Raise your hand if you do not give up your contact lenses even at the sea or in the pool. And he was warned by the optician or ophthalmologist that it is very risky behavior. Infections from Acanthamoeba, over one case per day. But let’s get to the numbers: the Italians who wear contact lenses are about 4 million, more than half are under 30 years old. Everyone in the summer (and not only) should pay particular attention to the hygiene of the lenses and always remove them for swimming in the sea or in the pool, but also in the shower. The lenses, especially if they are soft, are an ideal ground for the proliferation of germs and in the water there can be Acanthamoebaa pathogen responsible for very serious keratitis, more frequent in contact lens wearers.
Half of the cases do not respond to therapy
Up to 50% of cases of keratitis from Acanthamoeba it does not heal with medical therapies nor does it respond to antiamebics and patients are forced to undergo corneal transplantation, unfortunately not always decisive. Italian data, presented at the congress of the International Society of Cornea, Stem Cells and Ocular Science (SICSSO), show however that intervening in the most serious cases with an early transplant in which not all the cornea is replaced but only the intermediate layer, is successful. in 90% of patients.
Let’s take care of the cornea: disorders, diseases and possible therapies
by Irma D’Aria
Yet it would take little. According to experts, it is better to remove contact lenses before diving, as the water of swimming pools, sea, rivers, lakes and even that of the shower could be contaminated by pathogens capable of causing serious infections. In Italy over 400 keratitis per year are estimated, continuously increasing due to the greater aggressiveness of the pathogen Acanthamoeba, widespread especially in waters, and the increasingly widespread use of contact lenses. Unfortunately 12 to 50% of cases of keratitis from Acanthamoeba it does not respond to medical therapies and involves the need for a cornea transplant, which is not always decisive and fails in more than half of the cases, especially due to the delay of the operation.
Hope, however, comes from anterior lamellar cornea transplant, or DALK, in which the full thickness cornea is not implanted: the results of this technique applied to keratitis from Acanthamoeba, presented at the congress and obtained in our country, are satisfactory and guarantee success in 90% of patients, if the intervention is performed early in cases with a more severe degree of infection. However, the best weapon remains prevention, following the rules of hygiene in the use of contact lenses and remembering to remove them every time you take a bath.
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“In summer, the use of contact lenses increases moreover, to experience the summer with greater freedom – he explains Vincenzo Sarnicolapresident of SICSSO and member of the board of directors of the Italian Society of Ophthalmological Sciences (SISO), which presented the most updated data on keratitis from Acanthamoeba in our country – but if some essential precautions are not followed, there is a risk of serious complications. Unfortunately the lenses, especially the soft and more porous ones, favor the adhesion of microorganisms which are not always eliminated by the preservation liquids, in which there are no such powerful disinfectants. The likelihood that dangerous germs will remain on the lenses is even higher if they are stored in a simple saline solution “.
The bad habit of the bathroom with lenses
Added to this is the bad habit of bathing in the sea, in the pool or even showering with contact lenses: pathogens may be present in the water which then, in contact with the eye, cause infectious keratitis. “The most dangerous is the one from Acanthamoebaan almost ubiquitous protozoan that is very dangerous if it reaches the cornea – continues the expert – every summer we witness a progressive increase in access to the emergency room for keratitis caused by this parasite, especially at the sea or in the pool due to its greater aggressiveness and precisely for the increasingly widespread use of contact lenses “.
At first mild symptoms and slow evolution
In critical condition for its survival Acanthamoeba it engraves and thus is able to resist everything, even disinfectants; if the parasite infects the cornea the symptoms are initially mild, such as slight discomfort in the light, slightly blurred vision, sensation of a foreign body and the evolution is slow compared to bacterial keratitis. This often leads to a delay in diagnosis and specific treatment, so the parasite has the possibility of deeply infecting the cornea with involvement of the corneal nerves, causing injuries and severe pain. “In Italy it is estimated over one case a day: there are more than 400 patients a year and they are constantly increasing – continues Sarnicola – unfortunately specific medical therapies are not always able to eradicate the infection that does not respond to antiamebics, which are also difficult to be found in Italian pharmacies. The microorganism that is not eradicated thus has time to penetrate the cornea and damage it to the point of requiring a transplant in 12-50% of cases, which is also not always decisive “.
Classic and lamellar transplant
Classic full-thickness cornea transplant “fails in over half of cases – continues the expert – and in 40% of patients, glaucoma develops, an ocular disease associated with increased endo-ocular pressure and the subsequent appearance of blindness. ; rejections are frequent and in some cases unfortunately it is even necessary to enuclear the eye. Better results are possible with an anterior lamellar cornea transplant, or DALK, in which not all the cornea is replaced but only the intermediate layer. results presented show that early intervention in severely infected patients leads to transplant success in 90% of cases compared to 44% of later interventions, beyond 5 and a half months from infection “.
The best therapy? Prevention
The best therapy remains prevention. “Unfortunately, contact lens wearers are rarely told that the devices must be removed when taking a bath – concludes the expert – instead it is a simple rule that can really make a difference, avoiding keratitis with consequences that can be devastating “.