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2001 Ocular Microbiology and Immunology Group, Abstract 9

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Trends in Contact Lens-Associated Microbial Keratitis in South India
S. Sharma, S. Gopalakrishnan, B. Opt, M. Asuri, P. Garg and G.N. Rao
L.V. Prasad Eye Institute, Hyerabad, India

Purpose: To review the microbiological profile, clinical course, treatment, and outcome in patients with contact lens-associated microbial keratitis in the setting of a tertiary eye care center in south India.

Methods: Analysis of a non-comparative case series was carried out from a prospectively collected database of patients with corneal ulcers. Twenty-nine subjects seen in the contact lens clinic between February 1991 and September 2000, and presenting with corneal stromal infiltrate on slit lamp examination with a history of contact lens wear, were included in the study. All patients underwent standard diagnostic microbiologic evaluation, and a smear and culture guided topical antimicrobial therapy. A penetrating keratoplasty was performed in some patients.

Results: Twenty-nine out of 23,889 (0.12%) contact lens wearing patients presented with laboratory proven infectious keratitis. These patients constituted 0.72% of 4967 corneal ulcer patients seen during the same period. The majority (15/29) of the patients wore soft contact lenses on a daily wear basis. Rigid gas-permeable lenses were worn by six patients, therapeutic bandage contact lenses by four, and silsoft lenses by four. Laboratory results showed bacterial infections in 26 patients (86.6%) and Pseudomonas was the most common organism (13/26, 15%). Acanthamoeba, herpes simplex virus, and Aspergillus niger were isolated in one case each. Laboratory based medical therapy led to healing of ulcers in 24/29 (80%) patients while five patients required penetrating keratoplasty.

Conclusions: Contact lens-associated microbial keratitis is not seen commonly in south India. However, when it occurs, soft contact lens wear is the most common risk factor, with Pseudomonas as the predominant causative agent. Fungal, viral and Acanthamoeba keratitis are rare. The offending bacteria are usually sensitive to antibiotics and the treatment outcome with medical therapy is good.

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