A One Year Prospective Cross Sectional Study Of Clinical And Microbiological Spectrum Of Corneal Ulcers At Tertiary Care Hospital, Belgaum

Abstract

Background and Objectives Burden of corneal blindness is 5.1 % worldwide according to WHO2 and 9% in India 3. 65-90% cases are secondary to bacterial infections4-7 and 6-50% cases due to fungal infections8. For Acanthamoeba keratitis contact lens wear is the predominant risk factor in the developed world. However, in developing countries it is usually associated with exposure to contaminated water. The epidemiological data regarding prevalence and incidence of Acanthamoeba keratitis are lacking38-45. The aim of this study is to understand clinical and microbiological profile of corneal ulcers at a tertiary care centre. Methods The present one year randomized controlled trial was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during the period of January 2012 to December 2012 on 45 patients diagnosed with microbial keratitis. After obtaining written informed consent corneal ulcer was examined at slit lamp to achieve clinical diagnosis and microbiological investigations in terms of Gram’s smear, KOH preparation and inoculation of corneal scrapings on culture media like blood agar, chocolate agar, MacConkey’s agar and Sabouraud’s Dextrose Agar was done. Growth of organisms on different media were studied. Results Males accounted for 38(84.44%) and females 7(15.55%) out of total 45 patients enrolled in the study. Males were predominant with. M:F ratio of 5.42:1 in our study. Majority of the patients were from rural population 30 (66.66%) . Farmers accounted for 24(53.33%) of the study group, males were 22(57.89%) and females were 2(28.57%) . Out of 45 cases, patients with injury with a vegetative matter in the form of seeds, leaf, stems and sticks were found to be 35.55% and considered as a major risk factor associated with development of corneal ulcers. Majority of patients presented during first 10 days of the onset of symptoms 24(53.33%) and 27(60%) presented with an visual acuity of CF to HMCF, PL +. Streptococcus Pneumoniae 6/17 (35.29%) and Pseudomonas species 4/17(23.52%) were most common bacteria isolated where as Aspergillus sp positivity was 12/30(40%) followed by Fusarium 7/30( 23.33%). Conclusion and interpretation Present study concludes microbiological investigations offer a great help in diagnosis of corneal ulcer and provide a guideline to initiate an early specific treatment.