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Clinical features and prognosis of mixed microbial keratitis

Poster Details

First Author: M.Yagmur TURKEY

Co Author(s):    I. Harbiyeli   E. Erdem   O. Oruz   B. Cam           

Abstract Details


To identify and compare predisposing factors, clinical presentations, treatment outcomes and prognosis in different groups of cases with mixed microbial keratitis


Retrospective case series in a tertiary university hospital in southern Turkey.


The medical records of 297 patients with microbial keratitis presented between October 2010 and January 2018 at the Ophthalmology Department of Cukurova University Medicine Faculty were retrospectively reviewed. The cases with mixed microbial keratitis were identified. These cases analyzed in 3 subgroups. The group 1 consisted of cases with mixed bacterial and fungal keratitis, group 2 consisted of cases with bacterial pathogens which co-infected with different microbial agents (herpes simplex virus and acanthamoeba), and group 3 consisted of cases with fungal pathogens which co-infected with different microbial agents (herpes simplex virus and acanthamoeba).


Twenty-three cases of mixed keratitis in 23 patients were identified. Mean age was 48 ± 20.8 years, average follow-up time was 11.1 ± 21.4 months. Ocular trauma was the most common risk factor (30 %). Eight cases (% 34) underwent various surgical interventions. A large ulcer size (size over 15 mm2) was significant risk factor for failure of initial treatment and poor visual prognosis (p: 0.014). Subgroups (1, 2, 3) consisted of 9, 10 and 4 patients, respectively. There was no significant difference in risk factors, treatment response, need for surgical treatment and visual prognosis between subgroups (p>0.05 for all).


Mixed microbial keratitis represents a significant cause of ocular morbidity. The rate of cases with mixed microbial keratitis in cases with microbial keratitis was 7.7 % in our study, thus mixed infections should be considered in differential diagnosis, especially in cases with atypical clinical course and initial treatment failure. Prognosis may be poor especially in cases who present with a large ulcer, therefore close follow-up and aggressive treatment are important in these cases.

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