Lim C H L, Carnt N A, Farook M, Lam J, Tan D T, Mehta J S, Stapleton F
School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
Royal Melbourne Hospital, Parkville, VIC, Australia.
Eye (Lond). 2016 Mar;30(3):447-55. doi: 10.1038/eye.2015.250. Epub 2015 Dec 4.
To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load.
Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (P<0.2) were evaluated in a multivariate model.
In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 × lower risk compared with other races (95% CI: 2.3-21.3, P=0.001). Those aged between 25 and 44 years were at 3 × increased risk compared with younger wearers (95% CI: 1.1-9.6, P=0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 × higher risk (95% CI: 1.2-15.4, P=0.03) compared with daily use. Not washing hands before handling was associated with a 13 × increased risk (95% CI: 1.9-84.8, P=0.008). Use of multipurpose solution A carried a 16 × higher risk compared with hydrogen peroxide (95% CI: 1.5-174.0, P=0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%.
Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population.
调查新加坡与隐形眼镜相关的微生物性角膜炎的独立危险因素，并评估它们对疾病负担的影响。
病例为2008年至2010年间因微生物性角膜炎就诊于新加坡国立眼科中心的隐形眼镜佩戴者。招募社区隐形眼镜佩戴者作为对照。所有佩戴者均完成一份先前验证过的问卷，描述隐形眼镜佩戴史、卫生和依从习惯以及人口统计学特征。在多变量模型中评估单变量分析中有显著意义的危险因素（P<0.2）。
共识别出58例微生物性角膜炎病例和152名同期对照。在控制其他变量时，华裔与其他种族相比风险降低7倍（95%可信区间：2.3 - 21.3，P = 0.001）。年龄在25至44岁之间的佩戴者与年轻佩戴者相比风险增加3倍（95%可信区间：1.1 - 9.6，P = 0.04）。与每日佩戴相比，偶尔过夜佩戴隐形眼镜（每周少于一晚）的风险高4倍（95%可信区间：1.2 - 15.4，P = 0.03）。佩戴前不洗手的风险增加13倍（95%可信区间：1.9 - 84.8，P = 0.008）。使用多功能护理液A与使用过氧化氢相比风险高16倍（95%可信区间：1.5 - 174.0，P = 0.02）。可改变危险因素（偶尔过夜佩戴、不洗手和多功能护理液A）的合并归因危险百分比为82%。
与先前的研究结果一致，与隐形眼镜相关的微生物性角膜炎的独立危险因素包括手部卫生差、偶尔过夜佩戴以及护理液类型。该人群中长时间过夜或延长隐形眼镜使用情况并不常见。
