The Importance of Initial Management in the Treatment of Severe Infectious Corneal Ulcers

Purpose: To identify factors that influence the outcome of patients with severe infectious corneal ulcers. Method: A retrospective review was performed of the hospital records of all such patients admitted to the Doheny Eye Hospital during a 30 month period. Outcome variables examined were change in visual acuity, duration of hospitalization, hospital charges, and percentage of patients who required penetrating keratoplasty. Results: Sixty-two ulcers were included. An organism was identified and antibiotic sensitivities established in 52 patients (84%). Inpatient therapy involved a combination of fortified aminoglycoside and cephalosporin antibiotics in 39 patients (63%) and was found to be appropriate on the basis of sensitivity studies in 49 (94%) of 52 patients. Inappropriate initial treatment was related to increased hospital charge (P= 0.024) as well as increased risk of penetrating keratoplasty (P= 0.001). Conclusions: Appropriate initial therapy is most critical in the course of serious corneal ulcers, and aggressive, broad-spectrum antibiotic coverage is advocated.