ID: 17668
Clinico-Microbiological Profile of Bacterial
Keratitis in Shield Ulcers
Jagadesh C. Reddy
Abhishek Arunkumar Hoshing, Virender S.
Sangwan
The authors have no financial interests in the subject matter
of this presentation
Purpose
The purpose of this study was to describe the
clinico-microbiological profiles and outcomes of
treatment of bacterial keratitis in patients with
shield ulcers due to vernal keratoconjunctivitis
(VKC)
Methods
• Study design: Retrospective review of clinical
records Study location: Cornea service, LV Prasad
Eye Institute, India
• Study duration: January 2000 to December 2012
• Study ethics: Approved by the institutional review
board and was conducted in strict adherence to the
tenets of the Declaration of Helsinki
Methods
Data collected:
• Demographics
• Clinical features
• History of allergy
• Duration of VKC
• Visual acuity
• Culture & sensitity of organisms
• Duration of use of antibiotics and steroids,
• Resolution time
• Complications
Results
Number of eyes
33
Age, years
11 +/- 6 years
Gender, Mala : Female
27:5
Laterality, Right eye : left
eye
20:13
Duration of Vernal kerato
conjunctivitis
44 +/- 35 months
Duration of symptoms
17 +/- 20 days
Type of Vernal kerato
conjunctivitis
Mixed : 82%
Palpebral: 18%
Table-1, Patient characteristics
Results
Parameter
Number (percentage)
Pain
21 (64%)
Redness
28 (85%)
Itching
18 (54%)
Watering
22 (67%)
Discharge
15 (45%)
Photophobia
18 (54%)
Chemosis in the cornea
8 (24%)
Cellularity
30 (91%)
Plaque
12 (36%)
AC cells
12 (36%)
Hypopyon
8
(24%)
Table-2, Patient’s clinical features
Results
• At presentation, 9 (27%) patients were antibiotics, 2
(6%) patients on antifungals, 9 (27%) patients on
steroids and 14 (42%) patients on antiallergic topical
medications
• Based on smear examination fortified Cefazolin and
Ciprofloxacin eye drops were started which were
modified based on sensitivity report
• Topical antibiotics were used for at least a mean of
17 days
• Steroids were started simultaneously in 15 % of
patients
• In 85% of eyes the steroids were started at least
after 8 days (mean) of topical antibiotic usage
Results-Microbiological Profile
Smear
Culture
-
N.meningitidis
-
P.Alcaligenes
S
S
R
3
GPC
CoNS
Strep.Pneumonia
S
S
NA
4
5
6
7
8
9
10
11
GPC
Staph.aureus
S
NA
GPC
GPC
Strep.Pneumonia
NIL
S
-
S
-
1
2
12
13
14
GPC
GNB
GNCB
C
S
H.Parainfluenza
S
No
Corynebacterium s R
Klebsiella sp
S
Moglobinophillus
S
Hemophilus sp
I
O
S
S
Gent
Ga
t
V
Ce
Ch
S
R
S
S
S
NA
NA
R
NA
S
S
S
S
S
NA
NA
S
R
-
NA
-
S
-
S
-
S
-
S
-
NA
S
R
R
R
N
R
S
S
R
S
S
A
S
R
S
S
S
S
R
R
S
S
NA
R
NA
NA
NA
NA
R
S
S
R
NA
S
R
R
R
NA NA
GPC
Strep.Pneumonia
S
S
R
NA
S
S
S
S
GPC
Corynebacterium s
R
S
S
NA
R
S
S
R
GNC
Neisseria Sp
S
S
S
S
S
NA
NA
S
Results-Microbiological Profile
Smear
Culture
15
16
17
GPC
No
GNC
Neisseria sicca
GPC
18
C
O
Gent
A
Ga
t
V
Ce
Ch
No
R
-
S
-
S
-
S
-
S
-
NA
-
NA S
-
-
Staph.aureus
Moraxella sp
R
R
I
I
S
S
S
S
S
S
NA
NA
NA S
NA S
19
20
GPB
GNB
21
22
23
24
25
GPC
GPC
GPC
GPC
No
Pseudomonas Sp
Klebsiella Sp
Staph.aureus
Hemophilus sp
S
S
R
S
S
S
S
S
S
S
S
S
NA
NA
S
S
S
S
S
S
S
S
S
S
S
R
NA
NA
S
S
S
S
S
NA
NA
NA
NA
S
NA
S
S
S
NA
NA
S
NA
S
NA
NA
26
27
28
GNB
S
S
S
S
I
S
S
NA
NA
S
S
S
NA
S
S
NA S
S
S
S
S
GPC
GPB
Strept.pneumonia
Alph.hemoly.strep
Strept.pneumonia
S
Alph.hemoly.strep S
Corynebacterium s S
Moraxella sp.
R
S
S
S
I
NA
NA
Results-Microbiological Profile
Smear
Culture
29
30
31
GPB
Bacillus sp
GPC
Strept pneumonia
GPC
32
GPC
C
O
Gent
A
Ga
t
V
Ce
Ch
Strept pneumonia
S
S
S
S
S
S
S
S
S
NA
R
NA
S
S
S
S
S
S
S
S
S
S
S
S
Strept pneumonia
Brevibacterium
S
S
S
S
S
S
NA
NA
S
S
S
S
S
S
S
R
GPC
Strept pneumonia S
33
S
S
R
S
S
S
S
GPC- gram positive cocci, GNB- gram negative cocci, GPB- gram positive
bacilli, GNCB-gram negative cocco bacilli, Sp- species, S- sensitive, R- resistant,
I- intermediate, NA- not applicable, C- ciprofloxacin, 0- ofloxacin, Gentgentamycin, A- amikacin, Gat- gatifloxacin, V- vancomycin, Ce- cefazolin, Chchloramphenicol
• Complete resolution was seen at a mean of 20 days
• Surgical intervention was needed in 4 patients (12%)
• Three eyes required tissue adhesive application for corneal
perforation and one eye required therapeutic penetrating
keratoplasty
Conclusions
• Bacterial keratitis in shield ulcers due to VKC
usually resolves completely with medical
management
• Clinical diagnosis of secondary infection in a shield
ulcer is a diagnostic challenge but thorough history
and clinical features aid to a great extent
• The organisms isolated are sensitive to most of the
commonly used antibiotics
References
1.Gedik S, Akova YA, Gür S. Secondary bacterial keratitis
associated with shield ulcer caused by vernal conjunctivitis.
Cornea. 2006 ;25:974-6. 2: Arora R, Gupta S,
2.Raina UK, Mehta DK, Taneja M. Penicillium keratitis in
vernalKeratoconjunctivitis. Indian J Ophthalmol.
2002;50:215-6.3:
3.Jain V, Mhatre K, Nair AG, Shome D, Natarajan S.
Aspergillus keratitis in vernal shield ulcer--a case report and
review. Int Ophthalmol. 2010;30:641-4.
4.Reddy JC, Basu S, Saboo US, Murthy SI, Vaddavalli PK,
Sangwan VS. Management, clinical outcomes, and
complications of shield ulcers in vernal keratoconjunctivitis.
Am J Ophthalmol. 2013 ;155:550-559.