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Published on: April 6, 2016
Contact lens-associated fusarium keratitis in Switzerland
C Kaufmann1, B E Frueh, J Messerli
1Department of Ophthalmology, University of Zurich, Zurich, Switzerland. claude.kaufmann2@usz.ch
Background:
Fusarium has been an exceptionally rare cause of infectious keratitis. A recent outbreak of Fusarium keratitis in contact lens wearers in North America and Asia has been associated with the multipurpose disinfection solution ReNu with MoistureLoc (Bausch&Lomb). We report a series of Fusarium keratitis in Swiss contact lens wearers.
Patients And Methods:
A multicentre retrospective case review of patients with corneal ulceration and a positive microbiological identification of Fusarium species was undertaken.
Results:
Between September 2005 and August 2007, six cases of Fusarium keratitis were identified. Patients were 39 to 63 years of age. All patients were using disposable soft contact lenses for at least two years. Four patients used daily wear disposable lenses. Two patients were wearing 1-monthly disposable lenses and used ReNu with MoistureLoc solution. Due to multiresistant Fusarium, enucleation was required in two cases and an emergency keratoplasty was performed in three cases. An optical keratoplasty was undertaken in one case that developed corneal scarring. Final visual acuity in patients with preserved eyes ranged from light perception to 8 / 20.
Conclusions:
Exposure to ReNu with MoistureLoc is not the only risk factor for Fusarium keratitis. In addition to antifungal therapy, an early keratoplasty with excision of the infected tissue seems mandatory to improve prognosis.
Insights
Fusarium keratitis is rare but emerging in contact lens wearers. Early surgical intervention, like keratoplasty, is crucial for improving outcomes, not just antifungal therapy.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fusarium keratitis is an uncommon ocular infection.
- A recent outbreak linked to a specific contact lens solution (ReNu with MoistureLoc) has been reported in North America and Asia.
- This study investigates Fusarium keratitis cases in Swiss contact lens wearers.
Observation:
- Six cases of Fusarium keratitis were identified between September 2005 and August 2007.
- All affected patients were disposable soft contact lens users aged 39-63.
- Two patients used monthly disposable lenses with ReNu with MoistureLoc; the solution was not the sole risk factor.
Findings:
- Multiresistant Fusarium strains necessitated aggressive treatment.
- Two patients required enucleation, and three underwent emergency keratoplasty.
- One patient had an optical keratoplasty for corneal scarring, with final visual acuity ranging from light perception to 8/20.
Implications:
- Contact lens wear, particularly with specific solutions, poses a risk for Fusarium keratitis.
- Prompt surgical excision of infected corneal tissue (keratoplasty) alongside antifungal treatment is vital for better patient prognosis.
- This highlights the need for vigilance and potentially revised disinfection protocols in contact lens care.
