The epidemiology, clinical manifestations, and treatment outcomes of infectious corneal ulcers hospitalized at Nakornping Hospital, Chiang Mai

Pongpawat Anujaree

Authors

Pongpawat Anujaree Department of Ophthalmology, Lampang Hospital

Keywords:

infectious keratitis, epidemiology, causative pathogen, treatment outcome, Chiang Mai

Abstract

Objective: To investigate the epidemiology, clinical manifestations, causative pathogens, and treatment outcomes of hospitalized patients with infectious corneal ulcers at Nakornping Hospital.

Methods: This retrospective descriptive study reviewed electronic medical records of patients with infectious corneal ulcers hospitalized at Nakornping Hospital between October 1, 2018, and September 30, 2023. A total of 184 patients were included. Data were analyzed using descriptive statistics, and factors associated with poor treatment outcomes were evaluated using logistic regression analysis.

Results: Most patients were male (72.8%) with a mean age of 48.6 ± 19.0 years. The causes of corneal ulcers were ocular trauma 114 cases (62.0%), contact lens use 12 cases (6.5%) and unknown 48 cases (26.0%). Final diagnoses revealed bacterial and fungal infections in 49.5% and 25.5% of cases, respectively. Ulcers were located paracentrally in 46.2% and centrally in 44.6% of cases. Most ulcers were medium-sized (52.7%), followed by large ulcers (19.0%). Hypopyon was present in 41.8% of cases. Overall, 75% of patients showed clinical improvement, while 19.6% were referred for specialized care. Surgical intervention was required in 5.4% of patients. Poor clinical outcomes were observed in 46 cases (25.0%). Ulcer size greater than 6 mm (aOR 0.24, 95% CI 0.095–0.620, p = 0.003) and presence of hypopyon (aOR 4.30, 95% CI 1.853–9.986, p = 0.001) were significantly associated with poor treatment outcomes. The prediction model demonstrated acceptable discrimination with an ROC curve of 0.768. At the final follow-up, 10.8% of patients had visual acuity at hand movement or worse.

Conclusion: Infectious corneal ulcers are complex conditions that may cause vision loss despite treatment. Larger ulcer size and hypopyon were significant predictors of poor outcomes. Strengthening prevention, early diagnosis, standardized treatment, and healthcare workforce development is essential to improve corneal care.

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