Poor contact lens hygiene was not the major cause of the recent outbreak of Fusarium keratitis, confirmed the Fusarium Keratitis Investigation Team of the Centers for Disease Control and Prevention (CDC).1 However, Bausch & Lombs ReNu with MoistureLoc contact lens solution was specifically associated with the outbreak. These findings were published in the August 23/30 issue of the Journal of the American Medical Association.

Despite the link between the fungus and the contact lens solution, Fusarium was not recovered from the factory, warehouse, solution filtrate or unopened solution bottles.

Our findings, together with the results of environmental testing, suggest that exposure to Fusarium was likely the result of extrinsic contamination of contact lens solution bottles or lens cases occurring outside of the manufacturing or storage processes, perhaps in patients homes, the researchers wrote. However, suboptimal contact lens hygiene practices appear unlikely as the major explanation for the outbreak.

One-fourth of U.S. cases of Fusarium were initially treated with steroids.

Specifically, as of June 30, the researchers found that:

There were 164 confirmed cases of Fusarium keratitis in 33 states and in one U.S. territory.

Ninety-four percent (154) of the infected patients wore soft contact lenses.

Thirty-four percent (55) required corneal transplantation.

Patients with confirmed Fusarium keratitis were about 20 times more likely than control subjects to report using ReNu with MoistureLoc.

But, many of these patients did not initially receive the proper treatment, say physicians in an accompanying commentary.2 Patients who presented with acute red eyes were often treated with topical cortico­steroids, often without physical examination and without appropriate antimicrobial therapy.

One-fourth of the cases reported in the United States had received a topical corticosteroid prior to referral and initiation of antifungal therapy, the commentators wrote. Clinicians must immediately cease this potentially harm- ful practice.

1. Chang DC, Grant GB, ODonnell K, et al.; Fusarium Keratitis Investigation Team. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006 Aug 23;296(8):953-63.

2. Margolis TP, Whitcher JP. FusariumA new culprit in the contact lens case. JAMA 2006 Aug 23;296(8):985-7.


Vol. No: 143:09Issue: 9/15/2006