Original Paper - Travail original - Originalarbeit
Oph (hal mologica 1992;204:169-174
Seiji Hayasaka Kei-ichi Moriliiro Hitomi Shibasaki Sayuri Ugomori Tornoichi Setogawa
Superficial Punctate Keratopathy and Bacterial Growth in Patients with Unilateral Aphakia Using Extended-Wear Soft Contact Lenses
Department of Ophthalmology, Shimanc Medical University. Shimanc. Japan
Key Words
Abstract
Punctate keratopathy Bacterial growth Aphakia Contact lens
We prospectively examined corneal conditions and bacterial growth in 77 individials with unilateral aphakia who were using extended-wear soft contact lenses. The ratios of positive bac terial growth (70.6-79.4%) from 34 patients with superficial punctate keratopathy were significantly higher than those (41.9-46.5%) from the 43 subjects with normal corneas. Bacte rial growth was found frequently in patients w'ith superficial punctate keratopathy who w'ere older than 80 years and in those using soft contact lenses for more than 22 days. Several kinds of bacteria grew' from the specimens. Among the most common w'ere Staphylococcus epidermidis and Cornybacterium species. Pseudomonas aeruginosa grew' from patients with superficial punctate keratopathy w'ho were using extendedw'ear soft contact lenses.
Bacterial corneal ulcers have been report ed as severe complications of extended-wear soft contact lenses in America and in Europe 11.2.5-9.13.15.17.19,20,25], In Japan, mild corneal complications such as superficial
Received: November 25.1991 Accepted: D ecem ber 4. 1991
punctate keratopathy have been sometimes described in patients who were using soft con tact lenses (10, 16,22], We therefore examined the relationship between corneal lesions and bacterial growth in Japanese patients w'ho were using extended-wear soft contact lenses.
Seiji Hayasaka. M l) D epartm ent of Ophthalmology Shimane Medical University Izumo, Shimane 693 (Japan)
© 1992 S. Karger AG. Basel 0030-3755/92/20440169 $2.75/0
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/5/2018 7:44:50 AM
Introduction
Results
Wc examined the corneal conditions and bacterial growth of 77 patients with unilateral aphakia who were using extended-wear soft contact lenses at Shimane Medical University Hospital and affilitated hospitals in March and April 1991. Nondisposable extended-wear soft contact lenses with 78% water content (Breath-O. manufactured by Toray Inc.. Tokyo) were fitted by standard trial lens techniques. Special attention was given to patient comfort and visual acuity for those being fitted for lenses a few months after cataract sur gery. The lenses were disinfected with periodic boiling (once every 7-35 days). Most patients changed to new lenses every 6 months. None had received antibiotics or corticosteroids or had instilled eyedrops for at least 3 weeks before the examination. All had apparently nor mal lacrimal secretion and a patent lacrimal outflow system. For the bactériologie study, sterile dry swabs were applied to the inferior conjunctival fornix of the aphak ic eye, to the extended-wear soft contact lens or to the inferior conjunctival fornix of the fellow eye. Each swab was transported to the bacteriology laboratory within 15 min, where it was inoculated with media. Specimens were evaluated for growth of aerobic and anaerobic bacteria, as described previously [24]. After removing the soft contact lens, fluorescein solution was instilled topically. The corneal condition of the aphakic eye was evaluated by slit lamp bio microscopy, and was determined to be normal or affect ed. Superficial punctate keratopathy was diagnosed according to the descriptions of Leibowitz and Green [ 12] and of Bruce and Brennan [4]. In the present study, corneas stained with only a few dots or with lines appar ently resulting from trauma at the time of removal of the lens were considered normal. The fellow eyes did not wear contact lenses, and their corneas also were examined biomicroscopically after staining with fluo rescein. Excluded from the present study were hospi talized patients and those with a concomitant infectious disease in other organs. Statistical analysis was done by Student's t test. A probability of p < 0.05 was considered statistically sig nificant.
