From pathogen to prognosis: microbial keratitis spectrum and treatment outcomes in a 5-Year tertiary center experience.

BACKGROUND: Microbial keratitis is a vision-threatening corneal infection frequently encountered in tertiary eye care settings. Early identification of risk factors and prompt empirical treatment are essential for preventing permanent visual impairment and maintaining anatomical integrity. This study aimed to define the clinical and microbiological profiles of microbial keratitis and to evaluate empirical treatment responses and surgical outcomes. METHODS: This was a descriptive, retrospective study conducted through a review of clinical records over a five-year period (2020-2025). A total of 73 patients diagnosed with microbial keratitis at a tertiary eye care center were included. Data on demographic characteristics, predisposing risk factors, clinical presentation, microbiological culture results, and treatment modalities were collected. The patients' responses to empirical medical therapy and the need for surgical interventions, including penetrating keratoplasty, pars plana vitrectomy and evisceration were evaluated. RESULTS: Positive microbial cultures were obtained in 58.9% of the cases. Among these, Staphylococcus spp. was the most commonly isolated organism (36.9%), followed by Streptococcus spp. (21.7%), Klebsiella spp. (11.0%), Pseudomonas aeruginosa (9.0%) and fungal pathogens (4.3%). Trauma was identified as the most frequent predisposing risk factor across all age groups. Clinical improvement was observed in 65.8% of patients following topical empirical therapy. Surgical intervention was required in 25 patients due to clinical deterioration, including penetrating keratoplasty, re-keratoplasty, pars plana vitrectomy and evisceration. Endophthalmitis developed in 7 patients (9.5%) with causative organisms including Staphylococcus (44.4%), Streptococcus (33.3%), Klebsiella (11.1%) and Pseudomonas aeruginosa (11.1%). The anatomical success rate following treatment was 85.7%. CONCLUSIONS: Initiation of empirical therapy targeting regionally prevalent pathogens may may contribute to better visual outcomes in selected cases. In cases unresponsive to medical management, early intervention with penetrating keratoplasty prior to limbal involvement or corneal perforation may improve prognosis and reduce the incidence of severe complications such as endophthalmitis.