A Four-Year Review of the Epidemiology, Risk Factors, Treatment, and Outcomes for Corneal Ulcers at a Tertiary Referral Center in New Jersey
Ava Torjani1, Peter Wawrzusin2, Mina Mikhael2, Isabelle Nemeh2, Mohammad Dastjerdi2
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; 2Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey
Purpose: To summarize the demographics, risk factors, treatments, and outcomes associated with corneal ulcers at a tertiary referral center in New Jersey.
Methods: This was a retrospective chart review of electronic and paper chart medical records that included 142 eyes of 134 patients. A keyword search was conducted using the billing software for the hospital and outpatient center to identify patients with corneal ulcers from April 2014 to April 2019. Collected data included demographics, ulcer features (laterality, size, and location), date of initial encounter, culture results, antibiotic treatment, visual acuity before and after treatment, and any documented complications.
Results: The mean age of participants was 50.6 years old. Contact lenses were the most common cause of corneal ulcers (28.4%). The culture growth rate was 84.9%, of which the majority grew Coagulase-negative Staphylococcus species (25.8%) followed by Pseudomonas aeruginosa (21.5%) and Staphylococcus aureus (12.9%). Of cultures positive for Pseudomonas aeruginosa, 72.2% were contact lens wearers. While Pseudomonas aeruginosa isolates were found to be pan-sensitive, Staphylococcus aureus showed varying levels of resistance to penicillin, oxacillin, clindamycin, and gentamycin. 72.4% of patients were treated with fortified vancomycin and tobramycin, while 32.8% received steroid eye drops. The mean change in visual acuity before and after treatment was +0.29 logMAR. The most common complication was corneal scarring, affecting 25.4% of patients. 5.2% and 4.5% of patients required corneal transplant and corneal gluing, respectively.
Conclusions: Consistent with existing literature, contact lens use was the primary risk factor for corneal ulcer development at the tertiary referral center in New Jersey. Coagulase negative Staphylococcus and Pseudomonas aeruginosa are the most common etiologic organisms, with most patients requiring fortified antibiotic drops. Although the rate of complications such as corneal scarring was low, affected patients had significantly worse visual acuity and some even required surgery, highlighting the significant impact of corneal ulcers on vision and the importance of immediate and optimal management.