Purpose: To review the clinical course, treatment, and visual outcomes of keratitis caused by the gram negative rod Capnocytophaga. Design: Retrospective, noncomparative case series. Participants: Ten patients with culture-proven unilateral Capnocytophaga keratitis examined at the Bascom Palmer Eye Institute between January 1, 1989, and December 31, 1998. Intervention: All patients underwent standard diagnostic microbiologic evaluation, and topical antimicrobial therapy was instituted. A penetrating keratoplasty or enucleation was performed in some patients. Main Outcome Measures: The changes in visual acuity and clinical response to antimicrobial therapy. Results: Predisposing factors were present in all patients. Cultures identified Capnocytophaga species at a mean of 7.5 days. Initial topical treatment consisted of an aminoglycoside and vancomycin in four patients, a quinolone or aminoglycoside alone in two patients each, and ofloxacin with vancomycin or tobramycin with ceftazidime in one patient each. After the microbiologic identification of Capnocytophaga, treatment in four patients was changed to intensive, topical clindamycin. Five of the 10 eyes were medically cured (3 of these eyes underwent penetrating keratoplasty for corneal scarring), and 5 eyes required enucleation. The indications for enucleation included persistent infection with development of endophthalmitis or blind, painful eye. Five of the 10 eyes achieved 20/80 or better final visual acuity. Four of these five eyes were treated with topical clindamycin. Conclusions: Important factors in achieving a good visual outcome in Capnocytophaga keratitis include early microbiologic identification and intensive therapy with topical clindamycin. Capnocytophaga should be included in the differential diagnosis of bacterial keratitis in patients with suggestive predisposing factors or with protracted keratitis unresponsive to treatment. (C) 2000 by the American Academy of Ophthalmology.
ASJC Scopus subject areas