Review Article

Microbacterial keratitis: how safe is orthokeratology today?

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1FAAO, Nosch Optometrie, Kirchzarten, Germany
contact lenses
microbacterial keratitis
risk factors


The purpose of this review is to summarize and clinically evaluate microbial keratitis (MK) in accelerated orthokeratology (OK).

Material and Methods:

Based on a PubMed and EMBASE search, a systematic literature review of previous and current studies and theories on the pathogenesis of contact lens associated MK was performed. In chronological order, the results were described and analyzed.


Risk factors of MK are inadequate contact lens care, use of tap water, non-adherence to hygiene procedures and wearing contact lenses despite pre-existing ocular irritation. The statistical absolute incidence MK is 7.7 MK cases per 100,000 patient-years for all contact lens (CL) wearers and 13.9 per 100,000 patient-years for young CL wearers. The most significant germ is Pseudomonas aeruginosa followed by Acanthamoeba. The predominant age group is 15.4 years old on average, and the predominant ethnic group is persons of Asian descent. Most MK cases are diagnosed in the first 19 months – most users are not contact lens novices. The corneal epithelium is the most significant tissue for OK success and most significant for infection protection.


Contact lens practitioners have a high responsibility for safety in OK. MK in OK is highly preventable if risk factors and general hygiene are observed. Regular check-ups at short intervals, adherence to agreed procedures, discipline, education/training and communication are important tools to minimize the risk of MK in OK.

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