{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:01:22Z","timestamp":1793062882589,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"\n Purpose:<\/jats:title>\n To analyze the influence of infiltrate size, depth, and organism on the outcome of microbial keratitis.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective comparative study.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Medical records of patients with infective keratitis, who reported from January 2015 to December 2019 to a tertiary eye care center, were analyzed. Size and depth of ulcer at presentation were the factors used to group patients, and the influence on the outcome of the organism causing it was analyzed. Grouping was as follows: group A: ulcer size <6 mm\/anterior to midstromal infiltrate, group B: ulcer < 6 mm\/full-thickness infiltrate, group C: ulcer >6 mm\/anterior to midstromal infiltrate, group D: ulcer > 6 mm\/full-thickness infiltrate. Patients with viral keratitis or unidentified organism were excluded. Response to treatment and best-corrected visual acuity (BCVA) at the final follow-up were the outcome measures.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In the study, 1117\/6276 patients were included, with 60.8% patients in group A. A significant improvement in visual acuity was noted in groups A\/B compared to groups C\/D. Group A had the best response to medical management, irrespective of the organism. Higher risk for surgery was noted in group C compared to group B, with group A as the reference. Overall resolution with medical treatment was noted in 70% miscellaneous keratitis, 64.8% bacterial keratitis, 64.3% mixed keratitis, 62.5% acanthamoeba keratitis, 52.6% fungal keratitis, and 12.1%\n Pythium<\/jats:italic>\n keratitis. Bacteria and acanthamoeba responded better to medical management than fungal keratitis, whereas\n Pythium<\/jats:italic>\n had the highest risk for surgery.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n An interplay between virulence of the organism along with depth and size of the infiltrate determines the outcome of microbial keratitis.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_1022_23","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T01:05:39Z","timestamp":1703207139000},"page":"44-50","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Depth, size of infiltrate, and the microbe \u2013 The trio that prognosticates the outcome of infective keratitis"],"prefix":"10.4103","volume":"72","author":[{"given":"Shweta","family":"Agarwal","sequence":"first","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetha","family":"Iyer","sequence":"additional","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Pandey","sequence":"additional","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manokamna","family":"Agarwal","sequence":"additional","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richa","family":"Dhiman","sequence":"additional","affiliation":[{"name":"CJ Shah Cornea Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janani","family":"Surya","sequence":"additional","affiliation":[{"name":"Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Appakkudal R","family":"Anand","sequence":"additional","affiliation":[{"name":"L and T Microbiology Research Centre, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Sankara Nethralaya Cornea Emergency Team (SNCET)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"key":"R1-20260508","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1038\/s41433-020-01339-3","article-title":"Infectious keratitis: An update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance","volume":"35","author":"Ting","year":"2021","journal-title":"Eye"},{"key":"R2-20260508","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ajo.2018.07.040","article-title":"The Asia cornea society infectious keratitis study: A prospective multicenter study of infectious keratitis in Asia","volume":"195","author":"Khor","year":"2018","journal-title":"Am J Ophthalmol"},{"key":"R3-20260508","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/bjophthalmol-2017-310604","article-title":"Clinical profile of pythium keratitis: Perioperative measures to reduce risk of recurrence","volume":"102","author":"Agarwal","year":"2018","journal-title":"Br J Ophthalmol"},{"key":"R4-20260508","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1007\/s00417-020-04681-0","article-title":"Microbial keratitis in Sydney, Australia: Risk factors, patient outcomes, and seasonal variation","volume":"258","author":"Khoo","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R5-20260508","first-page":"S8","article-title":"Etiology and clinical outcomes of microbial keratitis at a tertiary eye-care centre in