Subjects and methods:
A series of 29 eyes of 29 patients with possible infectious corneal keratitis were treated in Wakayama Medical University Hospital between January 1st, 2016 and December 31st, 2018. The age of the patients ranged from 26 to 92 years (mean 68.0 ± 17.8). At the first visit, the corneal infection lesion was scraped from the epithelium to the substantially superficial layer, and the scraped matter was submitted to Gram staining and culture examination. Cases suspected of fungi and Acanthamoeba were examined directly with potassium hydroxide (KOH) treatment. For several days until drug sensitivity results were obtained, initial treatment was Antibiotic Wet Therapy (AWT) with ophthalmic eye ointment and transparent Tegaderm (3M) dressing. We retrospectively reviewed the culture results of corneal scrapings (detected bacteria and drug resistance) and the therapeutic outcome of AWT.
Nineteen eyes in which the causative bacteria were not identified and five eyes in which the causative bacteria (Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus (MSSA), Streptococcus, Corynebacterium.) were identified were successfully treated using AWT with ofloxacin ointment. methicillin-resistant Staphylococcus aureus (MRSA) was detected in 3 of 5 eyes in which AWT with ofloxacin was not successful, and filamentous fungi were detected in one eye. Two of the three eyes MRSA detected were healed by changing to vancomycin hydrochloride eye ointment, one of which was severely affected and was later enucleated. One eye with filamentous fungi was treated after changing to pimaricin eye ointment. A causative pathogen was not identified in the other eye, but because it was suspected to be fungal the ointment was changed to a pimaricin eye ointment, which led to healing.
AWT may be an option for initial treatment of corneal infections when the causative organism is unknown.