Faculty Bibliography

We examined seven patients with Acanthamoeba keratitis. All patients had a history of soft contact lens use. Predisposing factors included use of homemade saline, hydrogen peroxide disinfection, a history of improper lens care, and swimming with contact lenses. Currently recommended medical therapy, including topical propamidine isethionate and dibromopropamidine isethionate, miconazole, Neosporin, corticosteroids, and systemic ketoconazole, was used in all patients. Five patients have undergone penetrating keratoplasty for progressive primary Acanthamoeba keratitis (four patients) or recurrent infection (one patient) after maximal medical therapy. Two patients who began medical therapy less than three weeks after the onset of symptoms have done well. Early diagnosis of Acanthamoeba keratitis appears critical for successful medical therapy. Penetrating keratoplasty continues to have a central role in the management of more advanced cases that are unresponsive, or only transiently responsive, to medical therapy

In 52 patients with a history of using cosmetic extended wear soft contact lenses, corneal ulcers developed requiring admission to Wills Eye Hospital between January 1, 1982, and June 30, 1986. A retrospective study was conducted to determine the contact lens history, clinical presentation, culture and sensitivity results, and final visual acuity of these patients. Pseudomonas organisms were isolated in 75% of culture-positive cases. The final visual acuity was 6/60 or less in 12% of all cases and 25% of the Pseudomonas ulcers. Patients and practitioners must be aware of this vision-threatening problem in patients wearing cosmetic extended wear lenses. The pathogenesis of corneal ulcers in contact lens patients has not been established. There may be an inherent increased risk in the use of extended wear, compared to daily wear, soft contact lenses for cosmetic purposes