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Original articles
Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL
  1. Argyrios Tzamalis1,
  2. Vito Romano1,
  3. Robert Cheeseman1,
  4. Riccardo Vinciguerra1,
  5. Mark Batterbury1,2,
  6. Colin Willoughby1,2,
  7. Timothy Neal3,
  8. Sajjad Ahmad1,2,
  9. Stephen Kaye1,2
  1. 1 St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  2. 2 Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
  3. 3 Department of Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Dr Argyrios Tzamalis; argyriostzamalis{at}yahoo.com

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.

  • microbial keratitis
  • bandage contact lens
  • topical steroids
  • corneal collagen cross linking

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2018-000231

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    Footnotes

    • Contributors Concept and design of the study: AT, VR, MB, CW, SA, SK. Data acquisition: AT, VR, RC, RV, TN. Data analysis/interpretation: AT, VR, RC, SA, SK. Drafting of the manuscript: AT, RC, VR, SK. Critical revision of the manuscript: AT, VR, RC, RV, MB, CW, TN, SA, SK. Statistical analysis: AT, SK. Admin, technical or material support: TN, VR, RV. Supervision: MB, CW, SK. Final approval: AT, VR, RC, RV, MB, CW, TN, SA, SK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This retrospective cohort study was performed in adherence with the Declaration of Helsinki for research involving human subjects and after approval from the Institutional Review Board of The Royal Liverpool University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.