Atlas of Ophthalmology

Patient: 33 years of age, female, BCVA light perception at OD. Ocular Medical history: wear of a daily wear rigid gas permeable contact lens. Sudden begin of subjective symptoms with decreased vision. The interval between symptoms and presentation at the hospital was 3 days. Corneal scraping was obtained. The microbial analysis resulted in Pseudomonas aeruginosa. Due to a perforation of the central infiltrate the eye required corneal transplantation. General Medical History: empty. Purpose: to present corneal infiltration due to wear of contact lenses. Methods: Colour imaging. Findings: Colour image: flat anterior chamber with a central spontaneous corneal perforation combined with a stromal infiltrate. The size of infiltrate was 7 mm without presence of hypopyon. Discussion: Pseudomonas aeruginosa is a frequently isolated microorganism in contact lens wearers. It was reported (1), that the estimated annual incidence of microbial keratitis per 10,000 contact lens wearers, depending on lens type and wearing schedule, ranges between 1.2 for daily wear rigid gas permeable (RGP) lenses and 25.4 for extended wear of silicone hydrogel lenses. Microbial keratitis is a serious complication of contact lens wear, with approximately one out of five cases requiring corneal transplantation. Hoddenbach et al. (2) investigated the clinical presentation, isolated organism, treatment, and morbidity of contact lens-associated microbial keratitis needing hospitalization. He included 109 consecutive patients with contact lens-associated microbial keratitis from 2005 to 2009. In 69% Pseudomonas aeruginosa was isolated. Ofloxacin, or a combination of gentamicin and cephazolin, was suggested as an excellent first-choice therapy. In his study after intensive treatment 67 % achieved a BCVA ≥ 0.7 Snellen and 20 % required corneal transplantation. Literature: (1) Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62 (2) Hoddenbach JG, Boekhoorn SS, Wubbels R, Vreugdenhil W, Van Rooij J, Geerards AJ. Clinical presentation and morbidity of contact lens-associated microbial keratitis: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2013 Nov 27

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