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Contact Lens–Associated Microbial Keratitis in a Tertiary Eye Care Center in Turkey

Karaca, Irmak M.D., F.E.B.O., F.I.C.O.; Barut Selver, Ozlem M.D., F.E.B.O.; Palamar, Melis M.D.; Egrilmez, Sait M.D.; Aydemir, Sohret M.D.; Yagci, Ayse M.D.

doi: 10.1097/ICL.0000000000000617
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Objectives: To evaluate the risk factors, causative microorganisms, and presenting features of infection in patients with contact lens–associated microbial keratitis (CLAMK) admitted to a tertiary referral center in Turkey.

Methods: A retrospective review of the medical records of 62 patients who were diagnosed as CLAMK in our clinic between 2012 and 2018 was conducted.

Results: The mean age of the patients (22 men and 40 women) at the time of diagnosis was 24.5±8.3 years (range, 16–48). The mean best-corrected visual acuity (BCVA) was 0.7±0.9 log of minimal angle of resolution (logMAR) (0–3) before treatment and increased to 0.1±0.1 logMAR (0–0.4) at the end of the follow-up. All patients, except one using rigid gas-permeable CL, were frequent replacement soft CL users. Thirty-one (50%) patients declared overnight wear, and 37 (58.9%) patients declared showering or swimming in CLs regularly. Cultures of either corneal scrapings or CL materials were positive in 40 (64.5%) eyes, 12 (19.4%) of which had mixed infections. Thirteen strains of microorganisms were demonstrated, among which there were seven (53.8%) gram-negative bacteria, one (7.7%) gram-positive bacteria, four (30.7%) fungi, and Acanthamoeba (7.7%). The most common pathogen was Pseudomonas aeruginosa, followed by Serratia marcescens and Stenotrophomonas maltophilia. According to culture results, P. aeruginosa infections were associated with significantly worse BCVA. Keratitis foci were either centrally or paracentrally located in 39 (62.9%) eyes, and 16 eyes (25.8%) presented with hypopyon.

Conclusion: Along with growing number of CL users, CLAMK constitutes an important problem with possibly worse visual outcomes. Thus, in addition to meticulous treatment, management of risk factors and behavioral modifications is crucial.

Departments of Ophthalmology (I.K., O.B.S., M.P., S.E., A.Y.), and Microbiology (S.A.), Ege University School of Medicine, Izmir, Turkey.

Address correspondence to Melis Palamar, M.D., Department of Ophthalmology, Ege University Faculty of Medicine, Bornova 35040, Izmir, Turkey; e-mail: melispalamar@hotmail.com

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

Accepted March 31, 2019

© 2019 Contact Lens Association of Ophthalmologists, Inc.