P Garg1, U Mathur, S Athmanathan, G N Rao. 1. Sight Savers' Corneal Training Centre, L.V. Prasad Eye Institute, Hyderabad, India. prashant@lvpeye.stph.net
Abstract
PURPOSE: To analyze the clinical presentation, predisposing risk factors, in vitro antimicrobial susceptibility, and especially the outcome of therapy of Moraxella keratitis. METHODS: Retrospective review of 18 culture-proven cases of Morarella keratitis. RESULTS: Morarella keratitis was associated with Hansen's disease, uncontrolled diabetes mellitus, herpes zoster ophthalmicus, and chickenpox of the recent past and severe protein energy malnutrition. Other associated ocular conditions included lagophthalmos, blepharitis, steroid therapy, corneal degeneration, and scleritis. In four patients, no systemic or ocular predisposing factors could be identified. Three patients presented with an indolent peripheral, anterior stromal infiltrate while the remaining patients showed a central or paracentral ulceration with or without hypopyon. Moraxella species was the only pathogen isolated in 11 cases, whereas mixed infection was seen in seven cases. All isolates were sensitive to ciprofloxacin. Eight of 18 strains of Moraxella were resistant to cefazolin. All 14 eyes for which the follow-up data were available responded to medical treatment alone. CONCLUSIONS: Although considered to be associated with poor outcome, our experience suggests that a favorable outcome can be expected in Moraxella keratitis. Cefazolin resistance (as seen in our series) may pose a problem and, hence, monitoring of antimicrobial susceptibility would be beneficial. In view of cefazolin resistance, ciprofloxacin monotherapy appears to be an effective method in the medical management of these cases.
PURPOSE: To analyze the clinical presentation, predisposing risk factors, in vitro antimicrobial susceptibility, and especially the outcome of therapy of Moraxella keratitis. METHODS: Retrospective review of 18 culture-proven cases of Morarella keratitis. RESULTS:Morarella keratitis was associated with Hansen's disease, uncontrolled diabetes mellitus, herpes zoster ophthalmicus, and chickenpox of the recent past and severe protein energy malnutrition. Other associated ocular conditions included lagophthalmos, blepharitis, steroid therapy, corneal degeneration, and scleritis. In four patients, no systemic or ocular predisposing factors could be identified. Three patients presented with an indolent peripheral, anterior stromal infiltrate while the remaining patients showed a central or paracentral ulceration with or without hypopyon. Moraxella species was the only pathogen isolated in 11 cases, whereas mixed infection was seen in seven cases. All isolates were sensitive to ciprofloxacin. Eight of 18 strains of Moraxella were resistant to cefazolin. All 14 eyes for which the follow-up data were available responded to medical treatment alone. CONCLUSIONS: Although considered to be associated with poor outcome, our experience suggests that a favorable outcome can be expected in Moraxella keratitis. Cefazolin resistance (as seen in our series) may pose a problem and, hence, monitoring of antimicrobial susceptibility would be beneficial. In view of cefazolin resistance, ciprofloxacin monotherapy appears to be an effective method in the medical management of these cases.