Skip to main content

Advertisement

Log in

Clinical review of corneal ulcers resulting in evisceration and enucleation in elderly population

  • Cornea
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To identify the associated factors and study the clinical and microbiological characteristics of corneal ulcers resulting in evisceration and enucleation in elderly patients in a tertiary care hospital.

Methods

A review of all patients who required evisceration or enucleation due to microbial keratitis at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between July 1998 and November 2007 was performed. Of these, patients more than 60 years of age were included in the study for analysis.

Results

Forty-seven patients with microbial keratitis were included in the study. The mean age of patients was 81 ± 9.39 years. Major ocular factors associated were glaucoma (49%), persistent corneal epithelial defect (38%) and use of corticosteroid eye drops (23%). Most common associated systemic factor was rheumatoid arthritis (36%). The indications for evisceration or enucleation were extensive non-healing microbial keratitis (22/47) and corneal perforation secondary to microbial keratitis (17/47). Pseudomonas aeruginosa was the most common pathogen, present in 15 patients, and more than 45% of the strains tested were resistant to chloramphenicol.

Conclusions

Corneal ulcers that result in the loss of eye in elderly population are frequently associated with glaucoma and persistent epithelial defects. The majority of these cases have non-healing microbial keratitis caused by Pseudomonas aeruginosa.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Green MD, Apel AJG, Naduvilath T, Stapleton FJ (2007) Clinical outcomes of keratitis. Clin Experiment Ophthalmol 35:421–426. doi:10.1111/j.1442-9071.2007.01511.x

    Article  PubMed  Google Scholar 

  2. Cruz CS, Cohen EJ, Rapuano CJ, Laibson PR (1998) Microbial keratitis resulting in loss of the eye. Ophthalmic Surg Lasers 29:803–807

    PubMed  CAS  Google Scholar 

  3. Morlet N, Daniell M (2003) Empirical fluoroquinolone therapy is sufficient initial treatment. Br J Ophthalmol 87:1169–1172. doi:10.1136/bjo.87.9.1169

    Article  PubMed  CAS  Google Scholar 

  4. McLeod SD, LaBree LD, Tayyanipur R et al (1995) The importance of initial management in the treatment of severe infectious corneal ulcers. Ophthalmology 102:1943–1948

    PubMed  CAS  Google Scholar 

  5. Constantinou M, Daniell M, Snibson GR et al (2007) Clinical efficacy of moxifloxacin in the treatment of bacterial keratitis: a randomized clinical trial. Ophthalmology 114:1622–1629. doi:10.1016/j.ophtha.2006.12.011

    Article  PubMed  Google Scholar 

  6. Das S, Constantinou M, Daniell M, Taylor H (2006) Moraxella keratitis: predisposing factors and clinical review of 95 cases. Br J Ophthalmol 90:1236–1238. doi:10.1136/bjo.2006.095182

    Article  PubMed  CAS  Google Scholar 

  7. van der Meulen IJ, van Rooij J, Nieuwendaal CP, Van Cleijnenbreugel H, Geerards AJ, Remeijer L (2008) Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers. Cornea 27:539–544. doi:10.1097/ICO.0b013e318165b200

    Article  PubMed  Google Scholar 

  8. Parmar P, Salman A, Kalavathy CM, Kaliamurthy J, Thomas PA, Jesudasan CA (2006) Microbial keratitis at extremes of age. Cornea 25:153–158. doi:10.1097/01.ico.0000167881.78513.d9

    Article  PubMed  Google Scholar 

  9. Ormerod LD (1989) Causes and management of bacterial keratitis in the elderly. Can J Ophthalmol 24:112–116

    PubMed  CAS  Google Scholar 

  10. Butler TK, Spencer NA, Chan CC, Singh Gilhotra J, McClellan K (2005) Infectious keratitis in older patients: a 4-year review, 1998–2002. Br J Ophthalmol 89:591–596. doi:10.1136/bjo.2004.049072

