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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Abstract
PURPOSE To evaluate the reliability of manual annotation when quantifying cornea anatomical and microbial keratitis (MK) morphological features on slit-lamp photography (SLP) images. METHODS Prospectively enrolled patients with MK underwent SLP at initial encounter at 2 academic eye hospitals. Patients who presented with an epithelial defect (ED) were eligible for analysis. Features, which included ED, corneal limbus (L), pupil (P), stromal infiltrate (SI), white blood cell (WBC) infiltration at the SI edge, and hypopyon (H), were annotated independently by 2 physicians on SLP images. Intraclass correlation coefficients (ICCs) were applied for reliability assessment; dice similarity coefficients (DSCs) were used to investigate the area overlap between readers. RESULTS Seventy-five MK patients with an ED received SLP. DSCs indicate good to fair annotation overlap between graders (L = 0.97, P = 0.80, ED = 0.94, SI = 0.82, H = 0.82, WBC = 0.83) and between repeat annotations by the same grader (L = 0.97, P = 0.81, ED = 0.94, SI = 0.85, H = 0.84, WBC = 0.82). ICC scores showed good intergrader (L = 0.98, P = 0.78, ED = 1.00, SI = 0.67, H = 0.97, WBC = 0.86) and intragrader (L = 0.99, P = 0.92, ED = 0.99, SI = 0.94, H = 0.99, WBC = 0.92) reliabilities. When reliability statistics were recalculated for annotated SI area in the subset of cases where both graders agreed WBC infiltration was present/absent, intergrader ICC improved to 0.91 and DSC improved to 0.86 and intragrader ICC remained the same, whereas DSC improved to 0.87. CONCLUSIONS Manual annotation indicates usefulness of area quantification in the evaluation of MK. However, variability is intrinsic to the task. Thus, there is a need for optimization of annotation protocols. Future directions may include using multiple annotators per image or automated annotation software.
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Abdelghany AA, D’Oria F, Alio Del Barrio J, Alio JL. The Value of Anterior Segment Optical Coherence Tomography in Different Types of Corneal Infections: An Update. J Clin Med 2021; 10:jcm10132841. [PMID: 34199039 PMCID: PMC8267702 DOI: 10.3390/jcm10132841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) is a modality that uses low-coherence interferometry to visualize and assess anterior segment ocular features, offering several advantages of being a sterile and noncontact modality that generates high-resolution cross-sectional images of the tissues. The qualitative and quantitative information provided by AS-OCT may be extremely useful for the clinician in the assessment of a wide spectrum of corneal infections, guiding in the management and follow-up of these patients. In clinical practice, infections are routinely evaluated with slit-lamp biomicroscopy, an examination and imaging modality that is limited by the physical characteristics of light. As a consequence, the depth of pathology and the eventually associated corneal edema cannot be accurately measured with the slit-lamp. Therefore, it represents a limit for the clinician, as in vivo information about corneal diseases and the response to treatment is limited. Resolution of corneal infection is characterized by an early reduction in corneal edema, followed by a later reduction in infiltration: both parameters can be routinely measured with standardized serial images by AS-OCT.
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Affiliation(s)
- Ahmed A. Abdelghany
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia 61519, Egypt;
| | - Francesco D’Oria
- Section of Ophthalmology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70124 Bari, Italy;
| | | | - Jorge L. Alio
- Vissum Miranza, Miguel Hernandez University, c/Cabañal, 1, 03016 Alicante, Spain;
- Correspondence:
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Efron N, Morgan PB. Are hypoxia or modulus causes of contact lens‐associated keratitis? Clin Exp Optom 2021; 92:329-30. [DOI: 10.1111/j.1444-0938.2009.00381.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ho L, Jalbert I, Watt K, Hui A. Current understanding and therapeutic management of contact lens associated sterile corneal infiltrates and microbial keratitis. Clin Exp Optom 2021; 104:323-333. [PMID: 33689618 DOI: 10.1080/08164622.2021.1877530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Contact lenses are widely prescribed in clinical practice with multiple applications and advantages. However, contact lenses can be associated with various complications which range from innocuous to severe. Clinicians thus not only need to possess the ability to prescribe the most appropriate contact lenses for each individual patient but also be able to recognise and manage any associated complications. This review examines the existing literature on the management of corneal infiltrative events associated with soft contact lenses, including microbial keratitis, particularly in the context of practising in Australia. The definitions and diagnosis of corneal infiltrative events, as well as the current understanding of their aetiologies, will be explored. The various aspects of a successful management will be discussed, including the applications of therapeutic agents such as antimicrobial and anti-inflammatory agents, the role of microbiological investigations, and strategies to improve long-term prognosis. The currently available evidence supporting management options will be presented, highlighting the relative abundance of high-level evidence on management protocols, antimicrobial selection and treatment duration for microbial keratitis; and the relative paucity of studies and trials for sterile corneal infiltrative events, despite this condition being much more commonly encountered in clinical practice.
