Suresh Lakshmi, Hammoudeh Yasmeen, Ho Charlotte S, Ong Zun Zheng, Cairns Jessica, Gopal Bhavesh P, Krstic Lazar, Elsahn Ahmad, Lister Michelle M, Said Dalia G, Dua Harminder S, Ting Darren S J
Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK.
Department of Ophthalmology, Western Eye Hospital, London, UK.
Eye (Lond). 2024 Dec;38(18):3459-3466. doi: 10.1038/s41433-024-03323-7. Epub 2024 Sep 12.
BACKGROUND/OBJECTIVES: To examine the clinical characteristics, risk factors and outcomes of contact lens-related bacterial keratitis (CLBK) in a large UK tertiary referral centre.
SUBJECTS/METHODS: A retrospective analysis of all patients who presented to the Queen's Medical Centre, Nottingham, UK, with suspected CLBK between October 2015 to September 2022 (a 7-year period) was performed. Relevant data on demographic factors, CL wear behaviour, causes, clinical characteristics, and outcomes were analysed.
We included 138 patients with CLBK; the mean age was 42.0 ± 17.8 years and 74 (53.6%) patients were male. Most CLBK were related to soft CL wear (94.5%), particularly monthly disposable (42.5%) and daily disposable (24.4%) CLs. Poor CL wear behaviour/hygiene was documented in 57.1% cases. Among the 64 (46.4%) microbiological-positive cases (n = 73 organisms), Pseudomonas aeruginosa (36, 49.3%) and Staphylococcus spp. (16, 21.9%) were most commonly identified. Six (4.3%) cases were polymicrobial. Most (97.0%) patients were successfully treated with topical antibiotics alone, with 80.6% achieving good final corrected-distance-visual-acuity (CDVA) of ≥ 0.30 logMAR. Poor visual outcome (final CDVA < 0.30 logMAR) was significantly associated with presenting CDVA < 0.6 logMAR (p = 0.002) and central ulcer (p = 0.004). Poor corneal healing (complete healing of > 30 days from initial presentation) was significantly associated with age > 50 years (p = 0.028), female gender (p = 0.020), and infiltrate size >3 mm (p = 0.031).
Poor CL wear behaviour/hygiene is commonly observed in CLBK, highlighting the importance of improved counselling and awareness regarding CL use and hygiene. When presented early and managed appropriately, most patients are able to achieve good clinical outcomes with medical treatment alone.
背景/目的：在英国一家大型三级转诊中心研究与隐形眼镜相关的细菌性角膜炎（CLBK）的临床特征、危险因素及预后。
受试者/方法：对2015年10月至2022年9月（7年期间）期间到英国诺丁汉女王医疗中心就诊、疑似患有CLBK的所有患者进行回顾性分析。分析了有关人口统计学因素、隐形眼镜佩戴行为、病因、临床特征及预后的相关数据。
我们纳入了138例CLBK患者；平均年龄为42.0±17.8岁，74例（53.6%）患者为男性。大多数CLBK与软性隐形眼镜佩戴有关（94.5%），尤其是月抛型（42.5%）和日抛型（24.4%）隐形眼镜。57.1%的病例记录有不良的隐形眼镜佩戴行为/卫生习惯。在64例（46.4%）微生物学阳性病例（共73种微生物）中，最常鉴定出铜绿假单胞菌（36例，49.3%）和葡萄球菌属（16例，21.9%）。6例（4.3%）为混合感染。大多数（97.0%）患者仅通过局部使用抗生素就成功治愈，80.6%的患者最终矫正远视力（CDVA）≥0.30 logMAR，预后良好。视力预后差（最终CDVA<0.30 logMAR）与就诊时CDVA<0.6 logMAR（p=0.002）及中央溃疡（p=0.004）显著相关。角膜愈合不佳（从初次就诊起>30天完全愈合）与年龄>50岁（p=0.028）、女性（p=0.020）及浸润灶大小>3mm（p=0.031）显著相关。
在CLBK中常见不良的隐形眼镜佩戴行为/卫生习惯，这凸显了加强关于隐形眼镜使用和卫生的咨询及提高意识的重要性。如果早期就诊并得到适当治疗，大多数患者仅通过药物治疗就能取得良好的临床预后。
