Initial treatment of microbial keratitis.

PURPOSE: The common occurrence of failed medical treatment in microbial keratitis led us to investigate this phenomenon.

METHODS

We retrospectively reviewed all ulcers that presented to our department for 24 consecutive months. We classified each ulcer as either a therapeutic success or failure based on a precise definition of the response to initial antibiotic selection. We then analyzed multiple factors including: antibiotic selection, ophthalmic disease, ulcer characteristics, and management, to determine their significance in the success or failure in treating microbial keratitis. Complications were also examined.

RESULTS

Important factors in failure were non-fortified antibiotics (P < 0.001), ocular surface disease (P = 0.0178) and outpatient management (P < 0.001). Large ulcers (P = 0.051) were of borderline significance. Sensitivity results reflect high sensitivity among successfully treated patients when appropriate antibiotics are chosen.

CONCLUSIONS

This report provides insight into current practice patterns and potential means to improve success in managing microbial keratitis.