Initial treatment of microbial keratitis.

PURPOSE: The common occurrence of failed medical treatment in microbial keratitis led us to investigate this phenomenon.

METHODS: We retrospectively reviewed all ulcers that presented to our department for 24 consecutive months. We classified each ulcer as either a therapeutic success or failure based on a precise definition of the response to initial antibiotic selection. We then analyzed multiple factors including: antibiotic selection, ophthalmic disease, ulcer characteristics, and management, to determine their significance in the success or failure in treating microbial keratitis. Complications were also examined.

RESULTS: Important factors in failure were non-fortified antibiotics (P < 0.001), ocular surface disease (P = 0.0178) and outpatient management (P < 0.001). Large ulcers (P = 0.051) were of borderline significance. Sensitivity results reflect high sensitivity among successfully treated patients when appropriate antibiotics are chosen.

CONCLUSIONS: This report provides insight into current practice patterns and potential means to improve success in managing microbial keratitis.