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Microbial keratitis and its management at a rural centre: achieving success with limited resources

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Abstract

Purpose

Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre.

Methods

Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scra**s were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution.

Results

Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10–26 days).

Conclusion

Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres.

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Funding

This work was supported (non-financially) by the Hyderabad Eye Research Foundation (HERF), Hyderabad, India. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India

    Raksheeth Nathan Rajagopal

  2. The Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500034, India

    Raksheeth Nathan Rajagopal, Somasheila I. Murthy & Varsha M. Rathi

  3. Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), LV Prasad Marg, Hyderabad, India

    Varsha M. Rathi

  4. Indian Health Outcomes, Public Health Outcomes and Health Economics (IHOPE), L V Prasad Eye Institute, Hyderabad, India

    Varsha M. Rathi

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Raksheeth Nathan Rajagopal. The first draft of the manuscript was written by Raksheeth Nathan Rajagopal and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Somasheila I. Murthy.

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None of the authors have any proprietary interests or conflicts related to this submission.

Ethical approval

The study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee (13/06/2023/LEC-BHR-R-06-23-1058).

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Informed consent was obtained from all individual participants included in the study.

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Rajagopal, R.N., Murthy, S.I. & Rathi, V.M. Microbial keratitis and its management at a rural centre: achieving success with limited resources. Int Ophthalmol 44, 205 (2024). https://doi.org/10.1007/s10792-024-03125-6

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