J Korean Ophthalmol Soc.  2013 Sep;54(9):1327-1338.

Analysis of Inpatients with Contact Lens Related Bacterial Keratitis: Causative Microorganisms, Clinical Aspects, and Prognostic Factors

• Cho CH
• Lee SB

Abstract

PURPOSE
To investigate causative microorganisms, clinical characteristics, and prognostic factors for inpatients with contact lens related bacterial keratitis.
METHODS
Seventy-three eyes of inpatients with contact lens related bacterial keratitis and hospitalized at Yeungnam University Hospital between January 1998 and December 2011 were reviewed retrospectively. Their bacteriological profiles and clinical characteristics were evaluated.
RESULTS
Females in their 20s (35/73 eyes, 47.9%) were the most common gender and age group. Thirty eyes (30/45 eyes, 66.7%) used daily-wear soft contact lenses. The most common predisposing factor was sleeping while wearing contact lenses (30 eyes, 41.1%). Positive culture rate was 53.4%. The ratio of gram-positive and -negative bacteria was 8.3%: 91.6%. The most commonly-isolated microorganisms were Pseudomonas spp. (39.6%), followed by Serratia spp. (29.2%). The characteristics of the corneal lesions were: a central lesion in 49 eyes (67.1%), a lesion less than 5 mm2 in size in 54 eyes (74.0%), and hypopyon in 8 eyes (11.0%). The mean log MAR BCVA improved from 0.93 +/- 0.88 on the initial visit to 0.25 +/- 0.48 on the final visit. Twelve eyes (16.4%) had a BCVA of 0.3 or less after remission medical treatment. A BCVA less than 0.1 on the initial visit was a significant risk factor for poor visual outcome (p = 0.005) after remission medical treatment.
CONCLUSIONS
BCVA less than 0.1 on the initial visit, epithelial defect sized over 5 mm2, epithelial healing time over 10 days, and central corneal lesion were associated with poor visual outcome after remission medical treatment in contact lens related bacterial keratitis.

Keyword

Bacterial isolates; Bacterial keratitis; Contact lens; Prognostic factor; Visual outcome

MeSH Terms

Bacteria
Contact Lenses
Contact Lenses, Hydrophilic
Eye
Female
Humans
Inpatients
Keratitis
Pseudomonas
Retrospective Studies
Risk Factors
Serratia

Reference

References

1. Liesegang TJ. Contact lens-related microbial keratitis: Part I: Epidemiology. Cornea. 1997; 16:125–31.

2. Liesegang TJ. Contact lens-related microbial keratitis: Part II: Pathophysiology. Cornea. 1997; 16:265–73.

3. Green M, Apel A, Stapleton F. Risk factors and causative organ-isms in microbial keratitis. Cornea. 2008; 27:22–7.

4. Alfonso E, Mandelbaum S, Fox MJ, Forster RK. Ulcerative kerati-tis associated with contact lens wear. Am J Ophthalmol. 1986; 101:429–33.

5. Erie JC, Nevitt MP, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol. 1993; 111:1665–71.

6. Stapleton F, Keay L, Edwards K. . The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008; 115:1655–62.

7. Tchah HW, Kim JC, Hahn TW, Hahn YH. Epidemiology of contat lens related infectious keratitis (1995.4~1997.9) : Multi-center study. J Korean Ophthalmol Soc. 1998; 39:1417–26.

8. Mukerji N, Vajpayee RB, Sharma N. Technique of area measure-ment of epithelial defects. Cornea. 2003; 22:549–51.

9. Hahn YH, Hahn TW, Choi SH. . Epidemiology of infectious keratitis[I] A multi-center study. J Korean Ophthalmol Soc. 1998; 39:1633–51.

10. Hahn YH, Hahn TW, Tchah HW. . Epidemiology of infectious keratitis(II): A multi-center study. J Korean Ophthalmol Soc. 2001; 42:247–65.

11. Stern GA. Contact lens associated bacterial keratitis: past, present, and future. CLAO J. 1998; 24:52–6.

12. Sharma S, Gopalakrishnan S, Aasuri MK. . Trends in contact lens-associated microbial keratitis in Southern India. Ophthalmology. 2003; 110:138–43.

13. Bharathi MJ, Ramakrishnan R, Meenakshi R. . Ulcerative ker-atitis associated with contact lens wear. Indian J Ophthalmol. 2007; 55:64–7.

14. Preechawat P, Ratananikom U, Lerdvitayasakul R, Kunavisarut S. Contact lens-related microbial keratitis. J Med Assoc Thai. 2007; 90:737–43.

15. Lim SH, Lee SB. Analysis of inpatients with bacterial keratitis over a 12-year period: Pathogenic organisms and antibiotic resistance. J Korean Ophthalmol Soc. 2012; 53:372–84.

16. Kim JY, Yoon KC, Park YG. . Age-related clinical analysis of infectious keratitis in two tertiary centers. J Korean Ophthalmol Soc. 2010; 51:927–34.

17. Moriyama AS, Hofling-Lima AL. Contact lens-associated micro-bial keratitis. Arq Bras Oftalmol. 2008; 71((6 Suppl)):32–6.

