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



Tzamalis, Argyrios, Romano, Vito ORCID: 0000-0002-5148-7643, Cheeseman, Robert, Vinciguerra, Riccardo, Batterbury, Mark, Willoughby, Colin, Neal, Timothy, Ahmad, Sajjad and Kaye, Stephen ORCID: 0000-0003-0390-0592
(2019) Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL. BMJ open ophthalmology, 4 (1). e000231-e000231.

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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.

Item Type: Article
Uncontrolled Keywords: bandage contact lens, corneal collagen cross linking, microbial keratitis, topical steroids
Depositing User: Symplectic Admin
Date Deposited: 25 Apr 2019 14:46
Last Modified: 19 Jan 2023 00:53
DOI: 10.1136/bmjophth-2018-000231
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3038336