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Contact Lens Versus Non–Contact Lens–Related Corneal Ulcers at an Academic Center

Bennett, Lisa M.D.; Y. Hsu, Hugo M.D.; Tai, Shannon B.S.; Ernst, Benjamin M.D.; Schmidt, Eric J. M.D.; Parihar, Rohit M.D.; Horwood, Chelsea M.D.; Edelstein, Sean L. M.D.

doi: 10.1097/ICL.0000000000000568
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Purpose: To compare the infectious contact lens–related corneal ulcer (CLRU) and non-CLRU cases at Saint Louis University.

Methods: Retrospective review of corneal ulcer cases identified by search of the ophthalmology and microbiology department databases between 1999 and 2016.

Results: Six hundred seventy-seven cases of corneal ulcers were identified, of which 46% were CLRU. CLRU cases were seen more commonly in younger patients (P<0.001) and women (P=0.03) than non-CLRU cases. Many of the infections were vision-threatening as defined by central/paracentral location (73% CLRU and 71% non-CLRU [P=0.60]) and large size of ulcer >2 mm2 in 36% CLRU and 51% non-CLRU (P=0.002). Causative pathogen in cultured CLRU was predominately Pseudomonas species (44%, P<0.001 vs. the non-CLRU group), other gram-negative (6%), gram-positive (33%), fungi (13%), and Acanthamoeba (5%). Comparatively, cultured non-CLRU was predominately gram-positive (64%, P<0.001 vs. the CLRU group), gram-negative (26%), and fungi (11%). The combined oxacillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus isolates were 35% and 34%, respectively. Despite the progressive increase in the number of corneal ulcers seen, the annual trend for any one particular organism for either CLRU cases or non-CLRU cases did not change significantly.

Conclusions: Most of the cases were non-CLRU. CLRU was disproportionately associated with Pseudomonas species and non-CLRU with Staphylococcal species. Fungal infections were predominately caused by filamentous organisms in both groups. Acanthamoeba keratitis was exclusively associated with CL use.

Department of Ophthalmology (L.B., S.T., B.E., E.J.S., R.P., C.H., and S.L.E.), Saint Louis University Eye Institute, St. Louis, MO; Department of Ophthalmology (H.H.), Doheny Eye Institute, Los Angeles, CA; and Department of Ophthalmology (H.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA.

Address correspondence to Lisa Bennett, M.D., Department of Ophthalmology, Saint Louis University Eye Institute, 1755 South Grand Boulevard, St. Louis, MO 63104; e-mail: lisa.bennett@health.slu.edu

The authors have no funding or conflicts of interest to disclose.

Accepted November 12, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.