¡¡¡¡The success rate of bacterial isolation was high in the present study, with 80% of smear positive on blood, chocolate and Macª²Conkey agar. While Waxman et al[11] reported 70% of isolation of organism on same medium. As with most published studies there was a high prevalence of Gram positive bacteria with staphylococcus aureus accounting for 75 (60%) of all 125 bacterial isolates. Our study match to the Hyderabad study. Stephen et al reported higher incidence of streptococcus pneumonia (20%) in his study. Jayahar et al[12] study also reported the same. While Maske et al reported high (27%) incidence of Staphylococcus epidermidis in their study. Thus etiology of the corneal ulcers varies significantly from region to region.

¡¡¡¡The standard treatment of bacterial corneal ulcer in majority 114 (73.1%) of our patients consists of topical instillation of fortified antibiotics (cefuraxime 50g/L and fortified tobramycin 9g/L). Which has been the "gold standard" for the therapy of bacterial corneal ulcer[6]. However the use of fortified antibiotics were associated with complain of ocular irritation or intense conjunctival reactions during drop instillation. This was due to the local corneal and conjunctival toxicity to the fortified drops. The same issue was raised by Cutarelli et al in 1991. We also treated 42 (26.9%) patients by fluoroquinolones (Moxifloxacin) antibiotics. The antibacterial action results from inhibition of topoisomerase II (DNA gyrase) and topoisomerase IV. This is a new fourth generation fluoroquinolone with a broad spectrum of activity against Gram positive(including methicillin resistant Staphª²ylococcus aureus and ciprofloxacin resistant Staphylococus aureus) and Gram negative microª²organisms. In addition, it penetrates well in the anterior chamber and remains fairly stable for at least 12 hours[13]. This treatment was advised to those patients who did not stay at hospital and had small infiltration.

¡¡¡¡Visual prognosis after bacterial corneal ulcer depends on the size, locality, and depth of the ulcers as well as on the risk factors, bacteria isolated, age and general health of patient. In our study poor out come seen in patients having chronic surface ocular disorder, large size of ulcers, involving more than 2/3 of depth of the cornea and poor visual acuity at presentation. Patient presented very late or previously treated by topical steroids has also poor end result in our study.
¡¡¡¡Only forty percent of patients had good visual out come with visual acuity better than the level at admission. Among the others 60% patient, final outcome was same or poor than time of presentation.

¡¡¡¡CONCLUSION

¡¡¡¡Bacterial corneal ulcer is a serious ocular infectious disease that remains a therapeutic challenge and vision threatening ocular condition. Rapid isolation of bacteria and treatment with intensive ocular antibiotics represent decisive steps in the management of such pathologies.

¡¾²Î¿¼ÎÄÏס¿
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¡¡¡¡6 Chaudhuri PR, Godfrey B. Treatment of bacterial corneal ulcers with concentrated antibiotics eye drops. Trans Ophthalmol Soc UK 1982;102(1): 11ª²14

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¡¡¡¡10 Poole TR, Hunter DL, Maliwa EM, Ramsay AR. Aetiology of microbial keratitis in northern Tanzania. Br J Ophthalmol 2002;86(8):941ª²942

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