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2002 Ocular Microbiology and Immunology Group, Abstract 16

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Comparison of Clinico-Microbiological Features in Smear Positive and Smear Negative cases of Microbial Keratitis.
Savitri Sharma, Mukesh Taneja, Anjall Upponi, Prashant Garg, Usha Gopinathan, Nibaran Gangopadhyay, Rishitha Nutheti. LV Prasad Eye Institute, Hyderabad, lndia

Purpose: To compare culture results, clinical profile, and treatment outcome in two groups of suspected microbial keratitis patients, 1) corneal scraping smears positive, 2) corneal scraping smears negative; for bacteria, fungus, Acanthamoeba, or herpes simplex virus.

Methods: A prospective, non-randomized, comparative analsys (Fisher's exact test) of all patients seen with suspected microbial keratitis between 31st Dec 2001 and 1st March 2002 was done. All patients had undergone institutional protocol of slit lamp examination, corneal scrapings for microbiological evaluation, and standard treatment. The data was captured in the corneal ulcer database of the institute and analyzed.

Results: Out of 170 patients seen during this period 102(60%) were smear positive and 68(40%) were smear negative. Culture was sterile in significantly more number of patients with negative smears (57.3% vs 17.6%, p<0.05). There was no difference in frequency of isolation of gram positive and gram negative organisms in the two groups except Streptococcus pneumoniae (grown more in smear positive group), indicating over all low sensitivity of Gram stain. However, more fungi and Acanthamoeba were isolated in smear positive group, pointing that these are unlikely to be missed in smears. Smears were negative in significantly more number of patients with corneal infiltrate <25mm2 size (79.3% vs 49,0%, p<0.05). Although the severity of infection was more in smear positive cases the resolution of ulcer was also higher in this group indicating efficacy of specific treatment.

Conclusions: Initial smear examination results have significant influence on therapy and outcome of microbial keratitis.

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