The Impact of Etiological Agents on Clinical Course and Surgical Requirement in Infectious Keratitis: Experience from a Tertiary Referral Center

Objective: To evaluate the etiological distribution, clinical course, and factors associated with surgical requirements in patients with infectious keratitis.

Methods: This retrospective study included 119 eyes of 109 patients diagnosed with infectious keratitis at a tertiary referral center between 2023 and 2025. Demographic characteristics, etiological agents, presenting and final visual acuity, hospitalization duration, clinical outcomes, and complications were analyzed. Factors associated with advanced surgical intervention, defined as keratoplasty or evisceration/enucleation, were evaluated.

Results: Of the patients, 53 were female (48.6%) and 56 were male (51.4%). The mean age was 49.95 ± 22.61 years old. Viral keratitis was the most frequent etiological group (69.7% of cases). Medical cure was achieved in 86.6% of eyes, whereas advanced surgical intervention was required in 13.4% of eyes. The need for surgery was significantly higher in fungal keratitis, Acanthamoeba keratitis, and mixed infections (P .001). Poor presenting visual acuity and longer hospitalization were also significantly associated with advanced surgical interventions (P < .001). The etiological agent was identified in 88.2% of the eyes.

Conclusion: Most cases of infectious keratitis can be controlled with medical treatment alone. However, fungal keratitis, Acanthamoeba keratitis, and mixed infections are associated with a substantially higher risk of surgical intervention. Early etiological diagnosis and careful initial clinical assessment are essential for risk stratification and timely treatment.

Cite this article as: Gönen B, Demirtaş TD, Çalbay MA, Doğan C, Özdamar MA. The impact of etiological agents on clinical course and surgical requirement in infectious keratitis: experience from a tertiary referral center. Cerrahpaşa Med J. 2026, 50, 0080, doi: 10.5152/cjm.2026.26080.