Microbial keratitis associated with extended wear of silicone hydrogel contact lenses

Traditional hydrogel soft contact lenses (SCL) have limited oxygen permeability.1, 2 Recently introduced silicone hydrogel SCL have much higher oxygen transmissibility (Dk/t O2), allowing near normal oxygen supply to the cornea during extended lid closure, and are hoped by some to address most of the problems related to corneal hypoxia encountered with previous extended wear soft contact lenses.1, 3 They have therefore been approved for up to 30 days of continuous wear in both Europe and Australia. Four cases of microbial keratitis in patients who were using silicone hydrogel SCL (either CibaVision Focus Night and Day lenses (Lotrafilicon A, fluorosiloxane hydrogel) or Bausch & Lomb PureVision lenses (Balafilcon A, silicone hydrogel)) on an extended wear basis are presented. The minimum amount of continuous wear was 24 hours. All cases were treated either in private or at the corneal clinic of the Royal Victorian Eye and Ear Hospital from December 2000 to February 2001. All the patients underwent a complete ophthalmic examination by a corneal specialist. Microbiological specimens were taken from all patients via cornea scrapings and were submitted for Gram and Blankophor staining, and bacterial and fungal cultures via direct inoculation onto sheep blood agar, chocolate agar, and Sabouraud agar. Bacterial sensitivities of cultured organisms were also obtained. Where possible, the contact lenses themselves were also sent for microbial cultures. Each case is described in brief, and a summary presented in Table 1. View this table: Table 1 Summary of case details This 22 year old man presented with a 2 day history of left ocular injection, pain, photophobia, and blurred vision. He was wearing CibaVision Focus Night and Day SCL continuously for 10 days at a time, discarding the lenses after a month of use. He had swum in the sea while wearing the same lenses 2 weeks before, after which …