A Study of Various Factors and Laboratory Investigations in Non-Healing Corneal Ulcer

Abstract

Introduction: Corneal ulcers are a major cause of visual morbidity, particularly in developing countries. While most ulcers heal with appropriate therapy, a subset becomes non-healing or refractory, posing significant diagnostic and therapeutic challenges. These ulcers are often associated with systemic comorbidities, microbial resistance, and impaired corneal healing mechanisms. This study was undertaken to evaluate the ocular and systemic factors contributing to nonhealing corneal ulcers and to assess the role of laboratory investigations in guiding effective management. Material and Methods: A prospective observational hospital-based study was conducted in the Department of Ophthalmology, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, over an 18-month period (May 2023–October 2024). Patients of all ages and genders presenting with nonhealing corneal ulcers were included after informed consent. Cases with endophthalmitis or complicated corneal ulcers, such as perforation and descemetocele, were excluded. Detailed clinical evaluation, microbiological investigations (corneal scraping, bacterial and fungal cultures, antibiotic sensitivity testing), and systemic assessments, including glycemic status, were performed. Statistical analysis was carried out using the Chi-square test, with p < 0.05 considered significant. Results: The mean age of patients with non-healing corneal ulcers was 42.5 ± 10.4 years, with a higher prevalence in the 41 to 60 year age group. Diabetes mellitus was the most significant systemic risk factor (56.3%, p <0.001), followed by steroid use (28.7%, p = 0.001) and ocular trauma (41.4%, p = 0.037). A history of previous corneal surgery was significantly associated with non-healing ulcers (p = 0.006). Microbiological analysis revealed fungal growth in 55.2% and bacterial growth in 43.7% of non-healing ulcers, both significantly higher compared to healing ulcers. Corneal sensation was absent or reduced in 81.6% of non-healing cases (p < 0.001), indicating neurotrophic involvement. Elevated or reduced intraocular pressure was also significantly more common in non-healing ulcers (p <0.001). Tobramycin demonstrated the highest antibiotic sensitivity, while resistance to ciprofloxacin was noted. Conclusion: Early identification of risk factors, comprehensive microbiological evaluation, strict metabolic control, and individualized targeted therapy are essential to improve healing outcomes and prevent vision-threatening complications.