Contact Lens-related Corneal Ulcers Research Articles

Good Outcome of Corneal Ulcer With Hypopion After Long Use of Contact Lens

Introduction: Microbial keratitis is a corneal infection caused by microorganisms and is characterized by a profound corneal epithelial defect that infects the cornea and causes severe and progressive visual loss. In recent years, the incidence of microbial keratitis has increased. One of the critical risk factors for increasing this incidence is using contact lenses. As the number of contact lens users increases, the number of corneal ulcers associated with contact lenses also increases. Case Presentation: A 25-year-old man was admitted to the emergency department with a complaint of gradually blurry vision in his left eye four days after using contact lenses for overnight uses since the previous few days and did not routinely clean contact lenses or replace contact lens cleaning fluid. The visual acuity of the patient's left eye was hand movement with conjunctival and pericorneal injection in the conjunctiva and 6 x 7 mm stromal level infiltrate, blurred margin, and whitish color in the center of the cornea. After 28 days of treatment, an examination showed the patient's left eye improvement. Visual acuity was 3/60, conjunctival injection disappeared, corneal swelling significantly resolved, hypopyon disappeared, and ulcer completely re-epithelialized. Conclusions: Empirical therapy with broad-spectrum antibiotics and other adjunctive therapy has a good outcome in treating contact lens-related corneal ulcers.

Paediatric infectious keratitis at tertiary referral centres in Vancouver, Canada

ObjectiveTo report the clinical and microbiological profiles of paediatric patients with infectious keratitis in Vancouver, Canada.DesignIn this observational case series, the microbiology results and medical records of 17 eyes with...

Abcès de cornée sur port de lentilles de contact : aspects cliniques, microbiologiques et thérapeutiques

Corneal ulcers in contact lens wearers are becoming more common, and can sometimes lead to severe complications. The purpose of this study is to define the epidemiological, clinical, microbiological and therapeutic considerations of these ulcers within the above context. We conducted an uncontrolled, descriptive, retrospective study of 51 patients presenting with contact lens related corneal ulcers to the ophthalmology department of the August 20, 1953 Hospital in Casablanca between January 2009 and January 2012. The average age of our patients was 22 years, with a gender ratio of 7.5 female to male. General risk factors (diabetes and tuberculosis) were found in 17.5% of cases. The average length of hospital stay was 15 days. Of our patients, 58.8% wore cosmetic contact lenses and 41.18% wore therapeutic contact lenses. Mean duration prior to consultation was 5 days. The predominant clinical signs were eye pain and redness, with a decrease in visual acuity worse than 1/10 in 82.3% of patients. In 70.6% of cases, the ulcer was central. The average size was 4.3mm. An anterior chamber reaction was found in 47.1%. Corneal bacterial cultures were positive in 47.8%. Pathogens found were Staphylococcus aureus, Pseudomonas aeruginosa and Acanthamœba. Contact lens and solution cultures were positive in 73.6% of cases. Outcomes were favorable with local and systemic antibiotic treatment adapted to microbiological results in only 41.2% of cases. In the remaining patients, significant secondary opacities persisted. Cosmetic and therapeutic contact lens wear is a major cause of corneal ulcer. Delayed consultation results in severe sequelae with persistently decreased visual acuity. The ophthalmologist plays an important role in preventing complications of contact lens wear, through better hygiene instruction and follow-up of his or her patients.

Incidence of Infectious Corneal Ulcers, Portsmouth Study, UK

Aim: To identify the incidence of infectious keratitis in a population based in southern England.Methods: A retrospective review between January 1997 and December 2003 and a prospective study between January and December 2006 were undertaken at the eye casualty department of Queen Alexandra Hospital (QAH), Portsmouth, UK to identify the incidence of infectious keratitis.Results: QAH is a tertiary teaching hospital that serves Portsmouth and the catchment area of the county of Hampshire with an average population of 489,391 in the 7 year period of the retrospective study and 499100 in the one year prospective study. Infectious keratitis occurred in 1,786 patients in the retrospective study with an average of 255 patients per year and in 201 patients in the one year prospective study. The annual incidence of infectious keratitis was 52.1 and 40.3 per 100,000 persons in the retrospective and prospective studies respectively. The rate of bacterial and viral ulcers was lower in the prospective study than the average of either ulcer type in the retrospective study. A significant trend over time was found in the retrospective study that was mainly made by bacterial rather than viral ulcers. The rate of viral ulcers showed initial steady increase between 1997 and 2000 followed by continuous decline over the next three years of the retrospective study and maintained in the prospective study.Conclusions: Despite widely accepted views of the predominance of viral keratitis in the developed countries, these are decreasing in the population studied and contact lens-related bacterial corneal ulcers are more frequent than viral ulcers.

