Neonatal infectious keratitis

Abstract

Purpose: The aim of this study was to determine predisposing factors, clinico-microbiological profile, and outcomes of neonatal infectious keratitis.

Methods: The retrospective study included 39 eyes of 34 neonates treated for microbial keratitis at the L. V. Prasad Eye Institute, India, between January 2006 and December 2011. Etiologic microorganisms, predisposing factors, and management outcomes were evaluated.

Results: The Mean age at presentation was 16.9 + 7.7 days, male:female = 16:18. The potential risk factors and coexisting conditions identified were prematurity and prolonged Neonatal Intensive Care Unit (NICU) care, route of delivery, maternal infections, systemic associations, and ocular malformations. Microbiology workup yielded positive results in 29 eyes. Ten eyes were smear and culture negative, with results of immunofluorescent assay and polymerase chain reaction for herpes simplex virus being negative. Bacteria were the commonest (23/39 eyes, 59%) cause of infections, and Pseudomonas aeruginosa was the commonest (12/23 eyes, 52%) bacterial isolate. Multidrug-resistant Pseudomonas keratitis was identified in 8/12 (67%) eyes. Keratitis resolved on medical treatment in 34 eyes. Two of these eyes with scars underwent penetrating keratoplasty later. Of the 8 eyes with multidrug-resistant P. aeruginosa keratitis, 3 eyes had near-total corneal infiltrates, 2 eyes developed anterior staphyloma, 1 eye autoeviscerated, and 1 eye required a therapeutic tectonic graft. One of the 2 eyes with fungal keratitis underwent therapeutic penetrating keratoplasty.

Conclusions: Identification of the appropriate predisposing factors, etiologic microbial organisms, and treatment outcome from this study may aid in early recognition and treatment of microbial keratitis in neonates.