northern Thailand","volume":"95","author":"Tananuvat","year":"2012","journal-title":"J Med Assoc Thai"},{"key":"R6-20260508","doi-asserted-by":"crossref","first-page":"715118","DOI":"10.3389\/fmed.2021.715118","article-title":"Risk factors, clinical outcomes, and prognostic factors of bacterial keratitis: The Nottingham infectious keratitis study","volume":"8","author":"Ting","year":"2021","journal-title":"Front Med"},{"key":"R7-20260508","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1038\/eye.2012.99","article-title":"Predictors of outcome in fungal keratitis","volume":"26","author":"Prajna","year":"2012","journal-title":"Eye"},{"key":"R8-20260508","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jtos.2021.12.001","article-title":"Fungal keratitis: A review of clinical presentations, treatment strategies and outcomes","volume":"24","author":"Sharma","year":"2022","journal-title":"Ocul Surf"},{"key":"R9-20260508","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1136\/bjophthalmol-2017-310806","article-title":"Acanthamoeba keratitis in 194 patients: Risk factors for bad outcomes and severe inflammatory complications","volume":"102","author":"Carnt","year":"2018","journal-title":"Br J Ophthalmol"},{"key":"R10-20260508","doi-asserted-by":"crossref","first-page":"e0264021","DOI":"10.1371\/journal.pone.0264021","article-title":"Outcomes of amoebic, fungal, and bacterial keratitis: A retrospective cohort study","volume":"17","author":"Moe","year":"2022","journal-title":"PLoS One"},{"key":"R11-20260508","doi-asserted-by":"crossref","first-page":"273","DOI":"10.4103\/0301-4738.53051","article-title":"Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade","volume":"57","author":"Gopinathan","year":"2009","journal-title":"Indian J Ophthalmol"},{"key":"R12-20260508","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ajo.2003.09.001","article-title":"Clinical characteristics of microbial keratitis in a university hospital in Taiwan","volume":"137","author":"Fong","year":"2004","journal-title":"Am J Ophthalmol"},{"key":"R13-20260508","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1755-3768.2012.02489.x","article-title":"Profile of sight-threatening infectious keratitis: A prospective study","volume":"91","author":"Otri","year":"2013","journal-title":"Acta Ophthalmol"},{"key":"R14-20260508","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jinf.2021.05.016","article-title":"Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes","volume":"83","author":"Tananuvat","year":"2021","journal-title":"J Infect"},{"key":"R15-20260508","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.2147\/OPTH.S291880","article-title":"Medical history, clinical features, treatment outcome and its predictors among infectious keratitis patients in Jimma University Medical Center, Southwest Ethiopia: Prospective observational study","volume":"15","author":"Dago","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"R16-20260508","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1016\/j.ophtha.2008.04.038","article-title":"Prognostic factors affecting visual outcome in Acanthamoeba keratitis","volume":"115","author":"Tu","year":"2008","journal-title":"Ophthalmology"},{"key":"R17-20260508","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/ICO.0b013e3181ec905f","article-title":"Clinical outcomes and prognostic factors associated with acanthamoeba keratitis","volume":"30","author":"Chew","year":"2011","journal-title":"Cornea"},{"key":"R18-20260508","first-page":"541","article-title":"Experimental pseudomonas keratitis","volume":"79","author":"Hyndiuk","year":"1981","journal-title":"Trans Am Ophthalmol Soc"},{"key":"R19-20260508","doi-asserted-by":"crossref","first-page":"108647","DOI":"10.1016\/j.exer.2021.108647","article-title":"Foundational concepts in the biology of bacterial keratitis","volume":"209","author":"Ung","year":"2021","journal-title":"Exp Eye Res"},{"key":"R20-20260508","doi-asserted-by":"crossref","first-page":"14352","DOI":"10.1038\/srep14352","article-title":"L, Feil S.C, Morton CJ, Farrand AJ, Mulhern TD, Gorman M, et al. Crystal structure of Streptococcus pneumoniae pneumolysin provides key insights into early steps of pore formation","volume":"5","author":"Lawrence","year":"2015","journal-title":"Sci Rep"},{"key":"R21-20260508","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3389\/fcimb.2017.00193","article-title":"Persistence of innate immune pathways in late-stage human bacterial and fungal keratitis: Results from a comparative transcriptome analysis","volume":"7","author":"Chidambaram","year":"2017","journal-title":"Front Cell Infect Microbiol"},{"key":"R22-20260508","first-page":"3221","article-title":"Mechanism of basement membrane