FROM CONTACT LENSES TO PENETRATING KERATOPLASTY

The purpose is to highlight the severe complications that can occur in the case of inappropriate wearing of contact lenses.

Our retrospective study took place over a period of one year June 2022-June 2023 at the Sf. Spiridon Emergency Clinical Hospital, Iasi, Romania.

From the total number of patients with complications secondary to the inappropriate wearing of contact lenses, 12 cases were identified with severe keratitis with unfavorable or slowly favorable evolution despite etiologic treatment. Each case was complete from an ophthalmological point of view during the study following parameters such as visual acuity, the appearance of the anterior pole, the degree of corneal staining and the corneal topography. We will detail two clinical cases that required penetrating keratoplasty due to the imminent risk of corneal perforation. 

Pacient, aged 26, with an ophthalmological history of keratoconus for which epi-off crosslinking was performed 4 years ago, wearer of hard contact lenses, presents with a central corneal ulcer which the patient treated empirically through self-medication with progress unfavorable. The second case is that of a 55-year-old patient who presents with a central corneal ulcer. In the first case, the laboratory examination of the conjunctival secretions and the corneal scraping are negative. Amniotic membrane coverage was used, then penetrating keratoplasty. After keratoplasty, the case is complicated by fungal endophthalmitis with Fusarium solari identified by vitreous puncture. Under treatment, the evolution was slowly favorable. In the second case, the contact lens of the 55-year-old patient was removed and microbiologically evaluated, Klebsiela Pneumoniae was identified, and Pseudomonas aeruginosa was identified from the conjunctival secretions. The patient received treatment adapted according to the antibiogram, but after 4 weeks the patient reinserts the contact lens, the ulcer recurs, Burkholderia cepacia is isolated on the culture of the contact lens and due to the impending perforation, penetrating keratoplasty is performed with a favorable evolution.

Although contact lenses are widely used, the education and responsibility of patients regarding the rules of hygiene and handling of contact lenses is particularly important to avoid serious complications such as those described in our cases.