Detection of virulence factors in Serratia strains isolated from contact lens‐associated corneal ulcers

This paper reports on the microbiological findings pertaining to three Serratia isolates from soft contact lens-related corneal ulcers, which represent a complication of contact lens wear reported with increasing frequency. Bacterial identification and antibiotic susceptibility testing were performed using the Vitek system. Serratia's ability to form biofilm, produce gelatinase, elastase and alkaline protease, and invade human corneal epithelial (HCE) cells was investigated. The isolates' susceptibility to the following disinfectants was tested: (a) ReNu MultiPlus(®) , containing polyaminopropyl biguanide 0.0001%; (b) Opti-Free Express(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%; (c) Opti-Free Replenish(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%, and (d) Oxysept Comfort(®) , a one-step 3% hydrogen peroxide-catalase system. Two Serratia marcescens and one Serratia liquefaciens were identified. All the strains were susceptible to aminoglycosides and fluoroquinolones. No isolate formed biofilm or significantly invaded HCE cells; all produced alkaline protease and gelatinase, but not elastase. Opti-Free Express(®) and Opti-Free Replenish(®) were active against S. liquefaciens, but failed to kill the S. marcescens isolates within the minimum recommended time (6 hours). ReNu MultiPlus(®) needed 6 hours to kill one strain of S. marcescens, which is 2 hours more than recommended. Conversely, Oxysept Comfort(®) was always effective within the minimum recommended time (6 hours). The ability to produce alkaline protease and gelatinase may play a major role in the pathogenesis of contact lens-related Serratia keratitis. Several types of contact lens solutions may be ineffective in eradicating Serratia from contaminated contact lens cases within the minimum recommended time. Only exposure to Oxysept Comfort(®) was always effective against Serratia in this study.

Beauveria Keratitis and Biopesticides: Case Histories and a Random Amplification of Polymorphic DNA Comparison

The purposes of this study were to describe 2 contact lens-associated Beauveria keratitis cases and to compare the isolates of 3 contact lens-associated Beauveria keratitis cases with Beauveria-based biopesticides using random amplification of polymorphic DNA (RAPD). A 55-year-old diabetic woman from New Mexico and a 31-year-old healthy woman from southern Wisconsin developed soft contact lens-related corneal ulcers unresponsive to topical moxifloxacin and prednisolone acetate drops. Their corneal cultures grew B. bassiana. These isolates, an isolate from a third soft contact lens-related Beauveria keratitis case, and Beauveria-based biopesticides sold in the United States were analyzed using morphological features, DNA sequencing, and RAPD. A PubMed, Cochrane Library, OVID, UpToDate, and Google search using the term "Beauveria" found only 9 reported Beauveria keratitis infections. Patient 1 responded to topical natamycin, ketoconazole, and 200 mg oral ketoconazole twice daily before developing a secondary bacterial infection requiring penetrating keratoplasty. After subsequent cataract surgery, the best-corrected visual acuity was 20/20. Patient 2 was treated with topical natamycin, topical amphotericin, and 200 mg oral voriconazole twice daily for 1 month with residual scarring and a best-corrected visual acuity of 20/25. RAPD showed that all isolates were unrelated. Although earlier reported Beauveria keratitis cases occurred after corneal injury in patients who did not wear contact lenses, 3 recent patients wore soft contact lenses and denied trauma, mirroring a changing trend in microbial keratitis. RAPD analysis showed that the Beauveria isolates were unrelated to one another and to Beauveria-based biopesticides. In Patient 2, oral voriconazole worked well.

