Changing trends in the clinical course and outcome of bacterial keratitis at King Khaled Eye Specialist Hospital

Objective To evaluate changes in the predisposing factors and causative organisms, clinical course, and outcome of bacterial keratitis at King Khaled Eye Specialist Hospital (KKESH) between 1995 and 2005. Methods Retrospective review of 78 and 103 cases of culture-positive bacterial keratitis admitted to KKESH in 1995 and 2005. Main outcome measures Microbiological cure, visual outcome. Results There was little change in the predisposing factors for bacterial keratitis, initial clinical severity, or the microbiological profile between 1995 and 2005. While similar topical fortified antibiotic therapy regimens were used in both 1995 and 2005, there was a significant increase in the use of topical corticosteroids in 2005 (P < 0.001), either alone or in combination with medroxyprogesterone 1% and doxycycline. There were significant improvements in the percentage of eyes achieving microbiological cure with medical therapy alone (76.0 vs. 92.2%, P = 0.002) or in combination with surgical intervention (92.4 vs. 100.0%; P = 0.005). The percentage of eyes requiring enucleation or evisceration due to treatment failure declined significantly from 7.6 to 0% (P = 0.006). There was a significant improvement in the percentage of eyes achieving a final visual acuity ≥20/40 (10.1 vs. 29.1%, P = 0.001). Conclusions Significantly better clinical outcomes were achieved in 2005 compared to 1995. Increased emphasis on management of inflammation in conjunction with the infectious process may have contributed to the improved outcomes.