Microbial Keratitis in Stevens–Johnson Syndrome: A Prospective Study

Abstract

Purpose: To evaluate the microbiological profile and outcome in cases with infective keratitis in Stevens–Johnson syndrome (SJS). Methods: Eighty-three eyes of 68 patients with SJS presenting with microbial keratitis were recruited and managed with standard antimicrobial therapy. Results: Microbial keratitis developed in 34% of patients with SJS (83 eyes, 68 patients) over a period of 5 years. Four eyes (4.8%) had a history of concurrent topical steroid use at the onset of keratitis. Mean baseline best-corrected visual acuity was 1.8 ± 0.9 logMAR units. The site of corneal ulceration was central in 52 eyes (62.6%), paracentral in 17 eyes (20.5%), and peripheral in 14 eyes (16.8%). The mean ulcer area was 3.9 ± 2.7 mm2. Approximately 15 of 24 (62.5%) culture-positive eyes had bacterial infection, most of which (80%) were caused by Gram-positive bacteria. Polymicrobial infection was noted in 7 of 24 eyes (29.1%). Although 57 of 83 (68.6%) eyes healed with medical therapy, 26 of 83 (31.3%) eyes had corneal perforation and were managed with cyanoacrylate glue application (30.7%) or therapeutic keratoplasty (69.3%). Systemic infection as an inciting factor of SJS and an early presentation for keratitis were the major risk factors associated with corneal perforation. Large mean ulcer size, paracentral ulcers, and punctal involvement were associated with a good visual outcome. Conclusions: Infective keratitis in SJS is common, and unlike routine cases, surgical intervention is often required. However, the antibiotic sensitivity pattern suggests that resistance is not that high.

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

“…The most common bacteria isolated were Staphylococcus species (35% eyes). Sharma et al prospectively studied eyes with microbial keratitis and noted isolated bacterial infections in 63% eyes with polymicrobial infections in 29% eyes (19). Corneal perforation was noted in 31% eyes out of which 70% of eyes required a therapeutic penetrating keratoplasty, thus demonstrating a higher need for surgical interventions in these eyes.…”

Pathogens and Antibiotic Susceptibilities of Global Bacterial Keratitis: A Meta-Analysis

“…The following supporting information can be downloaded at: , Table S1: Positive rate of bacterial culture from corneal lesions in different regions, References [ 5 , 7 , 8 , 11 , 12 , 16 , 18 , 21 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ] are cited in the Supplementary Materials.…”

Matrix Metalloproteinase-9 and Topical Cyclosporine Are Associated with Conjunctival Microbiota Culture Positivity in Korean Patients with Stevens-Johnson Syndrome

“…How the ocular surface microbiome and ocular surface immunity interact is yet unknown, but studies have seen the importance of their balance and, therefore, given that SJS patients have generally abnormal ocular surfaces, they are prone to the imbalance that subsequently can induce commensal bacteria to become pathobionts and lead to possible opportunistic infections. [10,19,20,22,23] Previous studies reported that the conjunctival swab culture positivity of SJS patients was observed in 59 -95%. [8, 11, 18] Venugopal et al found that the most common isolate in SJS conjunctiva was Coagulasenegative Staphylococci followed by Corynebacterium species and that only 7.6% was observed to have multiple isolates.…”

“…[19] Likewise, a weakened and damaged ocular surface of SJS patients may be more prone to harbor pathobionts and allow opportunistic infections, which can also be aggravated by surgical interventions or medical therapy such as topical immunosuppressant or antibiotics. [19][20][21][22][23] Herein, we investigated the conjunctival microbiota of Korean SJS patients using conventional swab cultures, and identi ed factors associated with the conjunctival culture results.…”