Detection of Virulence Factors in Pseudomonas aeruginosa Strains Isolated From Contact Lens-Associated Corneal Ulcers

In microbial keratitis associated with contact lens use, Pseudomonas is the most common etiologic agent. The purpose of this study was to report on the microbiological findings of 8 P. aeruginosa strains isolated from contact lens-associated corneal ulcers. Scrapings from contact lens-related corneal ulcers were inoculated for culture. Identification and antibiotic susceptibility testing were performed by using the Vitek system (bioMérieux). The Pseudomonas' ability to form biofilm; produce gelatinase, elastase, and alkaline protease; and adhere to and invade human corneal epithelial cells was studied. Polymerase chain reaction with enterobacterial repetitive intergenic consensus primers (ERIC-PCR) was used to establish clonal relationship between the different isolates. All the strains showed multiple antibiotic resistance (resistance to 4 or more antibiotics), but all were susceptible to aminoglycosides and fluoroquinolones. Biofilm production was weak in 5 cases and absent in the remaining 3 cases. All isolates were able to produce alkaline protease and gelatinase but not elastase. Adherence to human corneal epithelial cells was poor (0-15 bacteria/cell) in 5 cases and medium (16-60 bacteria/cell) in 3 cases. Five isolates were found to be efficient invaders (>1000 CFU/mL). ERIC-PCR showed 8 different genetic patterns. Because multiresistant Pseudomonas isolates are common, we recommend antibiotic susceptibility testing in all cases of Pseudomonas keratitis so that, if there is no response to initial empiric treatment, antibiotics can be modified according to susceptibility results. The ability to produce alkaline protease and gelatinase and invade the corneal epithelium may play a major role in the pathogenesis of contact lens-related P. aeruginosa keratitis. Also, ERIC-PCR seems to be an inexpensive, fast, reproducible, and discriminatory DNA typing tool for effective epidemiologic surveillance of P. aeruginosa isolates potentially transmissible between patients with ocular infections.

This issue of Acta

The rather striking cover photograph on this issue of the journal shows gonioscopy images before and after Avastin® injection in a patient with neovascular glaucoma (Paula et al. in this issue). The editorial in this issue discusses the use and abuse of numbers in data values, in particular the excessive use of decimals when mean values are calculated. Professor Sven Erik G. Nilsson, recipient of the 2006 Acta Ophthalmologica Honorary Award, reflects on the journey he and his fellow scientists have made through the wonderlands of eye research. Massin et al., from Paris, review the use of optical coherence tomography in the evaluation of diabetic macular oedema and propose the technique as a key tool in the management of the condition. Pedersen et al., of Copenhagen and Reykjavik, found that optic nerve pH is slightly lower than arterial blood pH and both change in tandem. Optic nerve oxygen tension is influenced by CO2 concentration, but not by pH alone. German authors Huber et al. found increased blood flow velocity in the ophthalmic and central retinal arteries in normal subjects under hypercapnia. Contrast sensitivity was also improved by hypercapnia. Hacioğu et al., Turkey, found that polyunsaturated fatty acids have a beneficial effect on the visual evoked potentials in hypertensive rats. Swedish researchers Lundström et al. have designed a new clinical tool for evaluating indications for cataract surgery. The tool takes into account the objective measurements of visual acuity and the patient's subjective evaluation of visual function. Oslo-based Liv Drolsum found deep sclerectomy to be a safe and effective procedure in pseudoexfoliative glaucoma; the beneficial effect of the surgery lasts several years. Rekonen et al., Kuopio, also studied deep sclerectomy, in both primary open-angle and pseudoexfoliative glaucoma. They found deep sclerectomy to be equally effective in both conditions. Oliveira et al., based in New York and Erlangen, found evidence of exfoliation material in the middle-aged offspring of patients with pseudoexfoliation syndrome, thus substantiating the hereditary character of the syndrome. Slettedal et al., Oslo, used scanning electron microscopy to study the epithelium in donor corneas and found progressive epithelial cell loss with time. However, a healthy rim of peripheral epithelial cells remained, even after a week. Antwerp-based Verhelst et al. reviewed 107 cases of contact lens-related corneal ulcers and found severe ulcers requiring hospitalization to be an increasing problem in Belgium. Puell et al., writing from Madrid, found that dry eyes significantly impair contrast sensitivity. Japanese researchers Uchino et al. report the first child case of pseudomembranous conjunctivitis in acute graft versus host disease after stem cell transplantation. Mehta et al., London, describe subconjunctival crystals in paediatric blepharokeratoconjunctivitis, a condition that has not previously been reported in children. Finnish authors Leinonen et al. examined the variability of refractive error measurements and found it to be greater in eyes with lower visual acuity. Sadeghi et al., based in Sweden and the USA, examined the progressive loss of visual acuity and visual fields that begins in the second and third decades of life in both types 1 and 2 Usher syndrome. Gränse, writing from Lund, suggests that multifocal visual evoked potentials may be useful in evaluating the acute phase of Leber's hereditary optic neuropathy. Mauget-Faÿsse et al., Lyon, present a case of photodynamic therapy for choroidal metastasis from lung adenocarcinoma in the diagnosis/therapy section. Two letters report the use of Avastin. Paula et al., from Brazil, used Avastin successfully in neovascular glaucoma; the cover figure on the journal comes from this study. German practitioners Spandau et al. present a case of macular oedema due to central retinal vein occlusion where Avastin was helpful. The abstracts for the International Perimetric Society's 17th Visual Field and Imaging Symposium are printed in this issue. I hope that this issue of Acta proves to be both pleasurable and educational.

