Abstract
Purpose: :
To review the trends of Contact Lens-associated Microbial Keratitis (CL-MK) over a decade in a comprehensive eye health facility centre in Hyderabad, south India.
Methods: :
This is a retrospective study, where patients were identified with history of contact lens wear and having a corneal ulcer between September 2001 and November 2011 from the corneal ulcer database and medical record screening. Relevant clinical and microbiological variables were collected from medical records and laboratory database.
Results: :
Out of 20,903 lens wearers who attended the centre during this time, one hundred and twenty five cases (0.60%) were identified with CL-MK. The number of males and females were 63 (50.4%) and 62 (49.6%) each with a mean age of 24.14 (±6.7) years. 92% of the cases were using soft hydrogel lenses at the time of the event. Among them, 68 (55.3%) were replacing lenses at a frequency of < one year with a mean lens wearing hours of 13.3 (±5.1)/ day. 0.8 - 4.8% of the cases were identified between 2001 and 2003. However, this number was rapidly increased between 2004 (12%) and 2011 (17%). The median time to development of CL-MK for all the cases was 28 months, but this appeared to decrease to 19 months for those cases that occurred at or after 2004. 67% of the cases showed evidence of non-compliant behaviour, including 43.8% of people sleeping with daily wear CL and 46.4% being non-compliant with lens care and maintenance. When compared between duration of CL-MK healing groups 1 week and >2weeks,the mean visual acuity improvement was 0.4 log MAR units (p=0.003). Of the culture proven cases, Pseudomonas species were the predominant pathogen. Most of the bacterial isolates were susceptible to commonly used ocular antibiotics. Most patients were treated successfully with antibiotics but 8 cases (6.4%) required penetrating keratoplasty. After treatment, 77 (61.6%) cases were prescribed glasses, 23 (18.4%) were refitted with CLs, and 3 (2.4%) were treated by LASIK.
Conclusions: :
The rate of CL-MK increased gradually over the decade. Pseudomonas continued to be the predominant microbe isolated from events. Wearer compliance appeared to play a significant role in these cases. The treatment outcome with medical therapy was good in most cases.
Keywords: contact lens • microbial pathogenesis: clinical studies • clinical (human) or epidemiologic studies: outcomes/complications