Orthokeratology-Associated Infectious Keratitis in a Tertiary Care Eye Hospital in Hong Kong

To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. Retrospective study. Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included...

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Bibliographic Details
Published in:American journal of ophthalmology Vol. 158; no. 6; pp. 1130 - 1135.e2
Main Authors: Chan, Tommy C.Y., Li, Emmy Y.M., Wong, Victoria W.Y., Jhanji, Vishal
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.12.2014
Elsevier Limited
Subjects:
Acanthamoeba Keratitis - diagnosis
Acanthamoeba Keratitis - drug therapy
Acanthamoeba Keratitis - parasitology
Adolescent
Anti-Bacterial Agents - therapeutic use
Antiprotozoal Agents - therapeutic use
Child
Contact lenses
Contact Lenses - adverse effects
Corneal Ulcer - diagnosis
Corneal Ulcer - drug therapy
Corneal Ulcer - microbiology
Eye Infections, Bacterial - diagnosis
Eye Infections, Bacterial - drug therapy
Eye Infections, Bacterial - microbiology
Eye Infections, Parasitic - diagnosis
Eye Infections, Parasitic - drug therapy
Eye Infections, Parasitic - parasitology
Female
Hong Kong
Hospitalization
Hospitals, Special
Humans
Male
Myopia
Ophthalmology
Orthokeratologic Procedures - adverse effects
Retrospective Studies
Tertiary Healthcare
Ulcers
Young Adult
Hong Kong
ISSN:0002-9394, 1879-1891, 1879-1891
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Summary:To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. Retrospective study. Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes. A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9–23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6–131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P < .001). Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes.
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ISSN:0002-9394
1879-1891
1879-1891
DOI:10.1016/j.ajo.2014.08.026