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Jessica Lee, Xiaolin Zhang, Christine Marchetti, Ying Jiang, Yan Sun, Sara Debanne, Jessie Lemp, Beth Ann Benetz, Pearlman Eric, Loretta Szczotka-Flynn; In vivo confocal microstructural analysis of corneal epithelial cell changes related to daily wear use of silicone hydrogel contact lenses. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5459.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze clinical and in vivo microstructural corneal epithelial cell changes related to daily wear use of silicone hydrogel contact lenses.
In vivo confocal microscopy (Nidek ConfoScan 4; Nidek Technologies) of the central cornea was performed at the baseline and 5 month visits on 218 patients enrolled in the Daily Wear Corneal Infiltrative Event Study. All subjects wore daily wear lotrafilcon A lenses and were randomized to either a PHMB preserved multipurpose (MPS) or a peroxide based care solution. The morphological changes of the superficial epithelial cells (hyper-reflectivity) and basal cell density were analyzed by two masked experienced observers. Covariates of interest included solution use, corneal staining patterns, and substantial bioburden on lids, lenses and storage cases.
Epithelial Hyper-reflectivity: The use of the PHMB preserved MPS (compared to peroxide) was associated with a significantly greater number of hyper-reflective cells at 5 months (p=0.006) as well as > grade 2 corneal staining (MPS 46%, peroxide 10%, p<0.0001). Subjects that had solution induced corneal staining (SICS) in either eye were more likely to have at least 1 hyper-reflective cell in either eye (57% of SICS subjects had >=1 hyper-reflective cell vs. 29% non-SICS subjects). Substantial bioburden on lenses, lids, or cases did not show a statistical difference in the number of hyper-reflective cells as compared to subjects that had no such bioburden. (p>=0.07). Basal Cell density: In subjects that had substantial lens-associated bacterial bioburden there was decreased basal epithelial cell density from the baseline visit (p=0.03). Abnormal bacterial bioburden on lids and cases did not show a significant change in basal epithelial cell density (p>=0.09).
The PHMB-preserved solution tested increased epithelial cell hyper-reflectivity during daily wear of lotrafilcon A lenses; corneal staining is likely an intermediate step in this pathway. Substantial lens bioburden decreased basal cell density, suggesting that micro-organisms in contact with the corneal surface have an effect on corneal metabolism.
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