Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients

Abstract

To compare the risk for microbial keratitis in contact lens wearers stratified by wear schedule with the risk after laser in situ keratomileusis (LASIK). Hamilton Eye Institute and Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Comparative metaanalysis and literature review. An extensive literature search was performed in the PubMed database between December 2014 and July 2015. This was followed by a metaanalysis using a mixed-effects modeling approach. After 1year of daily soft contact lens wear, there were fewer microbialkeratitis cases than after LASIK, or approximately 2cases fewer cases per 10 000 (P=.0609). If LASIK were assumed to have essentially a 1-time risk for microbial keratitis, 5years of extrapolation would yield 11 more cases per 10 000 with daily soft contact lens wear than with LASIK, or approximately 3 times as many cases (P<.0001). The extended use of soft contact lenses led to 12 more cases at 1year than LASIK,or approximately 3 times as many cases (P<.0001), and 81 more cases at 5years (P<.0001). When incorporating an estimated 10% retreatment rate for LASIK, these results changed very little. Microbial keratitis is a relatively rare complication associated with contact lens use and LASIK postoperatively. The risk for microbial keratitis was similar between patients using contactlenses for 1year compared with LASIK. Over time, the risk for microbial keratitis was higher for contact lens use than for LASIK, specifically with extended-wear lenses.