Risk Factors for Bacterial Keratitis and Severe Disease in Hydrogel Contact Lens Users: A Multicenter Case-Control Study and Case-Only Analysis.

IF 2 4区 医学 Q2 OPHTHALMOLOGY Eye & Contact Lens-Science and Clinical Practice Pub Date : 2024-11-01 Epub Date: 2024-09-10 DOI:10.1097/ICL.0000000000001125
Loretta B Szczotka-Flynn, Sangeetha Raghupathy, Soham Shah, Kunal Suri, Farren Briggs, Sudha K Iyengar
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Abstract

Purpose: To assess risk factors for contact lens (CL)-related bacterial keratitis, cases and high-risk controls were enrolled. Using high-risk controls can help elucidate whether certain CL types or modalities are attributable to disease burden if risky wear patterns are similar between the cases and controls. This analysis identified whether such CL factors were associated with the occurrence of bacterial keratitis. In addition, a case-only analysis determined CL factors associated with severe disease.

Methods: From 2018 to 2021, 158 controls were enrolled at University Hospitals of Cleveland Eye Institute, and 153 bacterial keratitis cases were enrolled across 14 sites in the United States. Cases were soft CL wearers with either culture-proven bacterial keratitis or a corneal infiltrate with an overlying epithelial defect within the central 4 mm of the cornea, uveitis, or significant pain. Fungal, protozoan, or nonsoft CL wear-related microbial keratitis cases were excluded. Controls were recruited from high-risk CL wearers with no history of disease. All participants completed a questionnaire related to demographics, type of CL used, wearing schedule, lens handling practices, and storage case handling. Cases with ulcer/infiltrate size ≥2 mm in size, presence of hypopyon, or had fortified antibiotics prescribed were classified as severe keratitis. Univariate and multivariable logistic regression was used to assess association of CL variables with the occurrence of bacterial keratitis as well as occurrence of severe disease among the cases only.

Results: Compared with the control cohort, cases were older (mean age 45.6 vs. 38.9 years), had more males (42.5% vs. 23.6%), and had more current or former smokers (41.7% vs. 12.9%). There were no significant associations between CL material (silicone hydrogel vs. not) or CL type (daily disposable vs. reusable) and occurrence of bacterial keratitis. More than two-thirds (67.3%) of cases were classified as severe. Among cases only, univariate analyses found current smokers to have increased risk of severe disease (OR=2.87; 95% CI 1.13-7.26, P =0.03). Adjusting for age, sex, and smoking among the cases only, daily disposable lenses were protective against severe disease (OR=0.32; 95% CI 0.11-0.89, P =0.03). Reusable lenses increased risk of severe microbial keratitis between 3.0- and 4.4-fold compared with compliant daily disposability.

Discussion/conclusion: Compared with a high-risk control cohort, no specific lens factors were associated with occurrence of CL-associated bacterial keratitis. Among cases only, current smokers and patients wearing reusable lenses are at increased risk of severe keratitis. Daily disposable lenses were protective even when noncompliance to daily disposability was considered.

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水凝胶隐形眼镜使用者患细菌性角膜炎和严重疾病的风险因素:多中心病例对照研究和病例分析。
目的:为了评估与隐形眼镜(CL)相关的细菌性角膜炎的风险因素,我们招募了病例和高风险对照组。如果病例和对照组之间的危险配戴模式相似,使用高风险对照组有助于阐明某些隐形眼镜类型或方式是否会导致疾病负担。这项分析确定了这些角膜接触因素是否与细菌性角膜炎的发生有关。此外,一项仅针对病例的分析确定了与严重疾病相关的CL因素:从 2018 年到 2021 年,克利夫兰大学医院眼科研究所招募了 158 名对照组,美国 14 个地点招募了 153 名细菌性角膜炎病例。病例均为软性CL配戴者,其角膜中央4毫米范围内存在培养证实的细菌性角膜炎或角膜浸润并伴有上皮缺损、葡萄膜炎或明显疼痛。真菌、原生动物或与软性角膜接触无关的微生物性角膜炎病例除外。对照组是从无病史的高危角膜塑形镜佩戴者中招募的。所有参与者都填写了一份问卷,内容涉及人口统计学、所使用的角膜塑形镜类型、配戴时间、镜片处理方法和存储盒处理。溃疡/渗出物大小≥2 毫米、存在镜下脓肿或使用强化抗生素的病例被归类为严重角膜炎。采用单变量和多变量逻辑回归评估 CL 变量与细菌性角膜炎发生率的关系,以及仅病例中严重疾病发生率的关系:与对照组相比,病例年龄较大(平均年龄 45.6 岁对 38.9 岁),男性较多(42.5% 对 23.6%),目前或曾经吸烟者较多(41.7% 对 12.9%)。角膜塑形镜材料(硅水凝胶与非硅水凝胶)或角膜塑形镜类型(日抛型与可重复使用型)与细菌性角膜炎的发生无明显关联。超过三分之二(67.3%)的病例被归类为严重病例。仅在病例中,单变量分析发现当前吸烟者患严重疾病的风险增加(OR=2.87;95% CI 1.13-7.26,P=0.03)。仅对病例的年龄、性别和吸烟进行调整后,日抛型镜片对严重疾病具有保护作用(OR=0.32;95% CI 0.11-0.89,P=0.03)。与符合要求的日抛型镜片相比,重复使用型镜片会使严重微生物性角膜炎的风险增加 3.0 到 4.4 倍:与高风险对照组相比,没有特定的镜片因素与CL相关细菌性角膜炎的发生有关。仅在病例中,当前吸烟者和配戴可重复使用镜片的患者患严重角膜炎的风险增加。即使考虑到不遵守日抛原则,日抛镜片也具有保护作用。
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来源期刊
CiteScore
4.50
自引率
4.30%
发文量
150
审稿时长
6-12 weeks
期刊介绍: Eye & Contact Lens: Science and Clinical Practice is the official journal of the Contact Lens Association of Ophthalmologists (CLAO), an international educational association for anterior segment research and clinical practice of interest to ophthalmologists, optometrists, and other vision care providers and researchers. Focusing especially on contact lenses, it also covers dry eye disease, MGD, infections, toxicity of drops and contact lens care solutions, topography, cornea surgery and post-operative care, optics, refractive surgery and corneal stability (eg, UV cross-linking). Peer-reviewed and published six times annually, it is a highly respected scientific journal in its field.
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