Corneal ulceration in the elderly in Hyderabad, south India

• Published in: British journal of ophthalmology 2000-01, Vol.84 (1), p.54-59
• Main Authors: Kunimoto, Derek Y, Sharma, Savitri, Garg, Prashant, Gopinathan, Usha, Miller, David, Rao, Gullapalli N
• Format: Article
• Language: English
• Subjects: Acanthamoeba Keratitis - complications; Age; Aged; Aged, 80 and over; Antibiotics; Bacterial diseases; Bacterial diseases of the eye and orbit; Biological and medical sciences; Corneal Ulcer - epidemiology; Corneal Ulcer - microbiology; Corneal Ulcer - therapy; elderly patients; Eye Diseases - complications; Eye Diseases - microbiology; Female; Fungi; Human bacterial diseases; Humans; Incidence; India - epidemiology; Infectious diseases; Male; Medical sciences; microbial keratitis; Mycoses - complications; Older people; Original articles - Clinical science; Patients; Prevalence; Sex Distribution; Staphylococcal Infections - complications; Staphylococcus epidermidis; Streptococcal Infections - complications; Streptococcus infections; Streptococcus pneumoniae; Tropical medicine
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.84.1.54

AIMS To report demographic, microbiological, therapeutic, anatomical, and visual results of corneal ulceration in the elderly patients seen at a tertiary eye care centre in south India. METHODS 102 consecutive cases of microbial keratitis in patients 65 years and older were studied. Inclusion criteria were: (i) presence of corneal stromal infiltrate upon slit lamp examination; and (ii) microbiological evaluation of corneal scrapings for suspected microbial keratitis. RESULTS The principal predisposing factors identified in this study were ocular disease (38.2%), previous ocular surgery in the same eye (29.4%), trauma (17.6%), and severe systemic disease (16.7%). Contact lens wear was associated with only two cases (2.0%). 99 organisms were isolated in cultures of corneal scrapings from 74 (72.5%) of the 102 cases.Staphylococcus epidermidis (31.1%), filamentous fungi (25.7%), and Streptococcus pneumoniae (13.5%) were the most common isolates. 12 eyes (11.8%) required surgery, 15 (14.7%) eventually required evisceration, and nine (9.6%) of the 94 followed patients achieved an unaided vision of 20/60 or better at last follow up. CONCLUSIONS This work represents the largest recent single centre study on (non-viral) microbial keratitis in the elderly, its management, and outcomes of therapy. While the predisposing factors differ from those of general population, the spectrum of microbes responsible for keratitis in the elderly appears to reflect the local microbial flora rather than a predilection for elderly patients. Delay in diagnosis and systemic conditions associated with advancing age probably contribute to poorer outcome from therapeutic measures.