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  • PAK Outcomes Are Better for Contact Lens Wearers

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, July 2021

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    Pseudomonas aeruginosa is a common cause of bacterial keratitis among patients who wear contact lenses. Enzor et al. compared risk factors and out­comes for P. aeruginosa keratitis (PAK) between contact lens wearers (CLWs) and those who do not wear contacts. They observed better outcomes among CLWs. Strong predictors of poor visual acuity (VA) in both groups were worse initial VA, advanced age, larger infiltrate or epithelial defect at presentation, and greater maximum depth of stromal ne­crosis. Stromal necrosis required more than conservative treatment in nearly half of non-CLWs but in less than 14% of CLWs.

    For this retrospective study, the authors evaluated 214 eyes with PAK. Of these, 163 were in the CLW cohort. For both groups, the authors assessed patients’ clinical features, microbiologic findings, and treatment course. They also conducted analyses based on ma­chine learning to determine predictors of poor final VA.

    Patients’ average age was 39.2 years for CLWs and 71.9 for non-CLWs. At presentation, mean logMAR VA was 1.39 and 2.17, respectively (p < .0001). The mean final VA was 0.76 in CLWs and 1.82 in non-CLWs (p < .0001).

    Throughout treatment, PAK was more severe in non-CLWs. In addition, the hospitalization rate was signifi­cantly higher for this group (58.8% vs. 19.6%): The mean hospital stay was 9.29 days for non-CLWs, versus 5.44 days for CLWs. Stromal necrosis required surgical or procedural inter­vention in 13.5% of CLWs and 49.0% of non-CLWs (p < .0001). According to machine learning analyses, strong predictors of poor VA outcomes (i.e., worse than 20/40) were older age, worse initial VA, larger infiltrate or epitheli­al defect at presentation, and greater depth of stromal necrosis.

    In most published cases of PAK, the condition is linked to contact lens wear because P. aeruginosa is the most fre­quently isolated pathogen from corneal scrapings of patients with infectious keratitis who wear contacts. Although this relationship certainly deserves attention, the authors emphasized that PAK also is a common cause of keratitis in non-CLWs, as shown by their find­ings. They recommend further study of PAK, particularly to explore reasons for the major differences in outcomes between CLWs and non-CLWs. Al­though P. aeruginosa is more prevalent in CLWs, the related damage seems more severe for non-CLWs, leading to more challenging treatment courses and poorer VA outcomes.

    The original article can be found here.