Prognosis

Outcome in ophthalmology is generally measured in terms of final visual acuity, although cosmetic appearance, secondary eye problems such as glaucoma, and the need for surgery such as in penetrating keratoplasty are also important. A large study of microbial keratitis from Australia found that 22% of patients exhibited >2 Snellen lines of vision loss, and 2% lost ≥10 lines of vision.[58]

Bacterial keratitis

Patients with small or peripherally located medium-sized ulcers that receive treatment promptly have a good prognosis and generally retain excellent vision. Advanced or particularly aggressive ulcers, however, lead to severe scarring and complications. In a study from Singapore, 59% of all keratoplasties performed for infectious keratitis involved Pseudomonas aeruginosa.[59]

Fungal keratitis

Fungal keratitis can cause significant morbidity due to delayed diagnosis, fewer effective medications, and aggressive pathogens. A study from Florida (where ophthalmologists generally have a high degree of familiarity with fungal keratitis), found that final visual acuity was 20/40 or better in 70% of patients treated with medication alone and 16% of patients requiring keratoplasty. Surgical intervention in the acute phase was necessary in 23% of patients.[60]

Herpetic keratitis

Herpetic keratitis isolated to the epithelium tends to leave minimal visual sequelae and accounts for at least 66% or all herpetic keratitis, as reported in a study of herpes simplex virus (HSV) keratitis from France.[61] Stromal disease, on the other hand can result in severe scarring. A study from San Francisco showed that the share of corneal transplants where HSV keratitis is the indication is declining without a concomitant decline in HSV keratitis diagnoses, suggesting severe corneal scarring is becoming less frequent.[62]

Acanthamoeba keratitis

Acanthamoeba keratitis is notoriously difficult to diagnose and treat. A study from Wills Eye Hospital reported that patients who initially presented with less severe disease such as dendritiform or perineural keratitis retained better than 20/30 vision in 89% of cases. Patients with ring ulcers or stromal disease, however, had counting fingers final vision in 63% of cases.[63]

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