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Indian J Ophthalmol. 2019 Oct;67(10):1593-1598. doi: 10.4103/ijo.IJO_1821_18.

Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty.

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Department of Cornea and Refractive Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Lions Aravind Institute of Community Ophthalmology, Madurai, Tamil Nadu, India.
Francis I. Proctor Foundation, University of California-San Francisco, San Francisco, CA, United States of America.



To understand demographic and socioeconomic barriers and treatment-seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty (TPK) in a developing country.


This prospective non-comparative questionnaire- based study included all patients presenting to Aravind Eye Hospital, Madurai with infectious keratitis that eventuated to TPK between November 2015 and October 2016. A structured questionnaire was administered on post-operative day 3 to collect data on the demographic details, predisposing factors, prior treatment received, and treatment expenditures.


In total, 227 patients underwent TPK between November 2015 and October 2016 for infectious keratitis. The majority of patients were males (n = 132, 58.1%), illiterate (n = 129, 56.8%), and had a family monthly income of less than INR 6000 (n = 142, 62.5%). Most of the patients (n = 163, 71.8%) had prior treatment with an ophthalmologist before presenting to our hospital. The mean distance travelled to reach our centre was 269.2 ± 298.5 km. The mean duration of disease before the presentation was 20.3 ± 21.1 days. Corneal smear was positive for fungus in 163 (88.1%) and Aspergillus was the most commonly isolated fungi in 55 (41.3%) cultures. The mean total cost of treatment was INR 8752.87 ± 7615.39 per patient. There was a positive correlation between the duration of the disease (rho 0.19, P = 0.0034) and the costs of treatment (rho 0.2, P = 0.0024) with the distance travelled by the patient.


Patients who travelled a farther distance had a delayed onset of presentation and spent significantly more than their respective counterparts.


Demographic profile; Infectious keratitis; socioeconomic profile; therapeutic penetrating keratoplasty

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