Better diagnosis, treatment options key to nonresponsive bacterial keratitis
New treatment possibilities for nonresponsive bacterial keratitis are continually in development, including molecular-targeted therapy, the cautious use of topical corticosteroids, corneal crosslinking for superficial keratitis, and biologicals, Eduardo C. Alfonso, MD, reported.
Reviewed by Eduardo C. Alfonso, MD
Take-home: An accurate diagnosis can help lead to better treatment for nonresponsive bacterial keratitis.
Nonresponsive bacterial keratitis requires an accurate diagnosis so clinicians know how to treat it.
New treatment possibilities for nonresponsive bacterial keratitis are continually in development, including molecular-targeted therapy, the cautious use of topical corticosteroids, corneal crosslinking for superficial keratitis, and biologicals, Eduardo C. Alfonso, MD, reported.
Dr. Alfonso, the Kathleen and Stanley J. Glaser Chair in Ophthalmology; professor and chairman, Department of Ophthalmology; and director, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, shared statistics regarding the public health problem associated with bacterial keratitis.
“Information from the Centers for Disease Control shows that there are 1 million for keratitis and other contact lens-related problems,” Dr. Alfonso said. “(About) 60,000 are cared for in the emergency department. This is a significant resource burden that needs to be addressed.”
Analysis of problem
An analysis of nonresponsive bacterial keratitis at Bascom Palmer between 2011 to 2015 found that 75% of cases were bacterial; 43% were gram-negative; 31% were gram-positive; and 1% were mycobacteria. The remaining 25% were nonbacterial.
“The bacterial species isolated were Pseudomonas and Staphylococcus, with a wide variety of gram-positive and negative species,” Dr. Alfonso added.
When considering why bacterial keratitis may be nonresponsive, it is important to remember that in only 50% of cases, clinicians will identify an organism, Dr. Alfonso said.
“Consider that 80% will be treated empirically without any microbiologic studies,” he said. “It’s in this group where we’ll find most cases of poorly responsive presumed bacterial keratitis.”
The continuing discoveries in the microbiome reveal that there is more to learn about bacteria and other organisms that may be nonresponsive, he added.
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