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Affiliation(s)
- Lily Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
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Konda N, Garg P, Sharma S, Willcox MDP. Risk Factors for Contact Lens-Related Microbial Keratitis and Associated Vision Loss in a South Indian Population. Eye Contact Lens 2021; 47:118-126. [PMID: 33009258 DOI: 10.1097/icl.0000000000000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify risk factors associated with contact lens-related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population. METHODS A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss. RESULTS One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3). CONCLUSIONS Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
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Affiliation(s)
- Nagaraju Konda
- School of Optometry and Vision Science (N.K., M.D.P.W.), University of New South Wales, Australia; Brien Holden Vision Institute (N.K.), Sydney, Australia; Cornea Service (P.G.), L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and Jhaveri Microbiology Centre (S.S.), Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Flanagan G, Velez T, Gu W, Singman E. Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness. Mil Med 2020; 185:e2071-e2075. [PMID: 32676672 DOI: 10.1093/milmed/usaa187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Ulcerative keratitis (UK), or corneal ulcer, is a sight-threatening and readiness-lowering medical condition that begins with a corneal infiltrative event (CIE). Contact lens (CL) wear poses a particular risk for a CIE and therefore is restricted for most active duty service members (SMs). In this study, we explored a large Department of Defense/Veterans Affairs (DoD/VA) database to estimate the prevalence of UK and CIE and their association with CL wear. MATERIALS AND METHODS The DoD/VA Defense and Veterans Eye Injury Vision Registry, an initiative of the DoD/VA Vision Center of Excellence, was explored using natural language processing software to search for words and diagnostic codes that might identify cornea injuries and CL wear. The effect of UK and CIE on readiness was explored by evaluating the duration between the first and final visits noted in the database. RESULTS A total of 213 UK cases were identified among the 27,402 SMs for whom data were recorded in Defense and Veterans Eye Injury Vision Registry. The odds ratios of UK and CIE being associated with CL wear were 13.34 and 2.20, respectively. A less specific code (superficial corneal injury) was found to be the most commonly used diagnosis in the database, and the odds ratio of CL wearers having that diagnosis was 2.25. CL-wearing patients with corneal disease also required more clinic encounters than those who did not wear CLs. CONCLUSIONS This study supports the current restriction on CL wear among nonpilot active duty SMs and quantifies the significantly enhanced risk of developing corneal ulcers posed by that habit.
