Grant T, Chong M S, Vajdic C, Swarbrick H A, Gauthier C, Sweeney D F, Holden B A
Cornea and Contact Lens Research Unit, School of Optometry, University of New South Wales, Sydney, Australia.
CLAO J. 1998 Jul;24(3):145-51.
Ulcerative keratitis is the most serious adverse response associated with contact lens wear. However, some reports of microbial keratitis in the literature may refer to a less severe form of corneal ulceration, which we have termed contact lens induced peripheral ulcers (CLPU).
We present details of 11 cases of CLPU which occurred in clinical trials at our research unit.
CLPU episodes are characterized by a single, small (< 2 mm diameter) circular lesion in the corneal mid-periphery or periphery, involving a focal loss of the full thickness of the epithelium associated with subepithelial stromal infiltrates. Patient symptoms may include ocular irritation, pain, photophobia, and lacrimation. They are usually associated with the use of hydrogel extended wear contact lenses. The lesions are self-limiting, typically healing within 7 days without treatment. After resolution, a small circular scar remains, which does not affect vision because of its peripheral location. The etiology of CLPU is unclear. In our studies, the incidence of CLPU was similar in conventional (2.9% per patient year) and disposable (2.0% per patient year) hydrogel extended wear, but lower during intermittent extended wear (1.6% per patient year); only one case occurred during daily wear (< 0.5% per patient year).
A conservative approach to patient management of all suspected cases of corneal ulceration is encouraged. However, we suggest that future reports of ulcerative keratitis associated with various lens types and wearing schedules should differentiate between potentially devastating microbial keratitis and the relatively innocuous peripheral ulceration described in this paper.
溃疡性角膜炎是与隐形眼镜佩戴相关的最严重不良反应。然而，文献中一些关于微生物性角膜炎的报道可能指的是一种不太严重的角膜溃疡形式，我们将其称为隐形眼镜诱发的周边溃疡（CLPU）。
我们介绍了在我们研究单位的临床试验中发生的11例CLPU病例的详细情况。
CLPU发作的特征是角膜中周边或周边出现单个小（直径<2mm）圆形病变，涉及上皮全层的局灶性缺失并伴有上皮下基质浸润。患者症状可能包括眼部刺激、疼痛、畏光和流泪。它们通常与水凝胶长戴型隐形眼镜的使用有关。这些病变具有自限性，通常在未经治疗的情况下7天内愈合。愈合后，会留下一个小圆形瘢痕，由于其周边位置，不会影响视力。CLPU的病因尚不清楚。在我们的研究中，传统水凝胶长戴型（每年每位患者2.9%）和一次性水凝胶长戴型（每年每位患者2.0%）中CLPU的发生率相似，但在间歇性长戴期间较低（每年每位患者1.6%）；日常佩戴期间仅发生1例（每年每位患者<0.5%）。
对于所有疑似角膜溃疡病例，鼓励采取保守的患者管理方法。然而，我们建议未来关于与各种镜片类型和佩戴时间表相关的溃疡性角膜炎的报告应区分潜在的毁灭性微生物性角膜炎和本文所述的相对无害的周边溃疡。
