Comprehensive clinical algorithm for the assessment of microbial keratitis reduces complications

A clinical algorithm for the assessment and treatment of microbial keratitis (MK) reduced vision-threatening complications, according to a study in the American Journal of Ophthalmology. These patients are often considered one of the most difficult groups to judge disease severity.

According to the study researchers, implementation of the algorithm also decreased unnecessary care.

In this retrospective cohort study, researchers analyzed the benefit of utilizing the “1, 2, 3 Rule” (when any 1 of 3 clinical parameters is met: ≥1+ anterior chamber cells, ≥2 mm infiltrate, or infiltrate ≤3 mm distance from the corneal center) for the initial management of MK to determine when to perform corneal cultures. When the criteria is met, fortified topical antibiotics are mandated after cultures are obtained.

The algorithm was found to provide the most benefit in patients with lesions satisfying only 1 criterion. Patients undergoing culture at presentation, fortified antibiotic prescriptions, and reduction in vision-threatening complications increased in these patients. Patients who were not cultured initially but later required culturing decreased

Reference

Ung L, Wang Y, Vangel M, et al. Validation of a comprehensive clinical algorithm for the assessment and treatment of microbial keratitis. Am J Ophthalmol. 2020;214:97-109.