18. Dejaco-Ruhswurm I, Scholz U, Hanselmayer G, Skorpik C. Contact lens induced keratitis associated with contact lens wear. Acta Ophthalmol Scand. 2001; 79:479–83.

19. Inoue N, Toshida H, Mamada N. . Contact lens-induced in-fectious keratitis in Japan. Eye Contact Lens. 2007; 33:65–9.

20. Yu DK, Ng AS, Lau WW. . Recent pattern of contact lens-re-lated keratitis in Hong Kong. Eye Contact Lens. 2007; 33:284–7.

21. Reddy SC, Tajunisah I. Contact lens-related infectious keratitis in Malaysia. Ann Ophthalmol (Skokie). 2008; 40:39–44.

22. Bourcier T, Thomas F, Borderie V. . Bacterial keratitis: predis-posing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol. 2003; 87:834–8.

23. Kim YS, Lee SB, Chung WS. The causative organisms and therapy of corneal ulcers. J Korean Ophthalmol Soc. 1994; 35:1171–7.

24. Wang AG, Wu CC, Liu JH. Bacterial corneal ulcer: a multivariate study. Ophthalmologica. 1998; 212:126–32.

25. Toshida H, Kogure N, Inoue N, Murakami A. Trends in microbial keratitis in Japan. Eye Contact Lens. 2007; 33:70–3.

26. Keay L, Edwards K, Naduvilath T. . Microbial keratitis predis-posing factors and morbidity. Ophthalmology. 2006; 113:109–16.

27. Wilson LA, Sawant AD, Ahearn DG. Comparative efficacies of soft contact lens disinfectant solutions against microbial films in lens cases. Arch Ophthalmol. 1991; 109:1155–7.

28. Hahn YH, Lee SJ, Hahn TW. . Epidemiology of pseudomonas keratitis : A multi-center study. J Korean Ophthalmol Soc. 1999; 40:2411–22.

29. Ahn G, Hanh YH, Lee HB. Serratia marcescens keratitis. J Korean Ophthalmol Soc. 2002; 43:658–64.

30. Mayo MS, Schlitzer RL, Ward MA. . Association of pseudo-monas and serratia corneal ulcers with use of contaminated solutions. J Clin Microbiol. 1987; 25:1398–400.

31. Dart JK, Radford CF, Minassian D. . Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008; 115:–1647-54. –1654.e1-3.

32. Cheng KH, Leung SL, Hoekman HW. . Incidence of con-tact-lens-associated microbial keratitis and its related morbidity. Lancet. 1999; 354:181–5.

33. Schein OD, Buehler PO, Stamler JF. . The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis. Arch Ophthalmol. 1994; 112:186–90.

34. Matthews TD, Frazer DG, Minassian DC. . Risks of keratitis and patterns of use with disposable contact lenses. Arch Ophthalmol. 1992; 110:1559–62.

35. Poggio EC, Glynn RJ, Schein OD. . The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. N Engl J Med. 1989; 321:779–83.

36. Dart JK, Stapleton F, Minassian D. Contact lenses and other risk factors in microbial keratitis. Lancet. 1991; 338:650–3.

37. Stapleton F, Keay L, Jalbert I, Cole N. The epidemiology of contact lens related infiltrates. Optom Vis Sci. 2007; 84:257–72.

38. Fleiszig SM, Evans DJ. Pathogenesis of contact lens-associated microbial keratitis. Optom Vis Sci. 2010; 87:225–32.

39. Stapleton F, Edwards K, Keay L. . Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012; 119:1516–21.

40. Sung KR, Kim JY, Kim JC. . Change of conjunctival flora after disposable contact lens wear. J Korean Ophthalmol Soc. 1999; 40:3286–91.

41. Kim MK, Kim TJ, Park YK. . Contact Lens: Principles and Practice. The Korean Contact Lens Study Society. 2007; chap. 22..

42. Choi YK, Han TW, Tchah HW, Han YH. Microbial contamination of contact lens storage cases in contact lens-induced keratitis patients. J Korean Ophthalmol Soc. 1998; 39:2917–23.

43. Galentine PG, Cohen EJ, Laibson PR. . Corneal ulcers asso-ciated with contact lens wear. Arch Ophthalmol. 1984; 102:891–4.

44. Sun HJ, Lee JY, Kim SY, Jung MS. Clinical features of infectious keratitis in west coast area of Chungcheongnam-do, Korea. J Korean Ophthalmol Soc. 2010; 51:658–63.

45. Constantinou M, Daniell M, Snibson GR. . Clinical efficacy of moxifloxacin in the treatment of bacterial keratitis: a randomized clinical trial. Ophthalmology. 2007; 114:1622–9.

46. Mamalis N. The increasing problem of antibiotic resistance. J Cataract Refract Surg. 2007; 33:1831–2.

47. Agarwal T, Jhanji V, Satpathy G. . Moxifloxacin resistance: in-trinsic to antibiotic or related to mutation? Optom Vis Sci. 2012; 89:1721–4.

48. Holden BA, Mertz GW. Critical oxygen levels to avoid corneal edema for daily and extended wear contact lenses. Invest Ophthalmol Vis Sci. 1984; 25:1161–7.