170
Of 77 individuals with unilateral aphakia who were using extended-wear soft contact lenses, 43 subjects had normal corneas and 34 patients had superficial punctate keratopathy. The corneas of the fellow phakic eyes did not stain with fluorescein. No severe corneal ulcer was found. No major difference was noted in sex ratio, time after cataract extraction, or systemic disease between the groups (table 1). The mean age of the normal corneal group was younger (66.5 years) than that of the ker atopathy group (82.6 years). In the group with normal corneas (n = 43), 20 (46.5%) specimens from the conjunctival fornix of the aphakic eye, 19 (44.2%) speci mens from the soft contact lens, and 18 (41.9%) specimens from the conjunctival for nix of the fellow eye showed positive bacterial growth. In the group with superficial punctate keratopathy (n = 34), 27 (79.4%) specimens from the conjunctival fornix of the aphakic eye, 26 (76.5%) specimens from the soft con tact lens, and 24 (70.6%) specimens from the conjunctival fornix of the fellow eye showed positive bacterial growth. Bacterial growths in the aphakic eyes were almost the same as those in the phakic fellow eyes. The ratios of positive bacterial growth (70.6-79.4%) in pa tients with superficial punctate keratopathy were higher than those (41.9—46.5%) in the normal corneas. In particular, patients with superficial punctate keratopathy who were ol der than 80 years showed an increased ratio of positive bacterial growth (table 2). Bacterial growth also was found frequently in patients with superficial punctate keratopathy who had worn the lenses for more than 22 days (table 3). Several kinds of bacteria grew from both the normal corneas and those with super ficial punctate keratopathy (table 4). Among the specimens. Staphylococcus epidermidis and Corynebacterium species were found fre-
Hayasaka/Morihiro/Shibasaki/ Ugomori/Setogawa
Corneal Lesions and Bacterial Growth in Unilateral Aphakia
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/5/2018 7:44:50 AM
Subjects and Methods
Table 1. Sex ratio, age distribution, time after cataract Extraction and systemic disease of
the patients Patients using extended-wear soft contact lenses
Male: Female Age, years Mean Range Time after cataract extraction. years Mean Range Systemic disease Hypertension Cerebral infarction Diabetes mellitus Heart disease
normal cornea (n = 43)
superficial punctate keratopathy (n = 34)
12:31
10:24
66.5 49-85
82.6 55-89
4.0 0.8-6.5 14 6 6 4
5.6 0.8-7.2 13 5 5 4
Table 2. Positive bacterial growth and patients' age
Group
Normal cornea Conj. of aphakic eye Soft contact lens Conj. of fellow eye Superficial punctate keratopathy Conj. of aphakic eye Soft contact lens Conj. of fellow eye
Positive bacterial growth, n (%) 49-69 years (n = 26)
70-79 years (n = 17)
80-89 years (n = 24)
total (n = 77)
n = 20 8 (40) 8 (40) 7 (35) n=6 4 (66.7)* 3 (50)* 3 (50)*
n = 11 5 (45.5) 5 (45.5) 5 (45.5) n= 6 4 (66.7)* 4 (66.7)* 4 (66.7)*
n = 12 7 (58.3) 6 (50) 6 (50) n = 22 19 (86.4** 19 (86.4)** 17 (77.3)*
n=43 20 (46.5) 19 (44.2) 18 (41.9) n = 34 27 (79.4)*** 26 (76.5)*** 24 (70.6)**
p value (compared with the normal corneal group in the same age group): *p>0.05; **p
Oph (hal mologica 1992;204:169-174
Seiji Hayasaka Kei-ichi Moriliiro Hitomi Shibasaki Sayuri Ugomori Tornoichi Setogawa
Superficial Punctate Keratopathy and Bacterial Growth in Patients with Unilateral Aphakia Using Extended-Wear Soft Contact Lenses
Department of Ophthalmology, Shimanc Medical University. Shimanc. Japan
Key Words
Abstract
Punctate keratopathy Bacterial growth Aphakia Contact lens
We prospectively examined corneal conditions and bacterial growth in 77 individials with unilateral aphakia who were using extended-wear soft contact lenses. The ratios of positive bac terial growth (70.6-79.4%) from 34 patients with superficial punctate keratopathy were significantly higher than those (41.9-46.5%) from the 43 subjects with normal corneas. Bacte rial growth was found frequently in patients w'ith superficial punctate keratopathy who w'ere older than 80 years and in those using soft contact lenses for more than 22 days. Several kinds of bacteria grew' from the specimens. Among the most common w'ere Staphylococcus epidermidis and Cornybacterium species. Pseudomonas aeruginosa grew' from patients with superficial punctate keratopathy w'ho were using extendedw'ear soft contact lenses.
Bacterial corneal ulcers have been report ed as severe complications of extended-wear soft contact lenses in America and in Europe 11.2.5-9.13.15.17.19,20,25], In Japan, mild corneal complications such as superficial
Received: November 25.1991 Accepted: D ecem ber 4. 1991
punctate keratopathy have been sometimes described in patients who were using soft con tact lenses (10, 16,22], We therefore examined the relationship between corneal lesions and bacterial growth in Japanese patients w'ho were using extended-wear soft contact lenses.
