A case series of contact lens-associated Fusarium keratitis in Hong Kong

Purpose: To report the clinical features and management outcomes of a cluster of Fusarium keratitis in patients that used the Bausch & Lomb ReNu MostureLoc contact lens solution. Methods: Retrospective case series. Results: In a 1-year period starting from June 2005, we treated 12 patients with unilateral Fusarium keratitis in our tertiary care center. All patients were contact lens users that used ReNu MostureLoc contact lens solution and had no other specific predisposing conditions. Microbiological examination yielded growth of Fusarium spp. in 7 patients from corneal scrapings at presentation and from 3 patients in subsequent corneal specimens. For 2 other patients, fungi were not detected from corneal scrapings, but Fusaritum spp. were isolated from their contact lenses. The infections were treated with topical natamycin and amphotericin B eye drops and with systemic itraconazole in 8 patients. The infection resolved with medical treatment in 8 eyes, a conjunctival flap in I eye, and a therapeutic corneal graft in I eye. Two eyes required tectonic corneal grafts for perforation. Two of the 3 corneal grafts failed because of graft rejection. Final visual acuities ranged from count fingers to 1.0. Conclusions: This cluster of Fusarium keratitis seems to be related to the use of the ReNu MoistureLoc contact lens solution. The cure rate with medical therapy was 66%. However, corneal scarring limited visual recovery. This episode highlights the need for clinical vigilance when dealing with corneal infiltrates in contact lens users.