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Thomas P. Kislan; Case Characteristics of Persons Presenting With Contact Lens-associated Infiltrative Keratitis (CLAIK) With Multipurpose Solutions and Contact Lens Combinations. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6521.
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To further describe common case characteristics and their association with severity in persons presenting with CLAIK who use multipurpose solutions (MPS) and contact lenses (CL) seen consecutively over 22 months.
Chart review of consecutive CL patients who presented for an urgent care visit with CLAIK, hyperemia, and decreased VA from Jan 2009 to Nov 2010. Lens type, MPS use, wear type, smoking status, number and location of corneal infiltrates, conjunctival injection, photophobia, and treatment regimen were documented. Patients presented with solution bottle for confirmation. The association of factors with overall incidence, symptoms, and severity was assessed. The most severe events were defined as those presenting with pain, photophobia, >2 injection, and more infiltrates than the overall mean.
Over 22 months, there were 86 cases. Infiltrates were central (95.3%), numerous (mean 8.1), and most commonly +2 injected (mean 2.4). All but one case used silicone hydrogel lenses and 97.6% as daily wear. Of the most commonly used lenses, 61.6% wore senofilcon A (SA; Acuvue Oasys, Vistakon), 15.1% wore balafilcon A (PureVision, B+L), and 12.8% wore lotrafilcon A (Night&Day, CIBA). Alcon’s Opti-Free RepleniSH (OFR=70.9%) was the most commonly used, followed by renu fresh (16.3%). Overall, 60.5% of cases were using both OFR and SA lenses. Factors associated with the most severe events were use of OFR (100%; p=0.001), SA lenses (87.5%; p=0.005), OFR/SA combined (87.5%; p=0.003), and bilateral presentation (79.2%; p<0.001). Smoking, younger age, and female sex were not associated with increased severity. All cases fully resolved with corticosteroids and/or artificial tears.
Use of certain MPS and silicone hydrogel lenses, especially combined, may be associated with both increased incidence and severity of CLAIK. The high number of cases using OFR and SA cannot be explained by market share alone (OFR <35%, All Vistakon <45% estimated 2010 market share). The incidence and severity of cases of CLAIK based on these observations should be considered in selecting MPS and lens material combinations.
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