Transcript Keratitis Related to Multipurpose Contact Lens Solution

Keratitis Related to a
Multipurpose Contact Lens
Solution
Jules Winokur, MD
Michelle Lee, OD
Mohamed Osman, BS
Sid Mandelbaum, MD
Authors have no financial interest
Purpose
• To describe a non-infectious corneal
condition associated with use of contact
lenses disinfected with a multipurpose
contact lens solution (MPS)
Methods
• Observational case series
• Private corneal practice
• Retrospective chart review
Clinical Findings
• Symptoms included:
–
–
–
–
Ocular redness
Irritation
Decreased lens tolerance
Decreased visual acuity
• Signs included some
combination of:
– Punctate corneal
fluorescein staining (SPK)
– Pinpoint white epithelial
opacities, only some of
which stain with fluorescein
– Conjunctival injection
– Epithelial microcysts
– Small sub-epithelial
opacities
– Limbal thickening
– Whorl-like epitheliopathy
Sub-epithelial opacity
Microcysts, fluorescein stain
Pinpoint white epithelial opacities, only some of which stain with fluorescein
Findings
• 26 patients
over three
year period
• All patients
used Optifree solutions
• Most patients
had more
than one
finding
Treatment
• Many of the patients had already used topical
antibiotics and topical steroids without
apparent improvement
• Cessation of contact lenses and elimination
of Opti-free solution was effective treatment
• Resolution of signs and symptoms ranged
from 3 days to > 6 months
• Patients with more severe findings at
presentation took longer to resolve
• No patient had recognizable permanent
sequelae
Outcomes
• All patients with long-term follow-up returned
to CL use
• Many patients successfully resumed CL use
with the same lens parameters, but with
hydrogen peroxide disinfection
• Some patients switched to daily disposable
contact lenses
• Several patients who returned to Opti-free
solution disinfection had recurrence of clinical
picture
Background
• In 2002,
32,000,000 people
using lenses in
US1, 87% using
soft lenses
• Opti-free is the
most commonly
used solution for
soft lens
disinfection
Figure 1: Type of soft CL use in US2
Figure 2: Market share of disinfecting solutions3
Antimicrobials in MPS
• Polyhexamethylene biguanide (PHMB)
– Renu Multiplus (0.00005%) [B&L]
– AQuify (0.0001%) [Ciba]
• Myristamidopropyl dimethylamine (Aldox)
– Opti-free* (0.0005%) [Alcon]
• Polyquaternium-1 (Polyquad)
– Opti-free* (0.001%) [Alcon]
*Opti-free
solutions contain both Aldox and Polyquad
Possible Relationships
• Aldox and Polyquad are proprietary
disinfectants used only in Opti-free
• In vitro studies show cytotoxicity and
decreased corneal epithelial cell viability
after exposure to Opti-free4,5,6
• Study in rats did not show toxicity from
Polyquad7,8
• Combination of factors likely responsible
for clinical condition
Discussion
• Opti-free multipurpose contact lens
solution may be associated with a
particular pattern of corneal findings
• Corneal abnormalities slowly resolve with
discontinuation of contact lens use
• These patients were able to resume use of
contact lenses with a daily disposable lens
or peroxide-based disinfecting system
Notes
1. Barr, Joseph. "Contact Lenses 2002: Annual Report." Contact Lens Spectrum Jan.
2003: 24-31.
2. Nichols, JJ. http://www.clspectrum.com/article.aspx?article=103778 Diagram
reproduced with permission from author.
3. Ibid 2.
4. Mowrey-McKee M, Sills A, Wright A, CIBA Vision Corporation. Comparative
cytotoxicity potential of soft contact lens care regimens. CLAO J. 2002 Jul;28(3):1604.
5. Wright A, Mowrey-McKee M. Comparative cytotoxicity potential of soft contact lens
care products. Cutan Ocul Toxicol. 2005;24(1):53-64.
6. Cavet ME, Harrington KL, VanDerMeid KR, Ward KW, Zhang JZ. Comparison of the
effect of multipurpose contact lens solutions on the viability of cultured corneal
epithelial cells. Cont Lens Anterior Eye. 2009 Aug;32(4):171-5. Epub 2009 Jun 21.
7. Tripathi BJ, Tripathi RC, Kolli SP. Cytotoxicity of ophthalmic preservatives on human
corneal epithelium. Lens Eye Toxic Res. 1992;9(3-4):361-75.
8. Labbé A, Pauly A, Liang H, Brignole-Baudouin F, Martin C, Warnet JM, Baudouin C.
Comparison of toxicological profiles of benzalkonium chloride and polyquaternium-1:
an experimental study. J Ocul Pharmacol Ther. 2006 Aug;22(4):267-78.