Corneal biopy in the management of progreive microbial keratiti

PURPOE: To tudy the indication and role of diagnotic corneal biopy in the management of patient with progreive microbial keratiti. METHOD: The record of 33 conecutive patient who underwent a diagnotic corneal biopy from January 1, 1986, to December 31, 1998, were reviewed. The indication for corneal biopy wa progreive infectiou keratiti depite intenive broad-pectrum topical antimicrobial therapy, or progreive tromal infiltration inacceible to corneal craping. Microbiologic evaluation of all corneal biopie wa performed, and 11 of the 33 biopie were alo examined hitopathologically. REULT: A microorganim wa iolated from 27 (82%) of the 33 corneal biopie. Of the ix patient with a negative biopy, a penetrating keratoplaty wa performed in five patient and the pathogen wa identified by examination of the corneal button. In one patient no microorganim wa identified; however, the infection reolved with topical antimicrobial therapy. The mot common rik factor for keratiti wa foreign body expoure or corneal abraion (14 patient). A olid tromal infiltrate wa the mot common pattern of corneal involvement. Corneal biopy revealed previouly unidentified microorganim that led to a change in antimicrobial therapy in 24 (89%) of the 27 patient and confirmed prior culture reult in the remaining 3 patient. Microbiologic evaluation of the corneal biopy wa more enitive than hitopathologic examination. Acanthamoeba wa the mot commonly iolated pathogen (five cae), followed by Propionibacterium acne and Fuarium (four cae each). Gram-poitive organim were iolated in 16 patient. Only five of the 27 patient with a poitive corneal biopy required a penetrating keratoplaty, in contrat to five of the ix patient with a negative corneal biopy (P = .005). During the 13-year period of the tudy, only three corneal biopie were performed in the lat 6 year. CONCLUION: Microbiologic evaluation of a diagnotic corneal biopy contributed ignificantly to the diagnoi, treatment, and outcome of patient with progreive infectiou keratiti.