Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL

Argyrios Tzamalis, Vito Romano, Robert Cheeseman, Riccardo Vinciguerra, Mark Batterbury, Colin Willoughby, Timothy Neal, Sajjad Ahmad, Stephen Kaye

Research output: Contribution to journalArticle

4 Citations (Scopus)
16 Downloads (Pure)

Abstract

Objective To investigate the role of bandage contact lenses (BCL) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off corneal collagen cross-linking (CXL). Methods and Analysis Patients undergoing CXL between February 2011 and July 2017 were included. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2). Results 1273 eyes of 964 patients were included. Group 1 comprised 316 eyes and group 2 comprised 957 eyes. There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p=0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight (0.83%) patients (one case was bilateral) out of 1273 eyes. Staphylococcus aureus was cultured from corneal scrapes in seven out of nine (77.8%) cases and from contiguous sites in the two cases. All cases occurred in group 1 (incidence=2.85%) and none in group 2 (p<0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p=0.4). Conclusion The use of BCL and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis. S. aureus is the most common micro-organism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze.

Original languageEnglish
Article numbere000231
Pages (from-to)1-7
Number of pages7
JournalBMJ Open Ophthalmology
Volume4
Issue number1
Early online date16 Feb 2019
DOIs
Publication statusE-pub ahead of print - 16 Feb 2019

Keywords

  • bandage contact lens
  • corneal collagen cross linking
  • microbial keratitis
  • topical steroids

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