Outcomes of Pseudomonas aeruginosa Keratitis in Patients Using Extended Wear versus Standard Soft Contact Lenses

Abstract

Purpose : Pseudomonas aeruginosa is the most common cause of contact lens-related bacterial keratitis; overnight wear is the most important risk factor irrespective of lens type. Silicone hydrogel lenses with high oxygen permeability are FDA-approved for continuous overnight wear, typically for 1 week to 1 month. In this study, we compared outcomes of Pseudomonas aeruginosa keratitis (PAK) between patients wearing extended-wear (EW) versus standard soft contact lenses.

Methods : This retrospective cohort study includes 145 sequential cases of PAK in soft contact lens wearers (SCLW) at a single academic site from 1/2006 to 9/2019; 127 cases occurred in standard SCLW and 18 cases in EW SCLW. P values were calculated using unpaired 2-tailed Student’s t-test for continuous variables or chi-squared or Fisher’s exact test for binary variables.

Results : Mean age was 36.4 ± 18.1 years in standard SCLW and 56.8 ± 18.9 in EW SCLW (P<0.0001), and average time to presentation was 2.66 ± 2.55 days in standard SCLW and 4.22 ± 4.62 days in EW SCLW (P=0.033). Overnight wear of contact lenses was reported by 71 (55.9%) of standard SCLW and 17 (94.4%) of EW SCLW (P=0.0014). Corneal stromal thinning was present in 59 (46.5%) of standard SCLW and 10 (55.6%) of EW SCLW (P=0.47). Maximal stromal thinning was 18.4 ± 29.4% in standard SCLW and 29.4 ± 36.1% in EW SCLW (P=0.15), and a procedure (corneal glue, amniotic membrane, or penetrating keratoplasty) was required for progressive stromal thinning in 16 (12.6%) of standard SCLW and 3 (16.7%) of EW SCLW (P=0.71). The length of antibiotic treatment was 50.6 ± 67.2 days in standard SCLW and 78.3 ± 97.2 in EW SCLW (P=0.15). Final logMAR visual acuity was 0.75 ± 0.83 in standard SCLW and 0.83 ± 0.85 in EW SCLW (P=0.71).

Conclusions : Outcomes of PAK were similar between EW and standard SCLW. While not significantly different, a trend existed toward an increased rate of progressive stromal thinning and a longer course of antibiotic treatment in patients wearing EW contact lenses. Final visual acuity and need for a procedure for corneal stromal melting was similar between the two groups.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.