Venkata Nagaraju, Sharma Savitri, Gora Rashmi, Chhabra Rajni, Aasuri Murali K
Bausch & Lomb Contact Lens Center, L.V. Prasad Eye Institute, Hyderabad, India.
CLAO J. 2002 Jul;28(3):165-8.
Microbial keratitis (MK) is a serious complication associated with contact lens wear. In this case series we report three clinical presentations of MK associated with daily-wear monthly-replacement soft contact lenses. All of these patients were using vifilcon A (55% water content, ionic, U.S. Food and Drug Administration [FDA] group IV) monthly-replacement soft contact lenses. A gram-stained smear of the corneal scrapings of two patients showed numerous gram-negative cocci bacilli, and tissue cultures showed significant growth of Pseudomonas aeruginosa. In the third patient, the corneal scrapings showed numerous gram-negative bacilli, along with gram-positive cocci, and tissue culture showed significant growth of Aeromonas species and alpha-hemolytic streptococci. All these cases were resolved by medical therapy. This case series highlights the importance of patient symptoms, clinical features, and microbiologic work-up in making a differentiation between MK and sterile contact lens-induced peripheral ulcer (CLPU). A high index of suspicion and close follow-up care will avoid misdiagnosis and reduce complications.
微生物性角膜炎（MK）是与隐形眼镜佩戴相关的一种严重并发症。在本病例系列中，我们报告了3例与日戴型月抛软性隐形眼镜相关的MK临床表现。所有这些患者均使用含55%含水量、离子型、美国食品药品监督管理局（FDA）IV类的vifilcon A月抛软性隐形眼镜。两名患者角膜刮片的革兰氏染色涂片显示有大量革兰氏阴性球菌杆菌，组织培养显示铜绿假单胞菌大量生长。在第三名患者中，角膜刮片显示有大量革兰氏阴性杆菌以及革兰氏阳性球菌，组织培养显示气单胞菌属和甲型溶血性链球菌大量生长。所有这些病例均通过药物治疗得到解决。本病例系列强调了患者症状、临床特征以及微生物学检查在鉴别MK和无菌性隐形眼镜诱导的周边溃疡（CLPU）方面的重要性。高度的怀疑指数和密切的随访护理将避免误诊并减少并发症。
