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A Case-Control Study in Singapore

Seang-Mei Saw, MBBS, MPH, PhD; Peng-Lim Ooi, MBBS, MPH, MSc; Donald T. H. Tan, MBBS, FRCSE, FRCSG, FRCOphth; Wei-Boon Khor, MBBS; Chee-Weng Fong, MSc, MSocSc; Jayne Lim, BSc(Hons); Howard Y. Cajucom-Uy, MD; Derrick Heng, MBBS, MRCP, MPhil; Suok-Kai Chew, MBBS, MSc, DLSHTM; Tin Aung, MBBS, PhD, FRCS(Edin); Ai-Ling Tan, MBBS, DpBact, FRCPA; Cheng-Leng Chan, BSc(Pharm)(Hons); Steven Ting, MSc(Stats); Paul A. Tambyah, MBBS; Tien-Yin Wong, MBBS, PhD, FRCS(Glasg)

Arch Ophthalmol. 2007;125(5):611-617.

Objective  To evaluate the specific contact lens-related or other factors that may contribute to the outbreak of Fusarium keratitis.

Methods  A case-control study was conducted of Fusarium keratitis in contact lens users in Singapore from March 1, 2005, to May 31, 2006, and included 61 patients with Fusarium keratitis and 188 population-based and 179 hospital-based control subjects. Interviewers asked about contact lens solution use and other risk factors.

Results  Patients with Fusarium keratitis were more likely to use ReNu contact lens solutions (Bausch & Lomb, Rochester, NY) 58 [95.1%] of 61 cases) than were either population-based (62 [34.3%] of 181) or hospital-based (50 [30.1%] of 166) control subjects. After controlling for age, sex, contact lens hygiene, and other factors, the use of ReNu with MoistureLoc significantly increased the risk of Fusarium keratitis (odds ratio, 99.3; 95% confidence interval, 18.4-535.4; P<.001), and the risk was 5 times higher compared with the risk with use of ReNu MultiPlus, a multipurpose solution (odds ratio, 21.5; 95% confidence interval, 4.0-115.5; P<.001).

Conclusions  The use of ReNu contact lens solutions significantly increased the risk of contact lens–related Fusarium keratitis in Singapore. Our data support the recall of ReNu MultiPlus from the Singapore market and the need for further investigations into the role of ReNu MultiPlus in the development of Fusarium keratitis in other populations.

Author Affiliations: Departments of Community, Occupational, and Family Medicine (Dr Saw), Ophthalmology (Drs D. T. H. Tan, Aung, and Wong), and Medicine (Dr Tambyah), Yong Loo Lin School of Medicine, National University of Singapore; Singapore Eye Research Institute (Drs Saw, D. T. H. Tan, Khor, Cajucom-Uy, Aung, and Wong and Mr Ting); Ministry of Health, Singapore (Drs Ooi, Fong, Heng, and Chew and Ms Lim); Singapore National Eye Centre (Drs D. T. H. Tan, Khor, Cajucom-Uy, Aung, and Wong); Department of Pathology, Singapore General Hospital (Dr A.-L. Tan); Health Sciences Authority, Singapore (Dr Chan), Republic of Singapore; and Centre for Eye Research Australia, University of Melbourne (Dr Wong).

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