Unmasking Infection In An Autoimmune Disease : Clinicomicrobiological Correlation Of Microbial Keratitis In Moorens Ulcer

To evaluate the incidence and microbiological profile of secondary microbial keratitis in 237 patients diagnosed with Moorens ulcer ( MU). 

Study period - August 2014 to August 2024 

Place of study - Tertiary eye care centre in southern India 

All patients diagnosed clinically with Moorens ulcer and later developed microbial keratitis were included in the study.All patients underwent detailed microbiological evaluation as per the institute protocol. All cases with organism seen on either smear, culture or both were included for final analysis

Data included patient demographics, risk factors, previous treatment, duration of symptoms, clinical details including the size of infiltration, presence of hypopyon, microbiology results, the coexistence of any other pathogen, and treatment details including medical and surgical management and outcome of treatment. Associated systemic immunosuppression for Moorens ulcer was also evaluated. Severe ulcers underwent surgical management. 

237 patients of MU were reviewed of which smear and/ or culture positive 25 cases were included for analysis.Mean age was 65.2+/-17.6 years.Unilateral involvement was seen in 84% cases(n=21).Mean visual acuity was 1.7+/-0.8 logMAR.Median duration of presentation was 15 days (IQR 7,30).Sclera was uninvolved in all eyes.Mean size of infiltrate was 5.04*4.06mm(V*H).Smear examination showed fungal filaments(n=6),no organisms(n=5), Gram positive cocci (n=3), Gram positive bacilli(n=4).Culture showed no growth(n=7),Streptococcus pneumoniae(n=3),Aspergillus flavus(n=3),Pythium insidiousum(n=1), mixed growth (n=9).Topical steroids were added in 60.7%cases. 6 patients underwent therapeutic keratoplasty. Mean time of resolution was 30 days IQR 20,60)

Key predictors of final visual acuity included increased initial visual acuity,Age,Size of infiltrate had worse outcome. Trauma as inciting agent and mild ulcers had better outcome.Key Pathogens Identified were Aspergillus flavus and terreus (Fungal);Streptococcus pneumoniae (Bacterial).Pythium was isolated in one case.Fungal infections generally took longer to resolve and were associated with deeper involvement, requiring more prolonged care.Addition of topical steroids did not have any statistically significant difference in outcome Surgical interventions like therapeutic keratoplasty indicated more severe disease but were not independent predictors of poor vision in this analysis.Inadequate data on systemic immunosuppression was seen.