    Article  PubMed  CAS  Google Scholar 

  11. Kunimoto DY, Sharma S, Garg P, Gopinathan U, Miller D, Rao GN (2000) Corneal ulceration in the elderly in Hyderabad, south India. Br J Ophthalmol 84:54–59. doi:10.1136/bjo.84.1.54

    Article  PubMed  CAS  Google Scholar 

  12. Bourcier T, Thomas F, Borderie V et al (2003) Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 87:834–838. doi:10.1136/bjo.87.7.834

    Article  PubMed  CAS  Google Scholar 

  13. Miedziak AI, Miller MR, Rapuano CJ et al (1999) Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology 106:1166–1170. doi:10.1016/S0161-6420(99)90250-6

    Article  PubMed  CAS  Google Scholar 

  14. Coster DJ, Badenoch PR (1987) Host, microbial, and pharmacological factors affecting the outcome of suppurative keratitis. Br J Ophthalmol 71:96–101. doi:10.1136/bjo.71.2.96

    Article  PubMed  CAS  Google Scholar 

  15. Hooi SH, Hooi ST (2005) Culture-proven bacterial keratitis in a Malaysian general hospital. Med J Malaysia 60:614–623

    PubMed  CAS  Google Scholar 

  16. Morlet N, Minassian D, Butcher J (1999) Risk factors for treatment outcome of suspected microbial keratitis. Ofloxacin Study Group. Br J Ophthalmol 83:1027–1031. doi:10.1136/bjo.83.9.1027

    Article  PubMed  CAS  Google Scholar 

  17. Musch DC, Sugar A, Meyer RF (1983) Demographic and predisposing factors in corneal ulceration. Arch Ophthalmol 101:1545–1548

    PubMed  CAS  Google Scholar 

  18. Keay L, Edwards K, Naduvilath T et al (2006) Microbial keratitis predisposing factors and morbidity. Ophthalmology 113:109–116. doi:10.1016/j.ophtha.2005.08.013

    Article  PubMed  Google Scholar 

  19. Gudmundsson OG, Ormerod LD, Kenyon KR et al (1989) Factors influencing predilection and outcome in bacterial keratitis. Cornea 8:115–121. doi:10.1097/00003226-198906000-00007

    Article  PubMed  CAS  Google Scholar 

  20. Titiyal JS, Negi S, Anand A et al (2006) Risk factors for perforation in microbial corneal ulcers in north India. Br J Ophthalmol 90:686–689. doi:10.1136/bjo.2005.079533

    Article  PubMed  CAS  Google Scholar 

  21. Saleh GM, Kazakos DC, Patel J, Gormley P (2004) An unusual case of corneal perforation with crystalline lens extrusion secondary to pseudomonas keratitis in the presence of rheumatoid arthritis. Eye 18:437–439. doi:10.1038/sj.eye.6700683

    Article  PubMed  CAS  Google Scholar 

  22. van der Meulen IJ, van Rooij J, Nieuwendaal CP, Van Cleijnenbreugel H, Geerards AJ, Remeijer L (2008) Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers. Cornea 27:539–544. doi:10.1097/ICO.0b013e318165b200

    Article  PubMed  Google Scholar 

  23. Squirrell DM, Winfield J, Amos RS (1999) Peripheral ulcerative keratitis 'corneal melt' and rheumatoid arthritis: a case series. Rheumatology 38:1245–1248. doi:10.1093/rheumatology/38.12.1245

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rasik B. Vajpayee.

Additional information

Competing interests

None

Funding

None

Rights and permissions

Reprints and permissions

About this article

Cite this article

Constantinou, M., Jhanji, V., Tao, L.W. et al. Clinical review of corneal ulcers resulting in evisceration and enucleation in elderly population. Graefes Arch Clin Exp Ophthalmol 247, 1389–1393 (2009). https://doi.org/10.1007/s00417-009-1111-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-009-1111-9

Keywords

Navigation