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    The Asia Cornea Society Infectious Keratitis Study: A Prospective Multicenter Study of Infectious Keratitis in Asia
    (2018-11-01) Wei Boon Khor; Venkatesh N. Prajna; Prashant Garg; Jodhbir S. Mehta; Lixin Xie; Zuguo Liu; Ma Dominga B. Padilla; Choun Ki Joo; Yoshitsugu Inoue; Panida Goseyarakwong; Fung Rong Hu; Kohji Nishida; Shigeru Kinoshita; Vilavun Puangsricharern; Ai Ling Tan; Roger Beuerman; Alvin Young; Namrata Sharma; Benjamin Haaland; Francis S. Mah; Elmer Y. Tu; Fiona J. Stapleton; Richard L. Abbott; Donald Tiang Hwee Tan; Duke-NUS Medical School Singapore; Dr. Rajendra Prasad Centre for Ophthalmic Sciences; National Taiwan University Hospital; University of the Philippines Manila; St. Luke's Medical Center Quezon City; Aravind Eye Care System; Kyoto Prefectural University of Medicine; University of New South Wales (UNSW) Australia; Chulalongkorn University; University of Illinois at Chicago; Yong Loo Lin School of Medicine; Prince of Wales Hospital Hong Kong; Singapore Eye Research Institute; University of California, San Francisco; L.V. Prasad Eye Institute India; Singapore General Hospital; Osaka University Faculty of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University; Tottori University; Singapore National Eye Centre; Scripps Clinic; The Catholic University of Korea; Xiemen Eye Center; SHANDONG EYE INSTITUTE
    © 2018 Elsevier Inc. Purpose: To survey the demographics, risk factors, microbiology, and outcomes for infectious keratitis in Asia. Design: Prospective, nonrandomized clinical study. Methods: Thirteen study centers and 30 sub-centers recruited consecutive subjects over 12-18 months, and performed standardized data collection. A microbiological protocol standardized the processing and reporting of all isolates. Treatment of the infectious keratitis was decided by the managing ophthalmologist. Subjects were observed for up to 6 months. Main outcome measures were final visual acuity and the need for surgery during infection. Results: A total of 6626 eyes of 6563 subjects were studied. The majority of subjects were male (n = 3992). Trauma (n = 2279, 34.7%) and contact lens wear (n = 704, 10.7%) were the commonest risk factors. Overall, bacterial keratitis was diagnosed in 2521 eyes (38.0%) and fungal keratitis in 2166 eyes (32.7%). Of the 2831 microorganisms isolated, the most common were Fusarium species (n = 518, 18.3%), Pseudomonas aeruginosa (n = 302, 10.7%), and Aspergillus flavus (n = 236, 8.3%). Cornea transplantation was performed in 628 eyes to manage ongoing infection, but 289 grafts (46%) had failed by the end of the study. Moderate visual impairment (Snellen vision less than 20/60) was documented in 3478 eyes (53.6%). Conclusion: Demographic and risk factors for infection vary by country, but infections occur predominantly in male subjects and are frequently related to trauma. Overall, a similar percentage of bacterial and fungal infections were diagnosed in this study. Visual recovery after infectious keratitis is guarded, and corneal transplantation for active infection is associated with a high failure rate.