Epidemiology of Microbial Keratitis in Uganda: A Cohort Study
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Ophthalmic Epidemiology
Abstract
To describe the epidemiology of Microbial Keratitis (MK) in Uganda.
Methods: We prospectively recruited patients presenting with MK at two main eye units in
Southern Uganda between December 2016 and March 2018. We collected information on
clinical history and presentation, microbiology and 3-month outcomes. Poor vision was
defined as vision < 6/60).
Results: 313 individuals were enrolled. Median age was 47 years (range 18–96) and 174 (56%)
were male. Median presentation time was 17 days from onset (IQR 8–32). Trauma was reported by
29% and use of Traditional Eye Medicine by 60%. Majority presented with severe infections
(median infiltrate size 5.2 mm); 47% were blind in the affected eye (vision < 3/60). Microbiology
was available from 270 cases: 62% were fungal, 7% mixed (bacterial and fungal), 7% bacterial and
24% no organism detected. At 3 months, 30% of the participants were blind in the affected eye,
while 9% had lost their eye from the infection. Delayed presentation (overall p = .007) and prior
use of Traditional Eye Medicine (aOR 1.58 [95% CI 1.04–2.42], p = .033) were responsible for poor
presentation. Predictors of poor vision at 3 months were: baseline vision (aOR 2.98 [95%CI
2.12–4.19], p < .0001), infiltrate size (aOR 1.19 [95%CI 1.03–1.36], p < .020) and perforation at
presentation (aOR 9.93 [95% CI 3.70–26.6], p < .0001).
Conclusion: The most important outcome predictor was the state of the eye at presentation,
facilitated by prior use of Traditional Eye Medicine and delayed presentation. In order to improve
outcomes, we need effective early interventions.
Description
Keywords
Microbial keratitis, Bacterial keratitis, Fungal keratitis, Keratitis, Blindness
Citation
Simon Arunga, Guyguy M. Kintoki, James Mwesigye, Bosco Ayebazibwe, John Onyango, Joel Bazira, Rob Newton, Stephen Gichuhi, Astrid Leck, David Macleod, Victor H. Hu & Matthew J. Burton (2020) Epidemiology of Microbial Keratitis in Uganda: A Cohort Study, Ophthalmic Epidemiology, 27:2, 121-131, DOI: 10.1080/09286586.2019.1700533