Overview
Bacterial keratitis (BK) is a severe, potentially vision-threatening infection of the cornea, often requiring prompt diagnosis and treatment to prevent complications like corneal melting or perforation 1.Diagnosis
Clinical Presentation: Redness, pain, photophobia, and decreased vision 1.
Diagnostic Imaging: External eye photographs can aid in rapid screening using deep learning algorithms, with EfficientNet B3 showing high diagnostic accuracy 1.
Corneal Scraping: Essential for microbiological diagnosis; caution with preservative-free topical anesthetics to avoid false-negative cultures 3.
Microbiological Testing: Gram staining and culture to identify pathogens and their antibiotic sensitivities 2.Management
First-Line Antibiotics: Gram-positive coverage with vancomycin (no resistance noted) and fluoroquinolones like moxifloxacin or ciprofloxacin (low resistance rates) 2.
Gram-Negative Coverage: For Pseudomonas aeruginosa, consider aminoglycosides or ceftazidime 2.
Adjunctive Treatments: Topical corticosteroids may be used cautiously after infection control is established, guided by clinical response 2.
Monitoring: Regular follow-up to assess clinical improvement and adjust therapy based on culture and sensitivity results 2.Special Populations
No Specific Guidelines Provided: Abstracts do not cover unique management considerations for pregnancy, pediatrics, elderly, or specific comorbidities 123.Key Recommendations
Utilize deep learning algorithms, particularly EfficientNet B3, for rapid screening of bacterial keratitis via external eye photographs to expedite diagnosis 1 (Evidence: Moderate).
Initiate empirical antibiotic therapy targeting common pathogens; vancomycin for gram-positives and moxifloxacin or ciprofloxacin for broad coverage 2 (Evidence: Strong).
Exercise caution with preservative-free topical anesthetics during corneal scraping to prevent false-negative cultures 3 (Evidence: Weak).References
1 Kuo MT, Hsu BW, Lin YS, Fang PC, Yu HJ, Chen A et al.. Comparisons of deep learning algorithms for diagnosing bacterial keratitis via external eye photographs. Scientific reports 2021. link
2 Al-Dhaheri HS, Al-Tamimi MD, Khandekar RB, Khan M, Stone DU. Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye Specialist Hospital, 2011 to 2014. Cornea 2016. link
3 Pelosini L, Treffene S, Hollick EJ. Antibacterial activity of preservative-free topical anesthetic drops in current use in ophthalmology departments. Cornea 2009. link