DIAGNOSTIC AND TREATMENT DIFFICULTIES IN PATIENTS WITH CONTACT LENS-RELATED MICROBIAL KERATITIS - CASE SERIES

The use of contact lenses in Romania has increased in recent years, raising the microbial keratitis incidence, being the main risk factor. Microbial keratitis is a condition that can lead to corneal opacity, perforation or in severe cases, endophthalmitis and vision loss. Contact lenses affect the integrity of the corneal epithelium in two different ways: directly by abrasion and indirectly by altering normal physiological and metabolic cellular activities. A contact lens can act as a vector for microorganisms to attach and transfer to the ocular surface. Our aim of study is to present the difficulties in contact-lens related microbial keratitis diagnosis and treatment in our country.

Case report series.

We present a retrospective study of 5 patients who were admitted in the Emergency Department and were investigated in the Ophthalmology Clinic of "Sf. Spiridon" Emergency Clinical Hospital, Iasi, Romania during 2019 and 2023. All the patients included in the study developed bacterial keratitis after the incorrect use of contact lenses. The is a retrospective one followed the demographic characteristics for each patient, duration of symptoms, risk factors, isolated microorganisms, specific lesions, hospitalization, recovery and follow-up time and corrected visual acuity at first and last examination. 

The diagnostic of the patients was established by examining conjunctival secretions and the contact lenses. Multiple bacterial cultures were performed because the microbiological examination revealed various uncommon bacteria, different in conjunctival secretions compared to the ones from the contact lenses. Antibiotherapy, the treatment indicated and used in our patients is effective for the treatment of contact lens-related microbial keratitis, if it is chosen appropriately according to the antibiogram. After treatment our results vary from complete vision recovery to disorganized globe. In one of our selected cases, a 27-years-old patient, known with operated stage III keratoconus developed bacterial keratitis after wearing a hard contact lens with an unfavorable evolution of corneal perforation (for which coverage with amniotic membrane and penetrating keratoplasty was performed) and acute fungal endophthalmitis.

Although significant progress has been made in the medical therapy of microbial keratitis, delayed treatment can cause severe complications with the loss of visual acuity. Despite the difficulties encountered such as the lack of the materials needed, propamidine isethionate, our results were favorable but prevention remains the best treatment and contact lens wearers must be educated on proper lens use and care.