Corneal biopsy in the management of progressive microbial keratitis.

Authors

Alexandrakis G, Haimovici R, Miller D, et al. 

Institution

Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.

Source

Am J Ophthalmol 2000 May; 129(5) :571-6.

Abstract

PURPOSE
To study the indications and role of diagnostic corneal biopsy in the management of patients with progressive microbial keratitis.
METHODS
The records of 33 consecutive patients who underwent a diagnostic corneal biopsy from January 1, 1986, to December 31, 1998, were reviewed. The indication for corneal biopsy was progressive infectious keratitis despite intensive broad-spectrum topical antimicrobial therapy, or progressive stromal infiltration inaccessible to corneal scrapings. Microbiologic evaluation of all corneal biopsies was performed, and 11 of the 33 biopsies were also examined histopathologically.
RESULTS
A microorganism was isolated from 27 (82%) of the 33 corneal biopsies. Of the six patients with a negative biopsy, a penetrating keratoplasty was performed in five patients and the pathogen was identified by examination of the corneal button. In one patient no microorganism was identified; however, the infection resolved with topical antimicrobial therapy. The most common risk factor for keratitis was foreign body exposure or corneal abrasion (14 patients). A solid stromal infiltrate was the most common pattern of corneal involvement. Corneal biopsy revealed previously unidentified microorganisms that led to a change in antimicrobial therapy in 24 (89%) of the 27 patients and confirmed prior culture results in the remaining 3 patients. Microbiologic evaluation of the corneal biopsy was more sensitive than histopathologic examination. Acanthamoeba was the most commonly isolated pathogen (five cases), followed by Propionibacterium acnes and Fusarium (four cases each). Gram-positive organisms were isolated in 16 patients. Only five of the 27 patients with a positive corneal biopsy required a penetrating keratoplasty, in contrast to five of the six patients with a negative corneal biopsy (P =.005). During the 13-year period of the study, only three corneal biopsies were performed in the last 6 years.
CONCLUSIONS
Microbiologic evaluation of a diagnostic corneal biopsy contributed significantly to the diagnosis, treatment, and outcome of patients with progressive infectious keratitis.

Mesh

Acanthamoeba
Adolescent
Adult
Aged
Aged, 80 and over
Animals
Anti-Bacterial Agents
Bacteria
Biopsy
Cornea
Disease Progression
Eye Foreign Bodies
Eye Infections
Female
Fungi
Humans
Keratitis
Keratoplasty, Penetrating
Male
Middle Aged

Language

eng

Pub Type(s)

Journal Article Research Support, Non-U.S. Gov't

PubMed ID

10844046