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Affiliation(s)
- Gerald Flanagan
- Computer Technology Associates, Inc., 543 W. Graaf Ave., Ridgecrest, CA 93555
| | - Tom Velez
- Computer Technology Associates, Inc., 543 W. Graaf Ave., Ridgecrest, CA 93555
| | - Weidong Gu
- Vision Center of Excellence Defense Health Agency, Research and Development Directorate, Defense Health Agency, 1335 East-West Highway, SSMC1 Suite 9-100, Silver Spring, MD 20910
| | - Eric Singman
- Wilmer Eye Institute Johns Hopkins Hospital, Wilmer B29 @ Johns Hopkins Hospital, 600 N. Wolfe St.., Baltimore, MD 21287
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Efron N, Brennan NA, Chalmers RL, Jones L, Lau C, Morgan PB, Nichols JJ, Szczotka-Flynn LB, Willcox MD. Thirty years of 'quiet eye' with etafilcon A contact lenses. Cont Lens Anterior Eye 2020; 43:285-297. [PMID: 32278644 DOI: 10.1016/j.clae.2020.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/17/2022]
Abstract
Frequent replacement contact lenses made from the etafilcon A hydrogel lens material were introduced onto the market over 30 years ago, and etafilcon A remains the most widely used hydrogel lens material today. Although the prescribing of silicone hydrogel lenses is increasing, millions of lens wearers globally have been wearing hydrogel lenses for many years and exhibit a physiologically-stable 'quiet eye', with a low profile of adverse events. Hydrogel lenses are demonstrated to maintain a low inflammatory response and infection risk profile during daily wear, which in the case of etafilcon A, may be related to its low modulus, and the naturally-protective, anti-microbial, non-denatured lysozyme absorbed into the lens from the tear fluid. Although improved corneal physiology from decreased hypoxia with silicone hydrogel lenses is well accepted, equivalent levels of corneal oxygenation are maintained during daily wear of low to medium powered hydrogel lenses, which do not impede the daily corneal de-swelling process, and do not induce clinically significant changes in ocular health. Therefore, hydrogel lenses remain an important alternative for daily wear in modern contact lens practice.
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Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Australia.
| | | | | | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Charis Lau
- Johnson & Johnson Vision, Inc, Jacksonville, FL, USA
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, UK
| | - Jason J Nichols
- The University of Alabama at Birmingham, School of Optometry, Birmingham, AL, USA
| | - Loretta B Szczotka-Flynn
- University Hospitals Eye Institute, University Hospitals Cleveland Medical Center, Department of Ophthalmology & Visual Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Mark D Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Abstract
PURPOSE To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis. METHODS Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated. RESULTS Mean CT and IT at presentation were 650.5 ± 108 μm and 401.1 ± 91 μm, which reduced significantly at each follow-up [on days 7, 14, 28, and 42; 626.8 ± 113 μm (P < 0.001) and 367.3 ± 94 μm (P = 0.002), 601.4 ± 109 μm and 344.7 ± 94 μm (P < 0.001), 544.8 ± 103 μm and 305.1 ± 80 μm (P < 0.001), and 522.8 ± 97 μm and 291.4 ± 79 μm (P < 0.001), respectively]. The mean CT and scar depth at complete healing were 496.3 ± 101 μm and 283.2 ± 77 μm, respectively. In 10/50 (20%) eyes, the posterior border of the cornea was not clearly visible because of posterior shadowing; therefore, IT was measured along the maximum visible area of hyperreflectivity, whereas CT was measured just adjacent to the area of shadowing. The infiltrate width was measured in 35 eyes, and the mean values at days 0, 7, 14, 28, 42, and 56 were 5.5 ± 0.8 mm, 4.6 ± 0.7 mm, 4.4 ± 0.6 mm, 4.2 ± 0.6 mm, 4.1 ± 0.6 mm, and 4.1 ± 0.6 mm, respectively. A satellite lesion and endothelial plaque were seen in 30% (15/50) and 44% (22/50) eyes, respectively. CONCLUSIONS ASOCT is a useful adjunct in monitoring fungal keratitis especially in cases with deep stromal involvement and endothelial plaques. In addition, it also provides insight into the activity of keratitis.
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Steele KR, Szczotka-Flynn L. Epidemiology of contact lens-induced infiltrates: an updated review. Clin Exp Optom 2017; 100:473-481. [PMID: 28868803 DOI: 10.1111/cxo.12598] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022] Open
Abstract
Corneal infiltrative events (CIEs) are well established as a risk associated with soft contact lens wear. The incidence of symptomatic CIEs during extended soft lens wear ranges from 2.5 to six per cent; when asymptomatic CIEs are included, the incidence can be as high as 20-25 per cent. In daily soft lens wear, the annual incidence of symptomatic CIEs is about three per cent. There are various accepted methods of categorising CIEs, and a scoring system based on clinical signs and symptoms is a good approach to grade severity. Lens-related risk factors include extended wear, silicone hydrogel material, the use of multipurpose solutions, bacterial bioburden and reusable lenses. Recent studies report that daily disposable lenses reduce the risk of CIEs.