dissolution preceding corneal ulceration","volume":"32","author":"Matsubara","year":"1992","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R23-20260508","doi-asserted-by":"crossref","first-page":"8574","DOI":"10.1038\/ncomms9574","article-title":"The matrix protein Fibulin-5 is at the interface of tissue stiffness and inflammation in fibrosis","volume":"6","author":"Nakasaki","year":"2015","journal-title":"Nat Commun"},{"key":"R24-20260508","doi-asserted-by":"crossref","first-page":"108372","DOI":"10.1016\/j.exer.2020.108372","article-title":"The role of fungi in fungal keratitis","volume":"202","author":"Mills","year":"2021","journal-title":"Exp Eye Res"},{"key":"R25-20260508","doi-asserted-by":"crossref","first-page":"907","DOI":"10.3390\/jof7110907","article-title":"Recent perspectives in the management of fungal keratitis","volume":"7","author":"Raj","year":"2021","journal-title":"J Fungi"},{"key":"R26-20260508","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1097\/ICO.0b013e318199fa77","article-title":"Practice patterns in the management of fungal corneal ulcers","volume":"28","author":"Loh","year":"2009","journal-title":"Cornea"},{"key":"R27-20260508","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1080\/02681219180000631","article-title":"Invasion and survival of Fusarium solani in the dexamethasone-treated cornea of rabbits","volume":"29","author":"Kiryu","year":"1991","journal-title":"J Med Vet Mycol"},{"key":"R28-20260508","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S1542-0124(12)70071-X","article-title":"Pathogenesis of acanthamoeba keratitis","volume":"8","author":"Panjwani","year":"2010","journal-title":"Ocul Surf"},{"key":"R29-20260508","doi-asserted-by":"crossref","first-page":"323","DOI":"10.3390\/pathogens10030323","article-title":"Acanthamoeba keratitis, pathology, diagnosis and treatment","volume":"10","author":"Fanselow","year":"2021","journal-title":"Pathogens"},{"key":"R30-20260508","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1136\/bjo.86.5.536","article-title":"Acanthamoeba keratitis in England and Wales: Incidence, outcome, and risk factors","volume":"86","author":"Radford","year":"2002","journal-title":"Br J Ophthalmol"},{"key":"R31-20260508","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ophtha.2020.05.046","article-title":"Successful strategic management of pythium insidiosum keratitis with antibiotics","volume":"128","author":"Bagga","year":"2021","journal-title":"Ophthalmology"},{"key":"R32-20260508","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.4103\/ijo.IJO_1808_20","article-title":"Retrospective multifactorial analysis of Pythium keratitis and review of literature","volume":"69","author":"Gurnani","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R33-20260508","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.2147\/OPTH.S303721","article-title":"Clinical characteristics, histopathology, and treatment outcomes of pythium keratitis: A retrospective cohort study","volume":"15","author":"Puangsricharern","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"R34-20260508","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1136\/bjophthalmol-2017-311804","article-title":"Clinical profile, risk factors and outcome of medical, surgical and adjunct interventions in patients with Pythium insidiosum keratitis","volume":"103","author":"Agarwal","year":"2019","journal-title":"Br J Ophthalmol"},{"key":"R35-20260508","doi-asserted-by":"crossref","first-page":"ii9","DOI":"10.1093\/jac\/dkg249","article-title":"Linezolid in vitro: Mechanism and antibacterial spectrum","volume":"51","author":"Livermore","year":"2003","journal-title":"J Antimicrob Chemother"},{"key":"R36-20260508","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3390\/antibiotics5030029","article-title":"From erythromycin to azithromycin and new potential ribosome-binding antimicrobials","volume":"5","author":"Jeli\u0107","year":"2016","journal-title":"Antibiotics"},{"key":"R37-20260508","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.ajo.2015.07.028","article-title":"Comparison between polymicrobial and fungal keratitis: Clinical features, risk factors, and outcome","volume":"160","author":"Fernandes","year":"2015","journal-title":"Am J Ophthalmol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1022_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:22:20Z","timestamp":1787836940000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_1022_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,22]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_1022_23","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,22]]},"assertion":[{"value":"2023-04-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}