Achromobacter xylosoxidans Keratitis after Contact Lens Usage

To report on Achromobacter xylosoxidans keratitis in two healthy patients who had worn contact lenses foran extended period of time. A 36-year-old female and a 21-year-old female visited our hospital with ocular pain and blurred vision. Both patients had a history of wearing soft contact lenses for over fve years with occasional overnight wear. At the initial presentation, a slit lamp examination revealed corneal stromal infiltrations and epithelial defects with peripheral neovascularization in both patients. Microbiological examinations were performed from samples of corneal scrapings, contact lenses, contact lens cases, and solution. The culture resulting from the samples taken from the contact lenses, contact lens cases, and solution were all positive for Achromobacter xylosoxidans. Confrming that the direct cause of the keratitis was the contact lenses, the frst patient was prescribed ceftazidime and amikacin drops sensitive to Achromobacter xylosoxidans. The second patient was treated with 0.3% gatifoxacin and fortifed tobramycin drops. After treatment, the corneal epithelial defects were completely healed, and subepithelial corneal opacity was observed. Two cases of Achromobacter xylosoxidans keratitis were reported in healthy young females who wore soft contact lenses. Achromobacter xylosoxidans should be considered a rare but potentially harmful pathogen for lens-induced keratitis in healthy hosts.

Queratitis por Pseudomonas aeruginosa asociada al uso de lentes de contacto de hidrogel de silicona de última generación: Reporte de un caso / Pseudomonas aeruginosa keratitis associated with the use of last generation contact lens made of silicone hydrogel: case report

We report the case of a female patient, 56-year-old housewife, for the first time user of last generation contact lenses: Lotrafilcon B, which presented a severe corneal ulcer by Pseudomonas aeruginosa in hev left eye and subsequently required keratoplasty. Initially she reported pain and arrived at the emergency department with red eye, corneal central ulcer of three days of evolution and hypopion. Initially she received topic mydriatic drugs and prednisolone at 1 percent. At the next day the ophthalmologycal exam showed hypopion at 5 percent and a central severe ulcer greater than 3 mm in diameter with sharp edges and mucopurulent secretion. The treatment was changed to moxifloxacin and natamycin. The microbiological analysis performed in two laboratories yielded Aspergillus sp. and Pseudomonas aeruginosa sensitive to ciprofloxacin, tobramycin, gentamicin and moxifloxacin. The presence of Aspergillus was interpreted as a pollution lens case and likely colonization of the cornea because of the patient good performance. After four months although improving she required corneal transplantation. Photographic documentation of the case under illumination with slit lamp is presented.

Se comunica el caso de una paciente mujer, de 56 años de edad, ama de casa, usuaria por primera vez de lentes de contacto de última generación: lotrafilcon B, que presentó una úlcera corneal grave por Pseudomonas aeruginosa en su ojo izquierdo y posteriormente requirió quera toplastía. Inicialmente reportó dolor y llegó a la unidad de urgencia con ojo rojo, úlcera corneal central de tres días de evolución e hipopión. El tratamiento farmacológico inicial fue con midriático y prednisolona al 1 por ciento. La valoración oftalmológica del día siguiente demostró hipopión al 5 por ciento y úlcera central grave mayor a 3 mm de diámetro con bordes definidos y secreción mucopurulenta. Se cambió tratamiento a moxifloxacina y natamicina. El análisis microbiológico en dos laboratorios, confirmó el aislado de Aspergillus sp y Pseudomonas aeruginosa; esta última sensible a ciprofloxacina, tobramicina, gentamicina y moxifloxacina. La presencia de Aspergillus se interpretó como contaminación del estuche y probable colonización de la cornea por la clínica y buena evolución. A los cuatro meses de evolución, aunque presentó mejoría, requirió trasplante corneal. Se incluye documentación fotográfica del caso bajo iluminación con lámpara de hendidura.

