Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Cornea. 2010 May;29(5):564-8. doi: 10.1097/ICO.0b013e3181ba0cde.
To report a series of 5 patients with soft contact lens (SCL) related fungal keratitis caused by unusual organisms diagnosed at the Wills Eye Institute, Cornea Service in 2008.
Chart review of patients with SCL related Alternaria and Paecilomyces keratitis diagnosed in 2008 was performed. Causes of these fungal infections were compared to previous years.
During a period from 1999 to 2007, among 64 patients with fungal keratitis, Alternaria was isolated from one case after corneal foreign body removal in 2004, and Paecilomyces was not isolated in any of these patients. In 2008, however, 5 patients with SCL-related atypical fungal keratitis were diagnosed. Alternaria was isolated from 2 cases and Paecilomyces from 3 cases. All patients wore Acuvue SCL (Johnson & Johnson Vision Care): Acuvue Oasys, Acuvue Advance, and Acuvue 2 (1 case each) and Acuvue unspecified (2 cases). A total of 2 patients with Alternaria and 1 patient with Paecilomyces used ReNu or a generic-brand solution manufactured by Bausch & Lomb; 2 with Paecilomyces keratitis used Opti-free Replenish solution. A total of 3 patients wore lenses for daily wear and 2 wore them occasionally for overnight wear. The patients were treated with either voriconazole drops alone or combined with voriconazole 200 mg pills or Natamycin 5% drops. Three patients responded well to treatment. One patient with Paecilomyces keratitis developed a corneal perforation managed with tissue adhesive. One Paecilomyces keratitis patient required an emergency penetrating keratoplasty because of a perforated corneal ulcer present at the initial examination.
We report 2 cases of Alternaria and 3 cases of Paecilomyces keratitis in patients wearing frequent replacement lenses and using multipurpose solutions diagnosed during 2008. We want to raise awareness of fungal keratitis caused by unusual organisms associated with SCL wear.
报告在 2008 年威尔眼科研究所角膜科诊断的 5 例由不常见病原体引起的软性隐形眼镜（SCL）相关真菌性角膜炎患者系列。
对 2008 年诊断的 SCL 相关链格孢菌和拟青霉角膜炎患者进行图表回顾。将这些真菌感染的原因与前几年进行了比较。
在 1999 年至 2007 年期间，在 64 例真菌性角膜炎患者中，2004 年角膜异物取出后从 1 例中分离出链格孢菌，而这些患者中均未分离出拟青霉。然而，在 2008 年，诊断出 5 例与 SCL 相关的非典型真菌性角膜炎患者。从 2 例中分离出链格孢菌，从 3 例中分离出拟青霉。所有患者均佩戴 Acuvue SCL（强生视力保健）：Acuvue Oasys、Acuvue Advance 和 Acuvue 2（各 1 例）和 Acuvue 未指定（2 例）。共有 2 例链格孢菌和 1 例拟青霉菌患者使用 ReNu 或由 Bausch & Lomb 制造的通用品牌溶液；2 例拟青霉角膜炎患者使用 Opti-free Replenish 溶液。共有 3 例患者佩戴日戴镜片，2 例患者偶尔佩戴过夜。患者接受伏立康唑滴眼液单独治疗或联合伏立康唑 200mg 片剂或那他霉素 5%滴眼液治疗。3 例患者对治疗反应良好。1 例拟青霉角膜炎患者因角膜穿孔而使用组织胶治疗。1 例拟青霉角膜炎患者因初始检查时存在穿孔性角膜溃疡而紧急进行穿透性角膜移植。
我们报告了 2008 年诊断的 2 例链格孢菌和 3 例拟青霉角膜炎患者，他们佩戴频繁更换镜片并使用多用途溶液。我们希望提高对与 SCL 佩戴相关的不常见病原体引起的真菌性角膜炎的认识。