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Affiliation(s)
- Kelsy R Steele
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Loretta Szczotka-Flynn
- University Hospitals Eye Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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Nie Y, Gross H, Zhong Y, Duerr F. Freeform optical design for a nonscanning corneal imaging system with a convexly curved image. APPLIED OPTICS 2017; 56:5630-5638. [PMID: 29047704 DOI: 10.1364/ao.56.005630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/09/2017] [Indexed: 05/28/2023]
Abstract
Most existing techniques that are typically used by specialists to image the cornea are based on point, slit, or annular scanning due to a narrow field of view. The difficulty in achieving a larger field of view comes from the convex shape of the human eyeball. Field curvature for a refractive imaging system with positive power is typically negative and thus a concave image surface. In order to view the full cornea and sclera with snapshot imaging, we calculate qualified two- and three-mirror solutions from Seidel aberration theory. A three-mirror solution is further optimized as a high-resolution off-axis imaging system using freeform surfaces, which can obtain a full-field tailored image shell without scanning. The lateral resolution on the cornea is about 10 μm with good modulation transfer function (MTF) and spot performance. To ease the assembly, a monolithic design is achieved with slightly lower resolution, leading to a potential mass production solution.
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Callahan D, Kovacs C, Lynch S, Rah M. Biocidal efficacy of multipurpose solutions against Gram-negative organisms associated with corneal infiltrative events. Clin Exp Optom 2017; 100:357-364. [PMID: 28194876 PMCID: PMC5516204 DOI: 10.1111/cxo.12509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/09/2016] [Accepted: 11/06/2016] [Indexed: 12/22/2022] Open
Abstract
Background Because corneal infiltrative events (CIEs) may result from bacterial components on contact lenses, which can come from contaminated lens cases, we evaluated the biocidal efficacy of five multipurpose solutions against Gram‐negative commonly isolated and CIE‐associated organisms. Methods Of the multipurpose solutions tested, one contained polyhexamethylene biguanide (PHMB)/polyquaternium‐1 (PQ‐1; Bausch & Lomb Incorporated: Biotrue), one contained alexidine dihydrochloride (alexidine)/PQ‐1 (AMO: RevitaLens OcuTec) and three contained PQ‐1/myristamidopropyl dimethylamine (MAPD; Alcon: Opti‐Free PureMoist, PQ‐1/MAPD‐1; Opti‐Free RepleniSH, PQ‐1/MAPD‐2; Opti‐Free Express, PQ‐1/MAPD‐3). Challenge organisms were CIE‐associated Achromobacter xylosoxidans, Delftia acidovorans and Stenotrophomonas maltophilia at manufacturer‐recommended durations (stand‐alone), in lens cases without lenses (up to seven days) and in lens cases with etafilcon A lenses (up to 30 days). Results In stand‐alone testing against CIE‐associated organisms, PHMB/PQ‐1 and alexidine/PQ‐1 were significantly superior versus MAPD‐based multipurpose solutions against A. xylosoxidans (all p ≤ 0.01), D. acidovorans (all p ≤ 0.001) and S. maltophilia (all p ≤ 0.05). In lens cases, PHMB/PQ‐1 and alexidine/PQ‐1 achieved greater than 3‐log reductions against all challenge organisms at all times evaluated. PQ‐1/MAPD‐1 achieved a greater than 3‐log reduction against D. acidovorans at 24 hours; PQ‐1/MAPD‐1 and PQ‐1/MAPD‐3 achieved greater than 3‐log reductions at seven days against all organisms. In lens cases with lenses, PHMB/PQ‐1 and alexidine/PQ‐1 achieved greater than 3‐log reductions against all organisms at all times. PQ‐1/MAPD‐1 and PQ‐1/MAPD‐3 achieved greater than 3‐log reductions at seven or more days against all organisms. PQ‐1/MAPD‐2 did not achieve a greater than 3‐log reduction at any time; some regrowth was observed. Conclusions PHMB‐ and alexidine‐based multipurpose solutions demonstrated significantly greater biocidal activity compared with PQ‐1/MAPD‐based agents against Gram‐negative organisms commonly isolated and CIE‐associated pathogens.
