Orthokeratology-Associated Infectious Keratitis in a Tertiary Care Eye Hospital in Hong Kong

• Published in: American journal of ophthalmology 2014-12, Vol.158 (6), p.1130-1135.e2
• Main Authors: Chan, Tommy C.Y, Li, Emmy Y.M, Wong, Victoria W.Y, Jhanji, Vishal
• Format: Article
• Language: English
• Subjects: Acanthamoeba Keratitis - diagnosis; Acanthamoeba Keratitis - drug therapy; Acanthamoeba Keratitis - parasitology; Adolescent; Anti-Bacterial Agents - therapeutic use; Antiprotozoal Agents - therapeutic use; Child; Contact lenses; Contact Lenses - adverse effects; Corneal Ulcer - diagnosis; Corneal Ulcer - drug therapy; Corneal Ulcer - microbiology; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye Infections, Parasitic - diagnosis; Eye Infections, Parasitic - drug therapy; Eye Infections, Parasitic - parasitology; Female; Hong Kong; Hospitalization; Hospitals, Special; Humans; Male; Myopia; Ophthalmology; Orthokeratologic Procedures - adverse effects; Retrospective Studies; Tertiary Healthcare; Ulcers; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.08.026

Purpose To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013. Design Retrospective study. Methods Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes. Results A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9–23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6–131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P < .001). Conclusions Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes.