability of cornea to scatter 90% of infections are quite frequently encountered and are an important the incoming light rays. The lamellae in the posterior part of the - preventable cause of mono ocular blindness. In the developing stroma have an orthogonal layering i.e. the bundles are at right world corneal ulcers appear to be a occurring in epidemic propor angles to each other. In the anterior one third of the stroma, the tions, suppurative keratitis is the major cause of corneal blindness. lamellae have a more oblique layering. The glycosaminoglycans of - - While contact lens use is a major cause of corneal blindness in the the stroma are keratin sulphate and chondroitin sulphate, which - developing world, a high prevalence of fungal infections, agricul occur in the ratio 3:1. keratocytes occupy 3 - 5% of the stromal vol ture related trauma, and use of traditional eye medicines is unique ume. They are responsible for the maintenance of stromal compo - in the developing world. Pathogens will get entry into the cornea nents and they synthesize collagen degradative enzymes such as ria namely Neisseria gonorrhoea, Neisseria meningitides Cory- - because of the corneal epithelial layer barrier break, but few bacte matrix metalloproteases. The MMPs are particularly important in nebacterium diphtheria , and the pathogenesis of peripheral ulcerative keratitis as they accumu can invade the intact cornea. late in the tears and trigger an autoimmune response involving the ocular tissue. Keratocytes usually lie between the lamellae being Other causes like foreign body, erosions and abrasions due to flat with long attenuated processes extending from a central cell trauma can lead to intact epithelial barrier break and can cause - body in all directions. Depletion of keratocytes is a characteristics the bacterial keratitis. The infected lacrimal sac can be a cause for feature of acanthamoeba keratitis. bacterial keratitis in corneal epithelial layer break. Corneal ulcer Aim of the Study ation occurs due to the host cellular and immunological responses to the offending agent. Severity of the ulceration depends on the The present study aims to study the following objectives (i) - virulence of a offending agent, and host response. Hypopyon can be study the clinical features, etiology and microbiological profile of - seenAcanthamoeba in severe degree corneal ulcer. - suppurative keratitis (ii) to study the course, final visual and thera peutic outcome of the cases (iii) to study the various factors affect is a ubiquitous, protozoa and have been isolat ing the outcomes and their relationship with the micro biological ed from soil, water, air and dust. Fungal infections are common in - profile and clinical appearance and (iv) to identify the signs and tropical climatic regions and affect the immunosuppressed state, - symptoms (which carry a poorer prognosis or may indicate a ful topical steroid use or trauma with a vegetable matter. Prompt minant course). treatment is essential for all forms of corneal ulcer to prevent com Materials and Methods - - plications and permanent visual impairment. Usually consists of - systemic and topical broad-spectrum antibiotics until culture re A prospective observational study was conducted at Depart sults identify the causative organisms. The goals of treatment are ment of Ophthalmic, PES Institute of Medical Sciences and Re to eliminate the underlying cause of the ulcer and to relieve pain. search, Kuppam study period between January 2018 - 2019. A total Severe fungal keratitis on presentation and inadequate response Citation: et al. Acta Scientific Ophthalmology Mohan Das T., “A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital”. 3.7 (2020): 02-12. A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital - Tools and techniques to be used 04 - 80 subjects who diagnosed has corneal ulcer attending in depart - ment of ophthalmology, PESIMSR. The following inclusion and ex 1.
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