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Affiliation(s)
| | | | - Shawn Lynch
- Bausch & Lomb Incorporated, Rochester, New York, USA
| | - Marjorie Rah
- Bausch & Lomb Incorporated, Rochester, New York, USA
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Abstract
Purpose: To document the time course and resolution of contact lens–related corneal infiltrative events (CIEs) comparing slit-lamp images with anterior segment ocular coherence tomography (AS-OCT) images. Methods: Six silicone hydrogel (SiHy) soft contact lens (SCL) wearers presenting with newly diagnosed symptomatic CIEs were monitored with slit-lamp images, detailed drawings, and AS-OCT until the resolution of the CIE. A final follow-up visit was completed 4 weeks after CIE resolution to determine whether scar formation was present. Positive controls were 2 SiHy SCL wearers with established (inactive) corneal scars, and negative controls were 2 SiHy SCL wearers with clear corneas. High- and low-contrast logMAR visual acuities were measured, and subjective symptom questionnaires were completed at all visits. Results: Clinical signs, vision, and symptoms improved in tandem with the resolution of the CIEs as measured by imaging methods. Calibrated measures of infiltrate width from a slit-lamp biomicroscope appear to be similar to calibrated images from AS-OCT. Conclusions: Although further studies are needed to develop standardized procedures, AS-OCT can be a useful tool to characterize the development, progression, and resolution of corneal infiltrates as an objective measure of resolution and scar formation.
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Abstract
PURPOSE The aim of this study was to characterize the clinical signs, symptoms, and ocular and systemic comorbidities in a large case series of contact lens-related microbial keratitis. METHODS Two hundred ninety-seven cases of contact lens-related microbial keratitis, aged between 15 and 64 years were detected through surveillance of hospital and community based ophthalmic practitioners in Australia and New Zealand. Full clinical data were available for 190 cases and 90 were interviewed by telephone. Clinical data included the size, location, and degree of anterior chamber response. Symptom data were available from the practitioner and from participant self-report. Associations between symptoms and disease severity were evaluated. Data on ocular and systemic disease were collected from participants and practitioners. The frequency of comorbidities was compared between the different severities of disease and to population norms. RESULTS More severe disease was associated with greater symptom severity and pain was the most prevalent symptom reported. Ninety-one percent of cases showed progression of ocular symptoms after lens removal, and symptom progression was associated with all severities of disease. Twenty-five percent of cases reported prior episodes requiring emergency attention. Thyroid disease (p = 0.05) and self-reported poor health (p = 0.001) were more common in cases compared with age-matched population norms. DISCUSSION Information on the signs, symptoms, and comorbidities associated with contact lens-related microbial keratitis may be useful in patient education and for practitioners involved in the fitting of lenses and management of complications. Although pain was the most common symptom experienced, progression of symptoms despite lens removal was close to universal. Poor general health, particularly respiratory disease and thyroid disease was more common in cases than in the general population, which may prompt practitioners to recommend flexibility in wear schedules when in poor health or the selection of a lower risk wear schedule in at risk patients.
