Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers

Rikki Enzor; Eve M R Bowers; Brittany Perzia; Chandrashan Perera; Laura Palazzolo; Alex Mammen; Deepinder K Dhaliwal; Regis P Kowalski; Vishal Jhanji

doi:10.1016/j.ajo.2021.02.024

Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers

Am J Ophthalmol. 2021 Jul:227:1-11. doi: 10.1016/j.ajo.2021.02.024. Epub 2021 Feb 28.

Authors

Rikki Enzor¹, Eve M R Bowers¹, Brittany Perzia², Chandrashan Perera³, Laura Palazzolo¹, Alex Mammen⁴, Deepinder K Dhaliwal⁴, Regis P Kowalski⁴, Vishal Jhanji⁵

Affiliations

¹ From the Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
² Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
³ Myung Lab, Stanford University, Stanford, California.
⁴ From the Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; The Charles T Campbell Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁵ From the Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; The Charles T Campbell Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.. Electronic address: jhanjiv@upmc.edu.

PMID: 33657419
DOI: 10.1016/j.ajo.2021.02.024

Abstract

Purpose: To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group.

Design: Retrospective cohort study METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed.

Results: This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs (P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs (P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs (P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs (P < .0001). A machine learning-based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis.

Conclusions: Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Contact Lenses / microbiology*
Contact Lenses, Hydrophilic / microbiology
Corneal Ulcer / diagnosis*
Corneal Ulcer / drug therapy
Corneal Ulcer / microbiology
Eye Infections, Bacterial / diagnosis*
Eye Infections, Bacterial / drug therapy
Eye Infections, Bacterial / microbiology
Female
Humans
Machine Learning
Male
Microbial Sensitivity Tests
Middle Aged
Odds Ratio
Pseudomonas Infections / diagnosis*
Pseudomonas Infections / drug therapy
Pseudomonas Infections / microbiology
Pseudomonas aeruginosa / isolation & purification*
Retrospective Studies
Risk Factors
Treatment Outcome
Visual Acuity / physiology
Young Adult

Substances

Anti-Bacterial Agents