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Details About Fusarium Keratitis in Contact Lens Wearers

Use of ReNu with MoistureLoc was the primary risk factor, but no evidence of manufacturing contamination was found.

Previously, investigators in Singapore and Hong Kong found an association between a certain type of contact lens solution (Bausch & Lomb ReNu with MoistureLoc) and risk for fungal keratitis (Journal Watch Jul 13 2006). This report expands the investigation with more recent data from the U.S.

Electronic and print publicity directed at eye care professionals was used to gather data on 164 cases of fungal keratitis from 33 states and 1 U.S. territory; 154 of these cases occurred in wearers of soft contact lenses. Forty-five cases that were logged before widespread media publicity occurred were matched with 78 neighborhood controls (contact lens wearers without keratitis). In univariate and multivariate analyses, case patients were more likely than controls to use ReNu with MoistureLoc (odds ratio, 13.3). Fusarium species were not cultured from any solution (whether provided by a patient or the manufacturer) or from the manufacturing plant environment. Among the 39 fungal isolates cultured from keratitis patients, at least 10 different species were identified. Corneal transplantation was required in 55 of the 164 patients (34%).

Comment: These data further support an association between fusarium keratitis and a specific contact lens solution, ReNu with MoistureLoc, which was withdrawn permanently from the market in May. ReNu MultiPlus and other brands of contact lens solutions were not implicated. Manufacturing contamination does not appear to be the cause of the outbreak, and the large number and diversity of isolated Fusarium species suggests that contamination at multiple local sites was more likely.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine August 22, 2006

Citation(s):

Chang DC et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006 Aug 23; 296:953-63.

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