Objective: To provide data-based guidelines for selection of an appropriate initial therapy for management suppurative microbial keratitis (SMK) The spectrum of micro-organisms responsible for SMK varies somewhat with regard to the geographical locations according to climatic conditions, predisposing factors and demographic characteristics of the patients.2 8 In the developing countries, it is one of the leading causes of visual disability, with nonsurgical trauma being the most important predisposing factor. [9][10][11] In the developed countries, the incidence of SMK had increased during the last three decades with the widespread use of contact lenses.12-14 Corneal suppuration caused by fungi is a major public health problem in tropical regions, 15-17 while bacterial keratitis is the main cause of SMK in temperate regions. 18There is little information about SMK in Iraq as well as in the Middle East.The aim of this study is to define the profile and predisposing factors of SMK in Iraq and then to test in vitro isolated bacterial sensitivities toward commonly used topical antibiotics in order to provide data-based guidelines for selection an appropriate initial therapy for management of SMK in Iraq. PATIENTS AND METHODS SettingThis study was conducted in Ibn Al-Haetham Teaching Eye Hospital, Baghdad, which is the central teaching eye hospital in Iraq with about 25 specialised ophthalmologists working there.Patients from different parts of the country can directly attend this hospital; also, it acts as a secondary and tertiary referral centre. It contains 200 beds, and more than 600 outpatients are assessed each day. DesignThis is a case series study. Case definition and data collectionsCorneal suppuration was defined as stromal infiltrate and suppuration with signs of inflammation, frequently with concurrent overlying ulceration. Microbial keratitis may or may not be associated with suppuration. This study enrolled cases of suspected microbial keratitis with suppuration, while cases of suspected microbial keratitis without suppuration (eg, viral epithelial keratitis or mild bacterial keratitis) were not included, because these cases do not usually require laboratory investigations. Hypersensitivity keratitis (eg, marginal keratitis, or Mooren ulcer) was also not included in this study.Successive new patients attending the hospital from April 2002 to March 2005 were enrolled in this study if they had corneal suppuration presumed to be microbial. Each patient was asked about demographic features, duration of complaints, predisposing factors, therapy received prior to presentation, and associated systemic and ocular diseases. Visual acuity at presentation was recorded. Under slit-lamp visualisation, the investigating ophthalmologist examined each infected eye to document the size of the suppuration, size and depth of the concurrent ulceration, and anterior chamber reactions.Cases were graded as severe if the suppuration or ulceration involved half or more of the corneal diameter or if the ulceration involved the...

Purpose:To determine the etiologies of uveitis and the causes of visual loss in uveitis patients at a referral center in Baghdad, Iraq.Patients and Methods:A 4-year prospective study was performed at the uveitis clinic at Ibn Al-Haetham teaching eye hospital in Baghdad, Iraq. Referral cases of active uveitis were included. A complete ophthalmic examination was performed in all cases. If clinical picture did not indicate a specific etiology, patients were sent for a routine set of tests while ancillary tests were conducted when indicated.Results:Out of 318 patients included in this study, 236 patients (74.2%) had bilateral uveitis, and 212 patients (66.7%) had non-granulomatous uveitis. Posterior uveitis was recorded in 123 cases (38.7%) followed by panuveitis in 97 cases (30.5%), anterior uveitis in 78 cases (24.5%), and intermediate uveitis in 20 cases (6.3%). A diagnosis was established in 210 cases (66%) while etiology could not be determined in the remaining 108 cases (34%). Most common infectious causes were toxoplasmosis (13.8%) and presumed ocular tuberculosis (11.4%) while most common non-infectious causes were Vogt-Koyanagi-Harada disease (12.3%), Behηet's disease (8.2%), and pars planitis (5.7%). Out of 49 eyes with irreversible blindness, macular degenerations, or scars (46.9%) and optic nerve atrophy (34.7%) were the most important causes.Conclusion:At this referral center, toxoplasmosis and presumed ocular tuberculosis were the most common infectious causes of uveitis while Vogt-Koyanagi-Harada disease, Behηet's disease, and pars planitis were, in that order, the most common non-infectious causes. Macular degenerations or scars and optic nerve atrophy were the most important causes of irreversible blindness.

Purpose:To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq.Material and Method:Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization's definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment.Results:Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%).Conclusions:The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted.

In order to evaluate the efficiency of using Polymerase Chain Reaction (PCR) in the identifications of microorganisms causing microbial keratitis, 20 corneal scraping samples were collected from patients who attended the Eye Casualty Unit at the Southampton General Hospital in the United Kingdom. Samples cultured on blood agar and chocolate agar incubated at 37 ͦ C for 24hrs and on sabrouad agar at 28 ͦ C for one week. PCR procedure was performed with the primer paired that targeted to the 16S rRNA for bacterial species and 18S rRNA gene for fungal species, in addition to the species specific primer for the most common microbial keratitis causatives microorganisms. Results in the regards showed that out of the 20 presumed cases of keratitis, PCR showed positivity in 75% of them, from these 55% were due to the fungal infection and 20% of the cases indicated that the keratitis belonged to bacterial infections: In comparison, only 25% of positivity was obtained by the cultural method. The species specific primer showed that half of the 20% bacterial infection cases were caused by S. aureus and the other 10% referred to S.epidermidis infection. While the candida albicans primer gave a positive result only in 72% of the original percentage (55%), the rest 28% may belong to the other fungal infection. Depending on the above results, it can be concluded that PCR not only proved to be an effective rapid method for the diagnosis of bacterial and fungal keratitis, but was also more accurate and sensitive method than the culture methods.

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