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Steinemann TL, Ehlers W, Suchecki J. Contact Lens-Related Complications. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Lim TH, Lee JR, Choi KY, Chung KH, Cho BJ. Corneal Melting and Descemetocele Resulting From Noninfectious Keratitis Related to the Cosmetic Contact Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.5.774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hyung Lim
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Jong Rak Lee
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Kee Yong Choi
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Kyu Hyung Chung
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Beom Jin Cho
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
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The Clinical Investigation of the Base Curve and Comfort Rate of a New Prototype Silicone Hydrogel Contact Lens. Eye Contact Lens 2008; 34:146-50. [DOI: 10.1097/icl.0b013e3181506bbd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Efron N, Morgan PB. Prescribing daily disposable contact lenses in the UK. Cont Lens Anterior Eye 2008; 31:107-8. [DOI: 10.1016/j.clae.2008.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 01/14/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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Adverse Events and Discontinuations During 18 Months of Silicone Hydrogel Contact Lens Wear. Eye Contact Lens 2007; 33:288-92. [DOI: 10.1097/icl.0b013e318030c9b1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Efron N, Morgan PB, Makrynioti D. Chronic morbidity of corneal infiltrative events associated with contact lens wear. Cornea 2007; 26:793-9. [PMID: 17667611 DOI: 10.1097/ico.0b013e31806c79dc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the chronic morbidity of corneal infiltrative events (CIEs) associated with contact lens wear. METHODS The central corneas of both eyes of 13 subjects who had suffered a CIE 27 +/- 4 months previously were examined by using slit-lamp biomicroscopy, confocal microscopy, and ultrasound pachometry. Snellen visual acuity was recorded in both eyes. A questionnaire was administered to ascertain the type and extent of changes in contact lens wear and care since suffering from the CIE. RESULTS Slit-lamp biomicroscopy revealed the presence of a circular scar, approximately 1.5 mm in diameter, in the central cornea of the right eye of the patient who had suffered the most clinically severe CIE; no residual scar, or any other abnormality, was detected in any of the other 12 patients. No significant difference between the 2 eyes was found with respect to basal epithelial cell density; anterior or posterior keratocyte density; endothelial cell density, polymegethism, or pleomorphism; corneal thickness; or visual acuity. Anecdotally, however, markedly reduced pan-corneal cell counts, increased endothelial polymegethism, and reduced corneal thickness were observed in the affected eye of the patient who had suffered the most clinically severe CIE. After having suffered from a CIE, many patients changed lens type or brand, ceased to routinely sleep in lenses, or wore lenses less often. CONCLUSIONS In general, contact lens-associated CIEs do not compromise the long-term integrity of the cornea. Changes in lens-related behaviors of patients who have suffered from a CIE seem to be aimed at reducing the risk of a further occurrence. Anecdotally, more severe CIEs may be associated with chronic tissue morbidity.
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Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation and School of Optometry, Queensland University of Technology, Brisbane, Australia.
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Brennan NA, Coles MLC, Connor HRM, McIlroy RG. A 12-month prospective clinical trial of comfilcon A silicone-hydrogel contact lenses worn on a 30-day continuous wear basis. Cont Lens Anterior Eye 2007; 30:108-18. [PMID: 17420152 DOI: 10.1016/j.clae.2007.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Revised: 02/05/2007] [Accepted: 02/16/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the clinical performance of comfilcon A (Biofinity) during 12 months of continuous wear compared to other silicone-hydrogel lenses. METHOD Forty-five subjects were fitted in one eye with the comfilcon A (test) lens. For 22 subjects, the other eye was fitted with lotrafilcon A (group A) and for the remaining 23 subjects the other eye was fitted with balafilcon A (group B). Twelve-month data are presented on 48 measured variables. RESULTS There were no serious adverse events during the course of the study. A total of 33 subjects completed the study, with only 4 discontinuations for lens-related reasons, spread proportionately between the lenses. On preference scales, the test lens was superior to both control lenses for comfort (p<0.05) and overall preference (p<0.05) and in group A for vision (p<0.05). On grading scales, the test lens scored better than both control lenses for overall comfort (p<0.1 for group A, p<0.05 for group B), comfort during the day (p<0.05), end-of-day comfort (p<0.05) and overall preference (p<0.05), and better in group A for general vision quality (p<0.01), night vision quality (p<0.01) and handling (p<0.05). All lenses performed to a comparable degree on the basis of microcysts and corneal staining. There were significant differences between lenses in producing limbal redness (p<0.05), bulbar conjunctival hyperemia (p<0.1) and conjunctival NaFl staining (p<0.01) with the control lens in group A showing the greatest effect and the control lens in group B the least. CONCLUSION Comfilcon A offers performance advantages over first generation silicone-hydrogel materials for continuous wear.
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Affiliation(s)
- Noel A Brennan
- Brennan Consultants Pty Ltd., 110 Auburn Rd, Auburn Village, Melbourne 3122, Australia.