Avaliaçäo clínica de lentes de contato descartáveis em regime de troca planejada em usuários de lentes newvues e focus em uso diário / Clinical evaluation of frequent replacement disposable contact lenses on patients wearing NewVues and Focus (Ciba Vision) daily wear

Objetivo: foi realizado um estudo retrospectivo para avaliar o perfil e o comportamento de clientes particulares usuários de lentes de contato descartáveis de troca planejada (LCTP). Material e métodos: os prontuários de todos os pacientes adaptados com LCTP (lentes NewVues ou Focus, Ciba Visison) atendidos entre janeiro de 1995 e julho de 1996 foram revisados. Um questionário näo estruturado foi aplicado para obter dados sobre complicaçöes anteriores com lentes de contato, motivos de opçäo por LCTP, causas de abandono e opiniäo sobre as LCTP. Resultados: problemas ocorreram em 37,8p/c dos usuários de lente Focus. Mais de 80p/c dos pacientes consideraram bom e ótimo o conforto com estas lentes

Avaliaçäo clínica de lentes de contato descartáveis / Clinical evaluation of disposable contact lenses

Estudou-se, durante um ano, a adaptaçäo de lente de contato descartável em 51 pacientes, que trocavam as lentes semanalmente. Em três pacientes, o uso da lente foi suspenso devido a complicaçöes: um por simtomas de olho seco, um por meibomite e outro pelo desenvolvimento de infiltrados corneanos imunoalérgicos. Onze pacientes tiveram complicaçöes oculares que determinaram a suspensäo temporária do uso de LD. Treze pacientes foram excluídos do estudo: sete por näo comparecerem aos exames de controle, cinco mudaram de cidade e um apresentou paralisia facial com lagoftalmo. Dentro das condiçöes desse estudo, a adaptaçäo, acuidade visual e segurança com o uso da lente descartável foram consideradas satisfatórias, mesmo em pacientes que haviam abandonado o uso de outros tipos de lentes de contato. Recomenda-se seleçäo e orientaçäo rigorosas dos pacientes a serem adaptados e um programa regular (a cada três meses) de controle pós-adaptaçäo.

Lentes de contato descartáveis / Position paper on disposable contact lenses

O Comitê Internacional de Lentes de Contato reuniu-se para discutir o uso prolongado de Lentes de Contato Descartáveis e chegou à conclusäo que a reposiçäo regular das lentes reduziria a incidência de complicaçöes. Através de informaçöes clínicas e científicas, o artigo visa dar recomendaçöes aos adaptadores de lentes de contato descartáveis, proporcionando assim maior segurança e eficácia ao uso deste tipo de lente. O Comitê concluiu que as lentes descartáveis säo melhor usadas no sistema uso diário e observa que o número de ulceraçöes corneanas aumenta com o número de noites consecutivas de uso das lentes de contato

Complicaçöes das lentes hidrofílicas de uso diário e uso prolongado / Hydrophilic lenses complications of diary and prolonged use

A adaptaçäo de lentes de contacto gelatinosas de uso prolongado deve estar subordinada a um controle mais freqüente, que inclua a medida de acuidade visual, ceratometria, biomicroscopia e estesiometria

Complications associated with soft contact lens use

A retrospective study of 246 consecutive patients fit with daily and extended wear soft contact lenses was undertalken to determine the incidence and range of lens related problems is cosmetic, aphakic, and keratoplasty patients in a cornea service setting. Adequate data for inclusion in the study were available from 212 patients, who were folloowed for a minimum of six months (range 6-42 months; memdian 30 months). Approximately half (105 of 212; 50%) of the patients demonstrated problems. The most common problem was corneal neovascularization (61 of 212; 29%), which was greater than 1mm in 10% (22 of 212). Seious complications were infrequent. Two aphakic graft patients developed suture abscesses and three had rejection episodes. Overall, extended wear lens patients were significantly more likely to have complications (62 of 85; 73%) thandaily wear lens patients (43 of 127; 34%) (P < 001). Cosmetic lens patients were significantly less likely to have problems (34 of 98; 35%) than aphakic patients (35 of 50; 70%) (P , 001). Our data suggest that problems (including peripheral neovascularization, deposits, and chemical reactions related to soft lens wear) are common, but serious, visiontion, deposits, and chemical reactions related do soft lens wear) are common, but serious, visionthreatening complications (including corneal ulcers) are infrequent when lenses are fit carefully and patients are repeatedly instructed regarding lens use