Contact Lens–Related Keratitis Leading to Keratoplasty: Ongoing Serious Complication
Corneal ulcers related to contact lens (CL) use occur frequently but rarely progress to need keratoplasty for perforation and scaring. We aim to investigate the epidemiology.
Retrospective chart review at a single-center, university-based, two-surgeon corneal practice. Charts were searched electronically for all patients with microbial keratitis related to contact lens use that went on to receive keratoplasty over a ten-year period from 2004 to 2013. Data gathered included age, sex, organism identified, indication for transplant and possible risk factors relating to contact lens use or care.
Thirty-eight patients (57% female) met the inclusion criteria and had sufficient data for analysis. 27 (71%) achieved 20/40 or better corrected vision (BSCVA), 10 (26%) achieved 20/50 to 20/200 and 1 (3%) remained worse than 20/200 at an average follow-up of 25.6 months (range 1.8 to 74.2 months). Pseudomonas (71%) and Acanthamoeba (24%) were leading isolates. 20 (53%) patients were aged less than 30 years at time of surgery, with 5 (13%) aged less than 20 years. Insufficient data was available on individual CL practices to assess if poor lens care was associated with ulceration.
Microbial keratitis leading to corneal transplant remains a serious risk for contact lens wearers, predominantly affecting younger patients. Specific risk factors are difficult to identify in retrospect but the continuing number of affected patients is of concern given the large number seen in a single Canadian corneal practice.