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Mikrobielle Keratitis

Vierjahresstudie zu Risikofaktoren und traditioneller/komplementärer Medizin in Oman

Microbial keratitis

A 4 year study of risk factors and traditional/complementary medicine in Oman

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Zusammenfassung

Hintergrund

Risikofaktoren und Einfluss komplementärer/alternativer Medizin (CAM) bei der Behandlung infektiöser Keratitiden in einer monsunfreien Region im Sultanat Oman.

Studiendesign

Retrospektive Single-Center-Kohortenstudie.

Outcome measures

Demographische Daten, Risikofaktoren, Pathogene.

Methoden

Stationär behandelte Patienten mit eitriger stromaler Keratitis wurden in den Jahren 2001–2004 hinsichtlich klinischer und mikrobiologischer Daten, der Anwendung von CAM, Dauer des Krankenhausaufenthalts und der Ergebnisse evaluiert.

Statistik

χ2-Test, Z-Test.

Ergebnisse

320 Patienten (326 Augen) von 7524 stationären Patienten hatten eine schwere stromale Keratitis, die eine stationäre Behandlung erforderlich machte. Das mittlere Alter betrug 35,1±2,5 Jahre (1,5–63 Jahre), das Verhältnis männlich:weiblich war 2:3 in der Altersgruppe >13 Jahre und 2:1 in der Altersgruppe ≤12 Jahre. 203 Patienten (62,3%) hatten erfolglose CAM-Behandlungen erhalten. Okuläre Risikofaktoren waren Trachom, Meibomitis und weiche Kontaktlinsen. Systemische Risikofaktoren waren Diabetes mellitus und Immunsuppression. 215 Patientenaugen (66%) zeigten eine verzögerte oder keine Heilung (Therapieversager) und der Krankenhausaufenthalt (45 Tage) war gegenüber den 111 Antibiotika-Respondern (26 Tage) verlängert (p<0,001). Alle Augen der Patienten mit CAM hatten einen schlechteren Ausgangs- und Endvisus (p<0,001); 97 Augen der Diabetiker (p<0,001) und 68 Augen der Patienten mit Immunsuppression hatten ein schlechteres Endergebnis (Visus <0,1). Ein negatives mikrobiologisches Ergebnis war mit einem schlechteren Endresultat korreliert (p<0,05). Alle 13 Augen, die perforierten, waren CAM-vorbehandelt (p<0,001).

Schlussfolgerung

Trachom, Trauma und Kontaktlinsenübertragung sind signifikante Risikofaktoren für infektiöse Keratitiden in Oman und korrelieren mit spezifischen Altersgruppen. Die Anwendung von CAM hat einen signifikanten Einfluss auf ungünstige Therapieergebnisse gezeigt.

Abstract

Purpose

To determine the risk factors and the influence of complementary/alternative medicines (CAM) for infectious keratitis in a monsoon-free region of the Sultanate of Oman.

Study design

Retrospective single center cohort study.

Outcome measures

Demographic data, risk factors, and pathogens.

Methods

Patients with purulent stromal keratitis admitted from 2001–2004 were evaluated for clinical and microbiological data, CAM use, duration of hospitalization, and outcome of treatment.

Statistics

χ2-test, Z-test.

Results

A total of 320 patients (326 eyes) out of 7,524 admissions had severe infectious stromal keratitis requiring inpatient treatment. The average age was 35.1±2.5 years (range 1.5–63 years), the male:female ratio was 2:3 in the age group ≥13 years and 2:1 in the age group ≤12 years. Unsuccessful treatment by traditional healers prior to presentation was recorded for 203 patients (62.3%). Ocular risk factors included severe trachomatous dry eye conditions, meibomianitis and soft contact lens overwear. Systemic compromising risk factors were diabetes mellitus and medical immunosuppression. A total of 215 patient eyes (66%) had delayed or no healing (therapy drop-outs), and hospitalization (45 days) was significantly prolonged compared to the 111 antibiotic responders (26 days) (p<0.001). All eyes of patients with prior CAM had worse vision at admission and after therapy (p<0.001), and 97 eyes of patients with uncontrolled diabetes (p<0.001) and 68 eyes of patients with immunosuppression (p<0.001) had a poor visual outcome (vision <0.1). Thirteen eyes perforated. A negative microbiological result correlated with worse final vision (p<0.05). All 13 perforated eyes had received prior CAM (p<0.001).

Conclusions

Trachoma, trauma and contact lens overwear are significant risk factors for infectious keratitis in Oman and correlate with specific age groups. Delay in treatment due to the first-line utilization of CAM showed a significant adverse impact on outcome.

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Authors and Affiliations

  1. Department of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, 123 , Al Khod/Muscat, Oman

    A. Bialasiewicz, R. Shenoy & A. Thakral

  2. Department of Epidemiology and Medical Statistics, Sultan Qaboos University College of Medicine and Health Sciences

    A. A. Al-Muniri

  3. Department of Microbiology, Sultan Qaboos University College of Medicine and Health Sciences

    U. Shenoy & Z. Al-Mughairi

Authors
  1. A. Bialasiewicz
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  2. R. Shenoy
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  3. A. Thakral
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  4. A. A. Al-Muniri
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  5. U. Shenoy
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  6. Z. Al-Mughairi
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Corresponding author

Correspondence to A. Bialasiewicz.

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Bialasiewicz, A., Shenoy, R., Thakral, A. et al. Mikrobielle Keratitis. Ophthalmologe 103, 682–687 (2006). https://doi.org/10.1007/s00347-006-1363-2

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  • DOI: https://doi.org/10.1007/s00347-006-1363-2

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