Characterizing infectious keratitis in Asia
In Asia, infectious keratitis occurs predominantly in males and is frequently associated with trauma, according to data from the Asia Cornea Society Infectious Keratitis study (ACSIKS). Visual acuity following infection may be poor, and corneal transplantation for active disease is associated with a high failure rate.
Researchers prospectively examined 6,626 eyes of 6,563 individuals (median age 46 years; 60.8 percent male) from countries including Japan, Philippines, Taiwan, Thailand, Singapore, India, China and South Korea. They obtained data on demographics, risk factors, microbiology and outcomes.
Overall, 2,521 eyes (38.0 percent) had bacterial keratitis and 2,166 eyes (32.7 percent) had fungal keratitis. The most frequently isolated microorganisms (n=2,831) included the Fusarium species (n=518; 18.3 percent), Pseudomonas aeruginosa (n=302; 10.7 percent) and Aspergillus flavus (n=236; 8.3 percent). Common risk factors for infection were trauma (n=2,279; 34.7 percent) and contact lens use (n=704; 10.7 percent).
Cornea transplantation was carried out in 628 eyes to manage active infection. At the end of the study, 289 grafts (46 percent) had failed. Visual acuity for each study eye was documented in 6,489 eyes, and more than half (53.6 percent) showed moderate visual impairment or worse (Snellen vision <20/60).
Researchers pointed out that the management of infectious keratitis was not standardized in ACSIKS, with medical and surgical treatment determined by the individual ophthalmologist based on their institutions’ practice. While this can be considered a limitation of our study, the finding also indicates that there is no single standard of care that can be applied throughout Asia.
Additionally, researchers acknowledged that they were not able to identify demographic, clinical or microbiological factors that may predispose patients to poor outcomes.
Nevertheless, the present data should serve as a baseline for describing and understanding corneal infections in Asia, guide ophthalmologists in the assessment and initial management of infectious keratitis, and ultimately contribute towards reducing corneal blindness in the region, researchers added.