Contact Lens-Associated Microbial Keratitis Requiring Hospitalisation At Tertiary Referral Center: Clinical Characteristics, Microbiological Findings And Predictors Of Surgical Intervention

This study aimed to describe the clinical and microbiological features of hospitalised contact lens-related microbial keratitis (CL-MK) and to identify factors associated with surgical treatment.

Bursa Uludag University, Faculty of Medicine, Department of Ophthalmology

This retrospective observational study included 54 patients hospitalized for CL-MK between 2018 and 2025. Demographic data, clinical findings (infiltration localization and size, presence of hypopyon), microbiological findings, and treatment modalities (including topical, intrastromal, and systemic therapies, alone or in combination) were recorded.  Keratoplasty (KP) was performed in patients with isolated corneal involvement and insufficient response to medical therapy. Best-corrected visual acuity (BCVA) was recorded in logMAR units. Patients were divided into medical and KP  groups, and factors related to surgical treatment were statistically analyzed.

The mean age of the patients was 30.9 years. Soft monthly replacement CK was used by 94.4% of patients. Culture positivity was shown in 62.9% of eyes. P. aeruginosa was the most frequently encountered pathogen (26.4%), followed by S. marcescens (11.7%), and polymicrobial growth was observed in 14.8%. Hypopyon was seen in 23 (42.6%) eyes, and intrastromal injection was needed in 14 (25.9%) eyes. Forty-four eyes (81.4%) improved with medical treatment alone, while 10 eyes (18.6%) underwent KP. Older age (p = 0.003), presence of hypopyon (p = 0.024), and medium-to-large infiltrate size (p = 0.042) were identified as predictors of KP. Final BCVA was significantly worse in the KP group (p=0.011). Three eyes (33%) developed graft failure.

This study evaluated hospitalised CL-MK cases at a tertiary referral centre, focusing on their clinical and microbiological features and factors associated with a more advanced course, an area that has received limited attention in previous reports.  In our series, patients hospitalised for severe CL-MK frequently required surgical management, with approximately one in five undergoing PKP. Older age, the presence of hypopyon, and larger infiltrate size at presentation were associated with the need for surgery. Recognition of these features at initial evaluation may help guide follow-up and therapeutic decision-making.