Seiji Hayasaka. M l) D epartm ent of Ophthalmology Shimane Medical University Izumo, Shimane 693 (Japan)
© 1992 S. Karger AG. Basel 0030-3755/92/20440169 $2.75/0
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/5/2018 7:44:50 AM
Introduction
Results
Wc examined the corneal conditions and bacterial growth of 77 patients with unilateral aphakia who were using extended-wear soft contact lenses at Shimane Medical University Hospital and affilitated hospitals in March and April 1991. Nondisposable extended-wear soft contact lenses with 78% water content (Breath-O. manufactured by Toray Inc.. Tokyo) were fitted by standard trial lens techniques. Special attention was given to patient comfort and visual acuity for those being fitted for lenses a few months after cataract sur gery. The lenses were disinfected with periodic boiling (once every 7-35 days). Most patients changed to new lenses every 6 months. None had received antibiotics or corticosteroids or had instilled eyedrops for at least 3 weeks before the examination. All had apparently nor mal lacrimal secretion and a patent lacrimal outflow system. For the bactériologie study, sterile dry swabs were applied to the inferior conjunctival fornix of the aphak ic eye, to the extended-wear soft contact lens or to the inferior conjunctival fornix of the fellow eye. Each swab was transported to the bacteriology laboratory within 15 min, where it was inoculated with media. Specimens were evaluated for growth of aerobic and anaerobic bacteria, as described previously [24]. After removing the soft contact lens, fluorescein solution was instilled topically. The corneal condition of the aphakic eye was evaluated by slit lamp bio microscopy, and was determined to be normal or affect ed. Superficial punctate keratopathy was diagnosed according to the descriptions of Leibowitz and Green [ 12] and of Bruce and Brennan [4]. In the present study, corneas stained with only a few dots or with lines appar ently resulting from trauma at the time of removal of the lens were considered normal. The fellow eyes did not wear contact lenses, and their corneas also were examined biomicroscopically after staining with fluo rescein. Excluded from the present study were hospi talized patients and those with a concomitant infectious disease in other organs. Statistical analysis was done by Student's t test. A probability of p < 0.05 was considered statistically sig nificant.
170
Of 77 individuals with unilateral aphakia who were using extended-wear soft contact lenses, 43 subjects had normal corneas and 34 patients had superficial punctate keratopathy. The corneas of the fellow phakic eyes did not stain with fluorescein. No severe corneal ulcer was found. No major difference was noted in sex ratio, time after cataract extraction, or systemic disease between the groups (table 1). The mean age of the normal corneal group was younger (66.5 years) than that of the ker atopathy group (82.6 years). In the group with normal corneas (n = 43), 20 (46.5%) specimens from the conjunctival fornix of the aphakic eye, 19 (44.2%) speci mens from the soft contact lens, and 18 (41.9%) specimens from the conjunctival for nix of the fellow eye showed positive bacterial growth. In the group with superficial punctate keratopathy (n = 34), 27 (79.4%) specimens from the conjunctival fornix of the aphakic eye, 26 (76.5%) specimens from the soft con tact lens, and 24 (70.6%) specimens from the conjunctival fornix of the fellow eye showed positive bacterial growth. Bacterial growths in the aphakic eyes were almost the same as those in the phakic fellow eyes. The ratios of positive bacterial growth (70.6-79.4%) in pa tients with superficial punctate keratopathy were higher than those (41.9—46.5%) in the normal corneas. In particular, patients with superficial punctate keratopathy who were ol der than 80 years showed an increased ratio of positive bacterial growth (table 2). Bacterial growth also was found frequently in patients with superficial punctate keratopathy who had worn the lenses for more than 22 days (table 3). Several kinds of bacteria grew from both the normal corneas and those with super ficial punctate keratopathy (table 4). Among the specimens. Staphylococcus epidermidis and Corynebacterium species were found fre-
Hayasaka/Morihiro/Shibasaki/ Ugomori/Setogawa
Corneal Lesions and Bacterial Growth in Unilateral Aphakia
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/5/2018 7:44:50 AM
Subjects and Methods
Table 1. Sex ratio, age distribution, time after cataract Extraction and systemic disease of
the patients Patients using extended-wear soft contact lenses
Male: Female Age, years Mean Range Time after cataract extraction. years Mean Range Systemic disease Hypertension Cerebral infarction Diabetes mellitus Heart disease
normal cornea (n = 43)
superficial punctate keratopathy (n = 34)
12:31
10:24
66.5 49-85
82.6 55-89
4.0 0.8-6.5 14 6 6 4
5.6 0.8-7.2 13 5 5 4
Table 2. Positive bacterial growth and patients' age
Group
Normal cornea Conj. of aphakic eye Soft contact lens Conj. of fellow eye Superficial punctate keratopathy Conj. of aphakic eye Soft contact lens Conj. of fellow eye
Positive bacterial growth, n (%) 49-69 years (n = 26)
70-79 years (n = 17)
80-89 years (n = 24)
total (n = 77)
n = 20 8 (40) 8 (40) 7 (35) n=6 4 (66.7)* 3 (50)* 3 (50)*
n = 11 5 (45.5) 5 (45.5) 5 (45.5) n= 6 4 (66.7)* 4 (66.7)* 4 (66.7)*
n = 12 7 (58.3) 6 (50) 6 (50) n = 22 19 (86.4** 19 (86.4)** 17 (77.3)*
n=43 20 (46.5) 19 (44.2) 18 (41.9) n = 34 27 (79.4)*** 26 (76.5)*** 24 (70.6)**
p value (compared with the normal corneal group in the same age group): *p>0.05; **p
