A comparison of contact lens-related complications in various daily wear modalities.

PURPOSE: To determine the incidence of contact lens-related complications in various daily wear contact lens modalities. METHODS: The charts of 138 daily wear contact lens patients (35 daily disposable, 34 two week replacement, 34 frequent replacement, and 35 conventional daily wear lens users) were reviewed for subjective and objective contact lens problems. We also looked at two subgroups: first time lens wearers and patients with previous lens-related problems. The rate of lens related complications were calculated as events per person per year (E/P/Y) of lens wear for each year and for the total 3-year study. The percentage of patients in each group who experienced any complication was calculated. We also compared the complication rate for the groups in our current study to the rates calculated for disposable extended wear and conventional extended wear patients from our previous study. RESULTS: We found that the E/P/Y were significantly lower for daily disposable lens wearers, but no significant differences were noted for all other lens wear modalities. There was a trend in most groups toward decreased numbers of complications in the second and third years of lens wear. Of the 23 individual signs and symptoms that were analyzed, three occurred most frequently among daily disposable lens wearers, two were most common in the 2-week replacement group, four occurred most often in frequent replacement patients, and eight were most frequent in conventional daily lens wearers. (In three categories, there were two groups with ties for the highest rate of occurrence, and two categories with zero rates for all groups.) Most of the observed differences in complication rates for individual signs and symptoms did not reach the level of statistical significance. CONCLUSIONS: Daily disposable lens wearers had the lowest overall complication rate.

Peripheral corneal infiltrates associated with contact lens wear.

PURPOSE: We describe the epidemiological and clinical characteristics of peripheral corneal infiltrates associated with contact lens wear. METHODS: We conducted a retrospective study of 52 patients with contact lens associated peripheral corneal infiltrates. Demographic data, clinical characteristics of the infiltrates, contact lens parameters, treatment modality, and the time to resolution for the infiltrates were analyzed. RESULTS: Forty-four of the 52 patients in this study presented with a single infiltrate, while the remaining 8 patients had multiple infiltrates. Types of contact lenses worn were as follows: 40% of the patients wore disposable extended wear contact lenses; 21% wore conventional extended wear lenses; 19% wore conventional daily wear lenses; 12% used frequent replacement daily wear lenses; 6% wore rigid gas permeable (RGP) contact lenses; and 2% used disposable lenses as daily wear. Although there was no predilection for a specific quadrant of the cornea, when a subgroup of extended wear contact lens patients was analyzed, 19 of their 40 infiltrates were located in the superior quadrant. The epithelium was intact in 42% of the infiltrates, while 58% of the infiltrates had epithelial involvement, either punctate staining or frank defect. Eight of the 16 patients who had corneal cultures performed had positive cultures. All patients who had positive cultures used extended wear contact lenses. Smoking did not appear to have an effect on the associated inflammatory reaction, positive cultures, or time to resolution. Seventy-five percent of patients were treated with topical antibiotics. Antibiotic steroids were prescribed for 23% of patients, and 2% of patients were treated with topical steroids. The mean time to resolution for all infiltrates was 1.74 weeks. CONCLUSIONS: Focal peripheral infiltrates with or without epithelial disturbance represent a distinct clinical complication associated with contact lens wear. All patients in this study had resolution of their infiltrates without complications. We recommend that after resolution of corneal infiltrates, patients should be refit with daily wear soft or RGP contact lenses.

Peripheral corneal infiltrates associated with contact lens wear.

PURPOSE: A retrospective study was performed to review the clinical characteristics of peripheral corneal infiltrates in contact lens wearers. METHODS: The charts of all contact lens patients with peripheral corneal infiltrates 1.5 mm or less in size who presented to the office from 1987 to 1994 were reviewed. RESULTS: The epidemiological and clinical characteristics of peripheral corneal infiltrates associated with contact lens wear were reviewed in 52 patients (64 infiltrates). Forty-four patients presented with a single infiltrate, while the remaining 8 patients had multiple infiltrates. While there was no predilection for a specific quadrant of the cornea, when a subgroup of patients who wore extended wear lenses was analyzed, 19 of the 40 infiltrates were located in the superior quadrant. Forty percent of the patients were wearing disposable extended wear contact lenses, 21% were wearing conventional extended wear lenses, 33% were wearing conventional or frequent replacement/disposable daily wear contact lenses and 6% were wearing rigid gas permeable lenses. The majority of patients had minimal conjunctival inflammation, an anterior stromal cellular reaction and minimal anterior chamber activity. A subgroup of 16 patients had corneal cultures of their infiltrates. In this group, 8 of the 16 had positive cultures. All patients had a resolution of the infiltrates without complications and the majority were refitted to daily wear soft or rigid contact lenses. CONCLUSION: Peripheral corneal infiltrates in contact lens wearers appears to be more common in patients wearing extended wear soft contact lenses. While often considered "sterile" in the literature, a significant number have been shown to be culture-positive. The organisms that have been associated with peripheral infiltrates appear to be less "pathogenic" than those that have been reported to be associated with central corneal ulcer. However, it is probably advisable that patients with peripheral corneal ulcers secondary to contact lens wear should be initially treated with topical antibiotics.