Clinical features, risk factors and outcomes of contact lens-related bacterial keratitis in Nottingham, UK: a 7-year study

Abstract

Background/objectives: To examine the clinical characteristics, risk factors and outcomes of contact lens-related bacterial keratitis (CLBK) in a large UK tertiary referral centre.

Subjects/methods: A retrospective analysis of all patients who presented to the Queen's Medical Centre, Nottingham, UK, with suspected CLBK between October 2015 to September 2022 (a 7-year period) was performed. Relevant data on demographic factors, CL wear behaviour, causes, clinical characteristics, and outcomes were analysed.

Results: We included 138 patients with CLBK; the mean age was 42.0 ± 17.8 years and 74 (53.6%) patients were male. Most CLBK were related to soft CL wear (94.5%), particularly monthly disposable (42.5%) and daily disposable (24.4%) CLs. Poor CL wear behaviour/hygiene was documented in 57.1% cases. Among the 64 (46.4%) microbiological-positive cases (n = 73 organisms), Pseudomonas aeruginosa (36, 49.3%) and Staphylococcus spp. (16, 21.9%) were most commonly identified. Six (4.3%) cases were polymicrobial. Most (97.0%) patients were successfully treated with topical antibiotics alone, with 80.6% achieving good final corrected-distance-visual-acuity (CDVA) of ≥ 0.30 logMAR. Poor visual outcome (final CDVA < 0.30 logMAR) was significantly associated with presenting CDVA < 0.6 logMAR (p = 0.002) and central ulcer (p = 0.004). Poor corneal healing (complete healing of > 30 days from initial presentation) was significantly associated with age > 50 years (p = 0.028), female gender (p = 0.020), and infiltrate size >3 mm (p = 0.031).

Conclusions: Poor CL wear behaviour/hygiene is commonly observed in CLBK, highlighting the importance of improved counselling and awareness regarding CL use and hygiene. When presented early and managed appropriately, most patients are able to achieve good clinical outcomes with medical treatment alone.

Fig. 1. Visual outcome of contact lens-related bacterial keratitis (CLBK).

A scatterplot demonstrating the corrected-distance-visual-acuity (CDVA) of CLBK at initial presentation and final follow-up visit. The dotted red line (x = y) represents no change in the visual acuity. The points located below or above the dotted red line represent an improvement or decrease in the final CDVA, respectively, when compared to the initial CDVA.