Abstract: Purpose: To report on the clinical characteristics, and outcomes of patients who developed infectious keratitis associated with contact lens (CL) wear following penetrating keratoplasty (PK).
Methods: A retrospective chart review was performed to identify all patients who underwent PK between November 2012 and January 2023 at a single tertiary referral practice, and subsequently developed CL related infectious keratitis. 74 patients using CL following PK were identified. Charts were reviewed to obtain data about demographics, ocular history, CL usage, microbial culture reports, visual acuity, treatment, and clinical outcomes.
Results: CL-associated infectious keratitis occurred in 9 patients, more frequently in males (66%), and patients had a mean age of 54.5 ± 11.8 years old. The identified causative organisms included: Stenotrophomonas maltophilia (N = 3), Candida parapsilosis (N = 2), Moraxella nonliquefaciens (N = 1), Pseudomonas aeruginosa (N = 1), Staphylococcus epidermidis (N = 1), Streptococcus mitis (N = 1), Candida albicans (N = 1), and Acanthamoeba (N = 1). Contact lenses were used following PK for an average of 9.1 ± 10.8 months before development of keratitis. Patients were followed for 31.8 ± 30.2 months after infection. The mean best corrected visual acuity without CL prior to infection was 20/150 and decreased to 20/260 post-infection. Complications following the contact-lens-associated infectious keratitis included: central corneal haze (N = 8), chronic corneal epithelial defects (N = 3), perforation (N = 3), endophthalmitis (N = 1), and enucleation (N = 1). Three grafts required repeat PK.
Conclusions: CL-associated infectious keratitis following PK have high rates of complication. Patients should be monitored closely for signs of infection.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
References: Stechschulte SU, Azar DT (2000) Complications after penetrating keratoplasty. Int Ophthalmol Clin 40:27–43. (PMID: 10.1097/00004397-200040010-0000510713912)
Wietharn BE, Driebe WT (2004) Fitting contact lenses for visual rehabilitation after penetrating keratoplasty. Eye Contact Lens 30:31–33. (PMID: 10.1097/01.ICL.0000101488.84455.E614722466)
Deshmukh R, Nair S, Vaddavalli PK et al (2022) Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 67:1200–1228. (PMID: 10.1016/j.survophthal.2021.11.00534808143)
Severinsky B, Behrman S, Frucht-Pery J, Solomon A (2014) Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes. Cont Lens Anterior Eye 37:196–202. (PMID: 10.1016/j.clae.2013.11.00124300196)
Sah R, Sharma N, Priyadarshini K, Titiyal JS (2023) Contact lenses for the treatment of ocular surface diseases. Indian J Ophthalmol 71:1135. (PMID: 10.4103/IJO.IJO_17_233702624510276751)
Maier P, Kammrath Betancor P, Reinhard T (2022) Contact-lens-associated keratitis—an often underestimated risk. Dtsch Ärztebl Int 119:669–674. (PMID: 359124499830382)
Zimmerman A, Nixon A, Rueff E (2016) Contact lens associated microbial keratitis: practical considerations for the optometrist. Clin Optom 8:1–12.
Fleiszig SMJ, Kroken AR, Nieto V et al (2020) Contact lens-related corneal infection: intrinsic resistance and its compromise. Prog Retin Eye Res 76:100804. (PMID: 10.1016/j.preteyeres.2019.10080431756497)
Robaei D, Carnt N, Watson S (2016) Established and emerging ancillary techniques in management of microbial keratitis: a review. Br J Ophthalmol 100:1163–1170. (PMID: 10.1136/bjophthalmol-2015-30737126888977)
Song A, Deshmukh R, Lin H et al (2021) Post-keratoplasty infectious keratitis: epidemiology, risk factors, management, and outcomes. Front Med 8:707242. (PMID: 10.3389/fmed.2021.707242)
Dohse N, Wibbelsman TD, Rapuano SB et al (2020) Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty. Acta Ophthalmol (Copenh) 98:e895–e900. (PMID: 10.1111/aos.14404)
Mylla Boso AL, Gasperi E, Fernandes L et al (2020) Impact of ocular surface disease treatment in patients with glaucoma. Clin Ophthalmol 14:103–111. (PMID: 10.2147/OPTH.S229815320210746969675)
Zhang X, Vadoothker S, Munir WM, Saeedi O (2019) Ocular surface disease and glaucoma medications: a clinical approach. Eye Contact Lens 45:11–18. (PMID: 10.1097/ICL.0000000000000544301994256298827)
Zhang T, Xie L, Dong Y, Cheng J (2023) Therapeutic keratoplasty for severe Acanthamoeba keratitis: risk factors, clinical features, and outcomes of postoperative recurrence. Graefes Arch Clin Exp Ophthalmol 261(5):1299–1309. (PMID: 10.1007/s00417-022-05883-436367557)
Waghmare SV, Jeria S (2022) A review of contact lens-related risk factors and complications. Cureus 14:e30118. (PMID: 363818989644230)
Cheng KH, Leung SL, Hoekman HW et al (1999) Incidence of contact-lens-associated microbial keratitis and its related morbidity. The Lancet 354:181–185. (PMID: 10.1016/S0140-6736(98)09385-4)
Kawulok ER, Nau CB, Schornack MM (2022) Microbial keratitis associated with penetrating keratoplasty and scleral lens wear: a case series. Eye Contact Lens 48:217–221. (PMID: 10.1097/ICL.000000000000089535333807)
Fuller DG, Wang Y (2020) Safety and efficacy of scleral lenses for keratoconus. Optom Vis Sci 97:741–748. (PMID: 10.1097/OPX.0000000000001578329324007547898)
Schornack MM, Pyle J, Patel SV (2014) Scleral lenses in the management of ocular surface disease. Ophthalmol 121(7):1398–1405. (PMID: 10.1016/j.ophtha.2014.01.028)
Rosenthal P, Croteau A (2005) Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens 31:130–134. (PMID: 10.1097/01.ICL.0000152492.98553.8D15894881)
Özalp O, Atalay E, Köktaş Z, Yıldırım N (2020) Distribution of microbial keratitis after penetrating keratoplasty according to early and late postoperative periods. Turk J Ophthalmol 50:206–210. (PMID: 10.4274/tjo.galenos.2020.77026328544617469893)
Eltis M (2011) Contact-lens-related microbial keratitis: case report and review. J Optom 4:122–127. (PMID: 10.1016/S1888-4296(11)70053-X)
Processing Request
No Comments.