Carnt Nicole, Jalbert Isabelle, Stretton Serina, Naduvilath Thomas, Papas Eric
Vision Cooperative Research Centre, Sydney, Australia.
Optom Vis Sci. 2007 Apr;84(4):309-15. doi: 10.1097/OPX.0b013e318046551b.
Contact lens-associated solution toxicity manifests as generalized, mild punctate epithelial fluorescein staining and usually is widely reported as asymptomatic, with no substantial clinical sequelae. This study examined the relationship between solution toxicity and corneal infiltrative events (CIEs) in soft contact lens daily wear.
Several nonrandomized interventional clinical trials conducted between May and November 2005 were analyzed retrospectively. Subjects wore commercially available soft contact lenses bilaterally, on a daily schedule, disinfected overnight using marketed lens care solutions for 3 months with monthly disposal. Solution toxicity was defined as diffuse punctate staining in at least four of five areas of the cornea after instillation of sodium fluorescein. First events of corneal staining or corneal infiltrates were used to calculate incidence (per 100 eye months).
Toxic staining was detected in 77 of 609 subjects and all CIEs were mild and symptomatic or asymptomatic. The incidence of CIEs in eyes with a predisposition to toxic staining was 6.7% and in unaffected eyes was 2.3%. CIEs were 3-times more likely to occur in eyes that exhibited solution toxicity compared to unaffected eyes (odds ratio = 3.08, p = 0.008, 95% CI 1.40 to 6.76). Previous events of limbal redness (> or =grade 2.0) were not associated with CIEs (odds ratio = 1.53, p = 0.364, 95% CI 0.63 to 3.70). The rate of CIEs increased as the rate of toxic staining increased for specific lens type-solution combinations (Spearman's rho = 0.558, p = 0.025, n = 16), and peroxide-based solutions consistently resulted in the lowest rates of toxic staining and corneal inflammation.
Eyes that experience solution toxicity are more likely to experience a CIE. Daily wear soft lens wearers should be routinely examined with sodium fluorescein soon after lenses are inserted and alternative solution/lens type combinations should be investigated if toxic staining is detected.
与隐形眼镜相关的护理液毒性表现为广泛性、轻度点状上皮荧光素染色，通常被广泛报道为无症状，且无严重临床后遗症。本研究探讨了软性隐形眼镜日戴情况下护理液毒性与角膜浸润事件（CIE）之间的关系。
回顾性分析了2005年5月至11月期间进行的几项非随机干预性临床试验。受试者双侧每日佩戴市售软性隐形眼镜，每晚使用市售镜片护理液消毒，为期3个月，每月更换镜片。护理液毒性定义为滴入荧光素钠后角膜五个区域中至少四个区域出现弥漫性点状染色。以角膜染色或角膜浸润的首次事件计算发病率（每100眼月）。
609名受试者中有77人检测到毒性染色，所有CIE均为轻度，有症状或无症状。易出现毒性染色的眼睛中CIE的发病率为6.7%，未受影响的眼睛中为2.3%。与未受影响的眼睛相比，出现护理液毒性的眼睛发生CIE的可能性高3倍（优势比=3.08，p=0.008，95%可信区间1.40至6.76）。先前的角膜缘发红事件（≥2.0级）与CIE无关（优势比=1.53，p=0.364，95%可信区间0.63至3.70）。对于特定的镜片类型-护理液组合，CIE的发生率随着毒性染色率的增加而增加（Spearman相关系数=0.558，p=0.025，n=16），而过氧化物基护理液导致的毒性染色和角膜炎症发生率始终最低。
经历护理液毒性的眼睛更有可能发生CIE。日戴软性隐形眼镜佩戴者在插入镜片后应尽快常规使用荧光素钠进行检查，如果检测到毒性染色，应研究替代的护理液/镜片类型组合。
