Corneal ulcers and the use of topical fluoroquinolones

Purpose: To determine whether the widespread use of topical fluoroquinolones has changed the spectrum of ulcerative keratitis, and to determine how it has affected practice patterns in the treatment of corneal ulcers. Methods: We retrospectively reviewed the charts of 48 consecutive patients with infectious corneal ulcers from 7/1/91 to 12/31/91 and 47 consecutive patients from 7/1/94 to 12/31/94. Patients were treated with intensive topical antibiotics (either standard fortified antibiotics or topical fluoroquinolones) at a frequency of at least every hour while awake. Some patients were admitted to the hospital, and some underwent scraping for smears and cultures. Results: Ulcers which were seen in 1994 appear to have been more severe than those seen in 1991 as judged by the presence of more ulcers associated with hypopyons, (P<0.05) but not with regard to the size of the infiltrate or epithelial defect. More ulcers in 1994 were treated on an outpatient basis (P<0.02) and fewer ulcers were scraped and cultured than in 1991 (P<0.001). Culture results from the 1991 and 1994 groups were similar. The most frequently isolated organisms were coagulase-negative Staphylococus, Pseudomonas, Staphylococus aureus, and Streptococcus spp. Conclusion: The spectrum of ulcerative keratitis at a tertiary referral center may be showing a trend towards more severe ulcers, but the causative agents responsible for the infection are unchanged.