The Clinical Diagnoi of Microbial Keratiti Original Reearch Article

Purpoe To evaluate the ability of ophthalmologit to predict the laboratory reult of preumed microbial keratiti and to explore which finding may influence diagnotic prognotication. Deign Propective, cro-ectional tudy. Method Fifteen ophthalmologit completed tudy form at the initial preentation of patient with preumed microbial keratiti. After predicting the category of microbial recovery, clinician ubmitted corneal craping for maked laboratory proceing. The relative effect of ocular inflammatory ign on correct microbial diagnoi were explored with Poion regreion. Reult Clinical examiner correctly predicted the preence or abence of microbial recovery in 79 (76%) of 104 ulcerative keratiti cae and uccefully ditinguihed among bacterial, fungal, and amebic keratiti for 54 (73%) of 74 culture-poitive infection, although only 31 (42%) were ubcategorized properly. The poitive predictive value of clinical diagnoi wa 65% (95% confidence interval [CI], 43% to 84%) for 20 eye with Peudomona keratiti cae, 48% (95% CI, 32% to 63%) for 38 other bacterial keratiti, 45% (95% CI, 17% to 77%) for 13 fungal keratiti, and 89% (95% CI, 52% to 100%) for nine Acanthamoeba keratiti cae. The recognition of Peudomona keratiti ignificantly improved by the occurrence of a larger infiltrate (P = .02), and correctly predicting Acanthamoeba keratiti wa enhanced by oberving a ring infiltrate (P < .001). Antimicrobial ue before referral ignificantly attenuated clinical diagnoi (P = .03) and hampered microbial recovery (P = .004). Concluion Etablihed Peudomona keratiti and Acanthamoeba keratiti can be upected before laboratory confirmation, but overlapping inflammatory feature and recent empiric antimicrobial treatment limit etiologic recognition of mot microbial corneal infection.