The adhesion of Pseudomonas aeruginosa to high molecular weight human tear film species corresponds to glycoproteins reactive with Sambucus nigra lectin

Pseudomonas aeruginosa is a pathogen gaining prevalence in contact lens-related corneal ulcers. Tear outflow protects the ocular surface, where high molecular weight tear glycoproteins bind bacteria for removal from the eye. The purpose of the present study was to identify glycoproteins in human tears involved in the adhesion of ocular P. aeruginosa isolates. Basal human tears were applied to a bacterial adhesion assay involving electrophoretic separation of tear components, transfer to nitrocellulose and incubation with biotin-labelled bacteria. Glycoproteins were further characterised using lectin profiling. The results showed large-dimension agarose gels were imperative for the detection of at least four glycoproteins with a migration >200 kDa, including species not previously identified. P. aeruginosa 6294 preferentially bound to a well-defined glycoprotein near the origin of the gel that, unlike other glycoproteins >200 kDa, reacted with Sambucus nigra lectin (sialic acid α2–6) but not WGA lectin ( N-acetylglucosamine, sialic acid α2–3). Adhesion did not involve free biotin label or hydrophobic interactions. Also, the pre-incubation of separated tear glycoproteins with S. nigra lectin increased subsequent adhesion of 6294 to this tear glycoprotein. The less virulent Paer1 strain showed diffuse adhesion in the S. nigra-reactive region at the gel origin. In conclusion, an overlay adhesion assay was developed that identified slow-migrating sialylated glycoprotein species in human tears preferentially bound by P. aeruginosa ocular strains, and S. nigra lectin seemed to enhance the interaction. The study provides a basis for direct investigation of bacterial adhesion to glycoproteins with an apparent migration >200 kDa in tear fluid.

Contact lens‐related corneal ulcers requiring hospitalization: A 7‐year retrospective study in Belgium

To evaluate the clinical and epidemiological aspects of contact lens-related infectious corneal ulcers requiring hospitalization. A retrospective analysis was performed on the files of patients hospitalized for contact lens-induced corneal ulcer in the eight Belgian university hospitals over a 7-year period (January 1997 to December 2003). Diagnoses for all hospitalized patients are obligatorily registered using the ICD-9 code. A total of 107 patients with contact lens-related corneal ulcers were documented: the number increased from five in 1997 to 22 in 2003. A total of 99 subjects used soft contact lenses, of whom nine used disposables, 73 planned replacement and 17 conventional lenses. Only six patients used extended wear lenses. Three patients used daily disposable lenses. The most frequently cultured organisms were Pseudomonas and other Gram-negative germs (70%) and Acanthamoeba (16%). The majority (77%) of the corneal ulcerations were centrally located and resulted in an average visual loss of four lines. During the study period, the number of patients hospitalized rose, which is only partially explained by the increasing prevalence of lens wearers: 3.5% and 6.5% of the Belgian population used lenses in 1995 and 2003, respectively. These factual data highlight the need for improvements in patient education.

