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LETTER TO THE EDITOR
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 90

Integrating ocular microbiology as part of cornea clinics in secondary center for better patient management


1 Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, New Delhi, India
2 Head Department of Ocular Microbiology, Molecular Biology and Histopathology Head Ocular Laboratory Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India

Date of Submission10-Aug-2020
Date of Decision21-Sep-2020
Date of Acceptance28-Jan-2021
Date of Web Publication31-Jul-2021

Correspondence Address:
Sanil Shivaji Sawant
Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Marg, Daryaganj, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_158_20

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How to cite this article:
Sawant SS, Gandhi A. Integrating ocular microbiology as part of cornea clinics in secondary center for better patient management. J Clin Ophthalmol Res 2021;9:90

How to cite this URL:
Sawant SS, Gandhi A. Integrating ocular microbiology as part of cornea clinics in secondary center for better patient management. J Clin Ophthalmol Res [serial online] 2021 [cited 2022 Jul 2];9:90. Available from: https://www.jcor.in/text.asp?2021/9/2/90/322788



Dear Editor,

Corneal blindness contributes to 7% of the blindness globally.[1] The major causes of corneal blindness include infective keratitis, ocular trauma, bullous keratopathy, corneal degenerations, and Vitamin A deficiency. It has been reported that nearly 90% of the global cases of ocular trauma and infective keratitis leading to corneal blindness occur in developing countries.[2] The prevalence of corneal blindness in rural population was 0.12%, and 0.45% of people were unilaterally blind due to corneal disease.[3] Being a developing country with a predominantly rural population, India faces a significant challenge in eliminating corneal blindness.

Our secondary centers in North India are seeing patients with various corneal diseases which include infectious keratitis,corneal scars,pterygium, pseudophakic bullous keratopathy, dry eyes,keratomalacia due to vitamin A deficiency ,ocular surface chemical burns and corneal tear due to trauma. Management of infectious keratitis includes performing corneal scrapings and then initiation of medical treatment based on the isolation of microorganisms in the smears. Keratitis due to fungal organisms is more common, especially in rural areas due to vegetative trauma to field workers in farm.

In a study by Sengupta et al.,[4] they reported that 57.4% of patients had culture-proven infectious keratitis due to fungus. We see many patients with infective keratitis both newly diagnosed and referral from local ophthalmologists. Many have history of vegetative trauma as most are farmers or field workers by occupation. At our center, we are routinely performing gram and 10% potassium hydroxide (KOH) staining. Fungal hyphae can be easily picked up on 10% KOH staining. In a study by Gopinathan et al.,[5] they found 10% KOH mount highly sensitive in identification of fungal filaments, and acanthamoeba.

KOH mount is a rapid method which is useful to diagnose and initiate immediate and timely treatment to patients. The cultures are transported with proper temperature-controlled ice boxes within 3–4 h to our tertiary centers where reporting is done. Hence, examination of smears is important as the results can be obtained immediately and timely treatment started, especially in secondary centers where no microbiological laboratory facilities are available for ocular samples in nearby areas which sometimes could be as far as hundreds of kilometers. We have telecommunication facilities where clinical photos including smear pictures from secondary centers are sent to the base hospital for any opinion which is useful for further management. Digital Ocular Microbiology is used.

Thus, establishing cornea practices with microbiology set up in secondary centers is helping to serve the community and bridging the gap between rural and urban health-care facilities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Prevention of Blindness and Visual Impairment. Priority Eye Diseases-Corneal Opacities. Available from: http://index9.html. [Last accessed on 2014 Jul 13].  Back to cited text no. 1
    
2.
Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ 2001;79:214-21.  Back to cited text no. 2
    
3.
Gupta N, Vashist P, Tandon R, Gupta SK, Dwivedi S, Mani K. Prevalence of corneal diseases in the rural Indian population: the Corneal Opacity Rural Epidemiological (CORE) study. Br J Ophthalmol 2015;99:147-52.  Back to cited text no. 3
    
4.
Sengupta S, Thiruvengadakrishnan K, Ravindran RD, Vaitilingam MC. Changing referral patterns of infectious corneal ulcers to a tertiary care facility in south India-7-year analysis. Ophthalmic Epidemiol 2012;19:297-301.  Back to cited text no. 4
    
5.
Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN. The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India. Cornea 2002;21:555-9.  Back to cited text no. 5
    




 

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