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An Outbreak of Fusarium Keratitis Associated With Contact Lens Wear in Singapore
Wei-Boon Khor, MBBS;
Tin Aung, PhD, FRCS(Edin);
Seang-Mei Saw, PhD, MPH;
Tien-Yin Wong, PhD, FRCS(Edin);
Paul A. Tambyah, MBBS;
Ai-Ling Tan, FCRPA;
Roger Beuerman, PhD;
Li Lim, FRCS(Edin);
Wing-Kwong Chan, FRCS(Edin);
Wee-Jin Heng, FRCS(Edin);
Jimmy Lim, MRCS;
Raymond S. K. Loh, FRCOphth;
Sao-Bing Lee, MRCS;
Donald T. H. Tan, FRCS(Glasg)
JAMA. 2006;295:2867-2873.
Context Fungal keratitis is a potentially blinding condition that is rarely seen with contact lens wear.
Objective To describe a nationwide outbreak of fungal keratitis caused by Fusarium species among contact lens wearers in Singapore.
Design, Setting, and Patients Nationwide, hospital-based case series. All cases of fungal keratitis among contact lens wearers in all ophthalmology departments in Singapore were reviewed along with the charts of all contact lens wearers with culture-proven fungal keratitis from March 2005 through May 2006. A standardized telephone interview was conducted to obtain additional clinical information.
Main Outcome Measure Diagnosis of Fusarium keratitis associated with contact lens wear.
Results During the study period, 66 patients (68 affected eyes) were diagnosed with Fusarium keratitis associated with contact lens wear; the estimated annual national incidence is 2.35 cases per 10 000 contact lens wearers (95% confidence interval, 0.62-7.22). Patients ranged in age from 13 to 44 years (mean [SD], 27.1 [8.4] years), of which 32 (48.5%) were men. The vast majority (65 patients; 98.5%) wore soft, disposable contact lenses; 62 patients (93.9%) reported using 1 brand of contact lens cleaning solution (ReNu, Bausch & Lomb, Rochester, NY), including 42 patients (63.6%) who recalled using ReNu with MoistureLoc. Most patients (81.8%) reported poor contact lens hygiene practices, including overnight use of daily wear contact lenses (19.7%), and use of contact lenses past the replacement date (43.9%). The final best-corrected visual acuity ranged from 20/20 to 20/80. Five patients (5 eyes; 7.4%) required emergency therapeutic or tectonic corneal transplantation.
Conclusions A new and evolving epidemic of Fusarium keratitis associated with contact lens wear was found in Singapore. Physicians and eye care practitioners worldwide need to be aware of the likelihood of similar outbreaks emerging among contact lens wearers.
Author Affiliations: Singapore Eye Research Institute, Singapore (Drs Khor, Aung, Saw, Wong, Beuerman, L. Lim, Chan, Loh, and D. Tan); Singapore National Eye Centre, Singapore (Drs Khor, Aung, Wong, L. Lim, Chan, Loh, and D. Tan); Departments of Ophthalmology (Drs Aung, Saw, Wong, and D. Tan), Community, Occupational and Family Medicine (Dr Saw), and Medicine (Dr Tambyah), Yong Loo Lin School of Medicine, National University of Singapore; Department of Pathology, Singapore General Hospital, Singapore (Dr A.-L. Tan); Department of Ophthalmology, Tan Tock Seng Hospital, Singapore (Drs Heng and J. Lim); Department of Ophthalmology, Changi General Hospital, Singapore (Dr Loh); and Department of Ophthalmology, National University Hospital, Singapore (Dr Lee).
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