Trends in Contact Lens???Related Corneal Ulcers

To analyze the frequency of contact lens-related corneal ulcers and its relationship to the type of contact lens and care. Charts of 376 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from July 1, 1999 to December 31, 2002 were retrospectively reviewed. All patients with contact lens-related corneal ulcers were identified, and information regarding cultures, lens type, usage, and cleaning was obtained. Of the 376 cases, 113 (30%) were related to contact lens use. The contact lens history was recorded in 83 of 113 cases (73%). The soft daily wear frequent replacement lens was the most common lens type associated with corneal ulcers (n = 36/83, 43%). Corneal cultures were performed in 71 of 113 cases (63%) and were positive in 51 of 71 cases (72%). The most common microorganism involved was Pseudomonas aeruginosa (n = 17/51, 33%). The frequency of contact lens-related corneal ulcers from 1999-2002 (n = 113/376, 30%) was significantly greater than that from years 1996-1999 (n = 37/299, 12%) at our institution (P < 0.05). There was a significant increase in the number of contact lens-related corneal ulcers between 1999 and 2002 compared with previous years (P < 0.05). The contact lens type most frequently associated with corneal ulcers was the soft daily-wear frequent-replacement contact lens (43%). Contact lens-related corneal ulcers continue to be a serious problem despite a shift in the market to the use of frequent-replacement daily-wear contact lenses and advances in contact lens technology.

Contact lens–related corneal ulcers in compliant patients

Purpose To report a case series of contact lens–related corneal ulcers in compliant patients with no apparent predisposing factors. Design Retrospective case series. Methods Charts of 70 patients with contact lens–related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. Results Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. Conclusion Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses.

Ulcerative keratitis in contact lens wearers.

To determine the clinical microbiological characteristics of corneal ulcers in contact lens wearers. A retrospective study of 23 patients admitted to our department with contact lens-related corneal ulcers during a 43-month period. Detailed demographic data, the type of contact lens, duration of lens wear, and wearing schedule were derived from a self-administered questionnaire. The severity of the ulcer; cultures of corneal scrapings, storage solutions, and contact lenses; treatment; and final outcome were evaluated. Of the 86 cases of ulcerative keratitis admitted during the study period, 23 (26.74%) were attributed to contact lens use. Most patients were young women from urban areas. All of them were using soft contact lenses for 3 days to 20 years. Five patients used daily-wear lenses as extended-wear lenses. Most ulcers (47.82%) were mild; 30.43% were moderate; and 21.47% were severe. Corneal scrapings for cultures were obtained in 15 of the cases and were positive in 10 (43.47%) of them, whereas in 33.33% of the culture-positive storage solutions and in 66.67% of the culture-positive contact lenses, corneal scrapings were negative. Pseudomonas aeruginosa was the most frequent isolated pathogen (60%). The final visual acuity was 20/40 or better in 60.87% of the cases. Contact lens use is an important risk factor for the development of ulcerative keratitis, with P. aeruginosa remaining the predominant pathogen. It seems important to culture contact lenses and contact lens storage solutions, in addition to the corneal scrapings, and the role of initial therapy for the corneal ulcers remains important.

Trends in contact lens-related corneal ulcers.

To identify changes in number of contact lens-related corneal ulcers per year and the type of contact lenses involved. Charts of 299 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from January 1, 1996, to June 30, 1999, were retrospectively reviewed. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones. Of these 299 cases, 37 (12.4%) were related to contact lens use. Contact lens-related ulcers accounted for 10.7% of all corneal ulcers in 1996, 15.3% in 1997, 8.6% in 1998, and 18.2% in the first 6 months of 1999. The contact lenses most commonly associated with ulcers were conventional soft daily-wear contact lenses (33%). There were similar numbers of ulcers associated with extended wear (n = 16) and daily wear (n = 17) of soft contact lenses. In addition, the number of cases associated with conventional (n = 17) and disposable/frequent replacement (n = 16) lenses were similar. Corneal cultures were performed in 15 (40.5%) cases and were positive in 8. There has been a significant decrease in the number of contact lens-related ulcers treated at our institution compared with previous years (1988-1999, p < 0.01). The number of contact lens-related corneal ulcers in the past 4 years was significantly fewer than previous years at our institution. A similar number of ulcers were associated with conventional and disposable/frequent replacement lenses despite the commercial preponderance of the latter type of lenses.