Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series

Abstract

Objectives:To report on microbial keratitis (MK) in three scleral lens (SL) wearers who had undergone penetrating keratoplasty (PKP).Methods:This retrospective case series describes 3 cases of MK in patients who wore SLs after PKP.Results:All three patients wore SLs for visual rehabilitation for corneal irregularity induced by PKP; all three also had concurrent ocular surface disease (keratoconjunctivitis sicca and corneal exposure). Cultures identified the causative organism in two patients, and septated hyphae suggestive of fungal infection were identified in tissue removed during therapeutic PKP in the third patient. All three patients were receiving either topical or systemic immunosuppressive therapy before the infection developed.Conclusions:Scleral lenses are often used to manage complex ocular disease, which can make it difficult to determine the precise cause of complications that arise after wearing the lenses. Multiple factors, including SL wear, may have contributed to the initial development of MK in the three patients in this case series. Patients who wear SLs after PKP should be monitored closely.

Clinical Outcomes of Infectious Keratitis Associated with Contact Lens Wear Following Penetrating Keratoplasty: A Case Series

“…16 Scleral lenses may also be associated with a high risk of infectious keratitis compared to other types of contact lenses with reports between 0.5-1.6%. [17][18][19][20] Kawulok et al reported on three patients that microbial keratitis associated with scleral lens wear and penetrating keratoplasty. 17 Of the nine patients in our case series, seven patients wore scleral contact lenses, which suggests that this type of lens may be associated with risks of developing contact-lens-associated infectious keratitis, but comparative studies are needed to prove that theory.…”

“…[17][18][19][20] Kawulok et al reported on three patients that microbial keratitis associated with scleral lens wear and penetrating keratoplasty. 17 Of the nine patients in our case series, seven patients wore scleral contact lenses, which suggests that this type of lens may be associated with risks of developing contact-lens-associated infectious keratitis, but comparative studies are needed to prove that theory. In addition, the prevalence of microbial keratitis after penetrating keratoplasty without the use of contact lens has been reported as between 1.8% and 12.1%.…”

Survey-Based Estimation of Corneal Complications Associated with Scleral Lens Wear

“…1 Visual and physiologic benefits of wearing SLs have been described, 2 but risks of corneal complications associated with SL wear are less clearly defined. Isolated case reports 3,4 and retrospective reviews 5,6 have described microbial keratitis (MK) in SL wearers. Other corneal complications such as perilimbal corneal epithelial bullae, 7 transient epithelial bullae, 8 and corneal endothe-lial blebs 9 have also been reported.…”