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Bergenske P, Long B, Dillehay S, Barr JT, Donshik P, Secor G, Yoakum J, Chalmers RL. Long-term Clinical Results: 3 Years of Up to 30-Night Continuous Wear of Lotrafilcon A Silicone Hydrogel and Daily Wear of Low-Dk/t Hydrogel Lenses. Eye Contact Lens 2007; 33:74-80. [PMID: 17496699 DOI: 10.1097/01.icl.0000258591.35468.2c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To summarize results of a 3-year clinical trial assessing subjective and objective experience with lotrafilcon A silicone hydrogel (SH) lenses for up to 30 nights of continuous wear or low-Dk/t daily-wear (LDW) hydrogel lenses. METHODS Nineteen sites dispensed SH lenses to 317 subjects (286 current wearers and 31 new wearers) and 2-week replacement LDW lenses to 81 new wearers in a 3-year study. RESULTS For the SH cohort, limbal redness, conjunctival redness, and corneal neovascularization improved among 23%, 21%, and 13% of eyes, respectively (P<0.001), with no signs increasing significantly. For the LDW cohort, limbal redness, papillary conjunctivitis, and corneal staining increased among 11%, 21%, and 13% of eyes, respectively (P<0.02), with no signs improving significantly. The change in average spherical equivalent power was -0.03 diopters for the age-matched SH cohort and -0.40 diopters for the LDW cohort (P=0.007). During the 3 years, the SH group reported significantly less frequent dryness during and at the end of the day, redness, photophobia, lens awareness, and blurred vision. Significantly more LDW lens wearers reported frequent during-the-day and end-of-day dryness and blurred vision. CONCLUSIONS During the 3 years, lotrafilcon A lens wearers who wore their lenses continuously for up to 30 nights showed stable, long-term improvements in many signs of corneal health and symptoms along with less myopic progression versus daily wearers of low-Dk/t hydrogel lenses. Many biomicroscopy signs and symptoms worsened among neophytes wearing daily-wear low-Dk/t hydrogel lenses. The use of lotrafilcon A lenses may minimize many ocular changes from soft contact lens wear.
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Affiliation(s)
- Peter Bergenske
- Pacific University School of Optometry, Forest Grove, OR, USA
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Abstract
This review presents a critical analysis of the literature relating to the use of binomial and polynomial classification schemes for categorising corneal infiltrative events (CIEs) associated with contact lens wear and the epidemiology of such events. The results of the Manchester Keratitis Study-a 12-month, prospective, hospital-based epidemiological study of contact lens wearer suffering from CIEs-are used as a tool to challenge and test traditional thinking in relation to contact lens associated keratitis. An innovative aspect of this study is the use of a novel clinical severity matrix to systematically score the severity of CIEs based on 10 key signs and symptoms. The ambiguities inherent in using binomial classification schemes (such as, microbial versus sterile, ulcerative versus non-ulcerative etcetera) are highlighted. The failure of a polynomial scheme-due to extensive classification overlap between proposed sub-types of CIEs-is demonstrated using a Venn diagram. A cartographic analysis reveals that infiltrates tend to occur in the superior cornea of patients wearing extended wear silicone hydrogel lenses, in the central cornea of patients wearing daily wear hydrogel daily disposable lenses and in the peripheral cornea of patients wearing daily wear hydrogel (excluding daily disposable) lenses. Infiltrates that occur more towards the limbus are less severe. The incidence of CIEs is higher when contact lenses are worn overnight. Logistic analysis reveals that the risk of developing a severe CIE is five times greater with conventional hydrogel extended wear versus silicone hydrogel extended wear. The male gender, smoking, a healthy eye and body, and the late Winter months are associated with an increased risk of developing CIEs. The rate of significant visual loss as a result of developing a CIE is low. Two key conclusions are drawn from this work, which represent a radical rethinking of this potentially sight-threatening condition. CIEs should be considered as a continuous spectrum of ocular disease. If a contact lens wearer presents with a sore eye that is becoming progressively worse and a CIE is observed in that eye, lens wear should be suspended and anti-microbial therapy initiated immediately.
