Ten-Year Review of Pediatric Microbial Keratitis and Applicability of the 1-2-3- Rule

Purpose: To describe the current spectrum of bacterial etiologies, clinical features, medical management and visual outcomes of pediatric community-acquired bacterial keratitis and to evaluate the usefulness of the 1-2-3-Rule in predicting vision loss. Methods: A retrospective review was performed of consecutive cases of pediatric keratitis treated at a single institution over a 10-year period. The 1-2-3-Rule was applied retrospectively and analyzed to determine its accuracy in predicting vision loss. Results: Seventy-seven cases were identified. Pseudomonas was the most common organism identified followed by coagulase-negative staphylococcus and staphylococcus aureus. Only one case of staphylococcus aureus keratitis was methicillin resistant. Most (n=66) of the 74 verbal patients regained 20/30 or better visual acuity and 5 had final visual acuity of 20/100 or worse. The 1-2-3-Rule yielded high sensitivity and negative predictive values in our pediatric patients. Conclusions: Methicillin-resistant staphylococcus aureus (MRSA) is an infrequent pathogen in cases of pediatric community-acquired bacterial keratitis. Pseudomonas continues to be a common etiology. Most pediatric patients retain good visual acuity with treatment. When applied at a patient’s initial evaluation, the 1-2-3-Rule test may be helpful in predicting which pediatric patients will retain good visual acuity following treatment.