Outcome of Paediatric Microbial Keratitis in Tertiary Eye Center in Nepal

Abstract

Introduction: Corneal diseases are important ocular morbidity in childhood in developing countries and microbial keratitis is a common cause for it.

Methods: It is a retrospective study of 50 microbial keratitis occurring in children of < 18 years presenting in tertiary eye center in 18 months’ period.

Results: Average age of the patients having non-viral infective keratitis was 10.25 years. Sixty-four percent were males. Ninety percent of cases were from rural regions. Patients visited tertiary center at average duration of symptoms of 13.2 days. Twenty-five (50%) cases had history of trauma, of which 16 had trauma while playing. Topical steroids, as risk factor was present in 12 (24%) cases. Six (12%) cases had history suggestive of herpetic keratitis as predisposing factor for microbial keratitis. Thirty-one cases underwent diagnostic corneal scraping. Seven cases showed bacterial growth and three cases fungal growth. Twenty percent of cases had infiltrate size > 25% of corneal surface. Eleven (22%) were with hypopyon. Two cases were perforated at presentation. In total, 37 (74%) of the ulcers healed after treatment, five (10%) underwent therapeutic keratoplasty and eight (16%) were lost to follow up. Out of those healed, 17 had vision of ≥ 6 / 18 and 7 had vision < 3 / 60.

Conclusions: Awareness is important for care-takers to avoid trauma in eyes of children. Paediatric microbial cases present late in the tertiary center in our context. Timely referral is important to prevent complications and to avoid need of keratoplasty.