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Affiliation(s)
- Nathan Efron
- School of Optometry, Queensland University of Technology, Brisbane, Australia.
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Efron N, Morgan PB. Can Subtypes of Contact Lens-Associated Corneal Infiltrative Events Be Clinically Differentiated? Cornea 2006; 25:540-4. [PMID: 16783142 DOI: 10.1097/01.ico.0000214219.67872.3c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A schema has recently been described for clinical differentiation among 4 symptomatic subtypes of contact lens-associated corneal infiltrative events (CIEs): microbial keratitis (MK), contact lens-induced peripheral ulcer (CLPU), contact lens-induced acute red eye (CLARE), and infiltrative keratitis (IK). The clinical utility of this schema has been challenged in the literature. The aim of this study is to determine whether it is possible to clinically differentiate among these conditions. METHODS Criteria for MK, CLPU, CLARE, and IK were applied to a data set of 111 contact lens-associated CIEs, spanning a wide range of clinical severities, presenting consecutively to a hospital clinic. A Venn diagram analysis was used to determine the extent to which these conditions can be clinically differentiated. RESULTS Of the 111 CIEs, 20% could be classified unambiguously as MK, CLPU, CLARE, or IK, 56% could be classified as 1 of 2 conditions, 13% could be classified as 1 of 3 conditions, and 0% could be classified as 1 of 4 conditions. Eleven percent of CIEs could not be classified as any of the 4 conditions. CONCLUSIONS Although the etiology of CIEs is multifactorial, the considerable overlap between the clinical presentation of MK, CLPU, CLARE, and IK is such that it is not possible to clinically differentiate between them with any degree of certainty. A preferred approach might be to consider CIEs as part of a disease continuum whereby these events can manifest in various degrees of severity, depending as well on the point at which the condition is observed in the course of the natural history of the disease.
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Affiliation(s)
- Nathan Efron
- Eurolens Research, The University of Manchester, Manchester, UK.
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Efron N, Morgan PB. Impact of Differences in Diagnostic Criteria When Determining the Incidence of Contact Lens-Associated Keratitis. Optom Vis Sci 2006; 83:152-9. [PMID: 16534457 DOI: 10.1097/01.opx.0000204519.92436.70] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the effect of differences in within-study and between-study diagnostic criteria in determining the incidence of contact lens-associated keratitis. METHODS We applied the sets of criteria for "microbial keratitis" as described in five previous studies to the dataset of Morgan et al., which documents 118 cases of contact lens-associated keratitis across a wide range of clinical severities. For each set of criteria, the incidence of contact lens-associated keratitis was calculated for the following five lens type/modality combinations: daily-wear rigid, daily-wear daily disposable hydrogel, daily-wear hydrogel, extended-wear hydrogel, and extended-wear silicone hydrogel. The effect of varying the clinical severity score for the differentiation of nonsevere versus severe keratitis was also examined with respect to the dataset of Morgan et al. RESULTS The size and location of the corneal infiltrative events identified as representing "microbial keratitis" for each of the different sets of criteria are illustrated in a series of cartograms. A key between-study difference in the incidence values calculated for the various sets of criteria relates to the categories of extended-wear hydrogel and extended-wear silicone hydrogel lenses. Specifically, the incidence of "microbial keratitis" was found to be statistically significantly greater for extended-wear hydrogel compared with extended-wear silicone hydrogel lenses when the set of criteria of Morgan et al. was applied, but not when the other sets of criteria were applied, to the dataset of Morgan et al. Increasing the threshold clinical severity criterion for differentiating between nonsevere and severe keratitis within this dataset resulted in lower incidence values; however, such changes in threshold had a minimal impact on relative risk values. CONCLUSIONS The choice of criteria for diagnosing contact lens-associated "microbial keratitis" has a significant impact on calculations of the incidence of this condition.
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Affiliation(s)
- Nathan Efron
- Eurolens Research, The University of Manchester, Manchester, United Kingdom
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Efron N. Are silicone hydrogel lenses safer? Cont Lens Anterior Eye 2005; 28:153-5. [PMID: 16332498 DOI: 10.1016/j.clae.2005.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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