title: A multi-country outbreak of fungal keratitis associated with a brand of contact lens solution: the Hong Kong experience.
abstract: OBJECTIVE
  Starting in mid-2005, an increase in fungal keratitis caused by Fusarium spp was observed among contact lens wearers in Hong Kong, Singapore, and the USA. The objective of this study was to describe the outbreak and to determine any association with the use of Bausch & Lomb (B&L) ReNu contact lens solution.
  
  
  METHODS
  We defined a case as a disposable contact lens user with ophthalmologist-diagnosed keratitis and a positive culture of Fusarium spp reported to the Department of Health from January 1, 2005 to May 31, 2006. We identified cases through inpatient discharge data and the electronic laboratory databases of all public hospitals, and from physician reporting. Controls were recruited from three outpatient clinics. Risk factors were collected using a standardized questionnaire and analyzed by univariate analysis and binary logistic regression.
  
  
  RESULTS
  From January 2005 through May 2006, we identified 33 cases of Fusarium keratitis. Most were in young adults (mean age 28 years) who presented with eye pain (100%), redness (84%), photophobia (41%), and tearing (34%). Twenty-four cases and 86 controls were recruited in the case-control study. By logistic regression, B&L ReNu solution showed the strongest association with being a case (adjusted odds ratio 26.1, 95% confidence interval 3.0-225.3) after adjusting for potential confounders.
  
  
  CONCLUSIONS
  Using B&L ReNu contact lens solution was strongly associated with Fusarium keratitis among disposable contact lens users in Hong Kong. B&L ReNu with MoistureLoc was permanently withdrawn from the market globally in May 2006.
authors.affiliation: Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health, 147C Argyle Street, Kowloon, Hong Kong Special Administrative Region. edmondmask@yahoo.com.hk
authors.forename: Siu-keung Edmond
authors.initials: SK
authors.lastname: Ma
authors.forename: Kellie
authors.initials: K
authors.lastname: So
authors.forename: Pui-hong
authors.initials: PH
authors.lastname: Chung
authors.forename: Ho-fai Thomas
authors.initials: HF
authors.lastname: Tsang
authors.forename: Shuk-kwan
authors.initials: SK
authors.lastname: Chuang
mesh_terms: D000328:Adult; D018639:Contact Lens Solutions / Q000009:adverse effects*; D015821:Eye Infections, Fungal / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005670:Fusarium; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007634:Keratitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D018639:Contact Lens Solutions