Recent years have seen newfound interest in scleral contact lens prescribing for more patients beyond those with cornea irregularities, and researchers are also exploring whether this lens modality could be used as a vehicle to deliver antibiotics in severe infectious keratitis cases.

The investigative team from Mexico added moxifloxacin to the fluid reservoir of sclerals and reported this alternative approach was both an effective and comfortable option to treat infectious keratitis. Additionally, they observed no complications or side effects in the 12 eyes that were treated for the condition at the Conde de Valenciana Institute of Ophthalmology in Mexico City.

The study used a scleral lens filled with 0.5% moxifloxacin as a reservoir and replaced it every 24 hours until epithelization was complete or the culture report and/or antibiogram demonstrated either a microorganism not susceptible or resistant to moxifloxacin. All patients completed at least one month of follow-up.

Of the 12 eyes, seven had culture-positive bacterial infection, two were mycotic and three had no culture growth. The researchers discontinued treatment in three eyes due to lack of response in one eye and the presence of mycotic infection in the other two. All infections resolved favorably at the final follow-up.

This novel approach may provide an equally effective therapy and avoid the need for frequent instillation of eye drops, the researchers noted.

“The main advantage was having the lens full of antibiotics, thereby avoiding the need to apply drops every hour or to have to wake up at night to apply drops. The protection provided by the scleral lens could also help improve keratitis symptoms,” the investigators wrote in their paper. Although the wait time was almost the same between lens adaptation and saturation time, the number of drops required was reduced from 37 drops to five, which could also be cost effective, the authors added.

Polania-Baron E, Santana-Cruz O, Lichtinger A, et al. Treatment of severe infectious keratitis with scleral contact lenses as a reservoir of moxifloxacin 0.5%. Cornea. 2021;40(7):831-6.