1/68. Epithelial inclusions in association with mucin ball development in high-oxygen permeability hydrogel lenses.Debris trapped behind contact lenses may be associated with adverse reactions in extended wear. Although streaks and clumps of cellular material have been reported after overnight wear of conventional materials, recent experience with several high-oxygen permeability (Dk), silicone-containing hydrogel lenses indicates that certain participants are prone to the development of a unique back surface debris. This debris forms as spherical, translucent entities and results in depressions within the ocular surface after lens removal. Little information is known about these spherical bodies, particularly with respect to their composition and development. In this report, we provide photographic evidence of this debris (sometimes termed "mucin balls" or "lipid plugs"), discuss its differential diagnosis and describe a case in which material seems to be embedded in the epithelium as a direct consequence of their presence.- - - - - - - - - - ranking = 1keywords = wear (Clic here for more details about this article) |
2/68. Corneal subepithelial opacities associated with inappropriate contact lens care.PURPOSE: To report two cases of corneal subepithelial opacities, which may be related to improper lens care by the patients. methods: Slit-lamp examination and monitoring of contact lens care procedures. RESULTS: Two female patients experienced similar symptoms of soreness, blurring, and red eyes after wearing soft contact lenses. Slit-lamp examinations demonstrated numerous subepithelial opacities in the central cornea. Both patients used the same kind of cleaner (MiraFlow) inappropriately, which resulted in the possibility of residual cleaner remaining in the lenses. The symptoms and signs gradually subsided after discontinued use of soft contact lens and application of topical steroid. CONCLUSIONS: Residual MiraFlow in soft contact lenses may result in corneal subepithelial opacities.- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
3/68. Iatrogenic keratectasia after laser in situ keratomileusis for less than -4.0 to -7.0 diopters of myopia.PURPOSE: To study 13 eyes with less than -4.0 to -7.0 diopters of myopia that developed central or inferior keratectasia after laser in situ keratomileusis (LASIK). methods: The progress of the ectasia was determined by a series of pre- and post-LASIK topographies and the case histories. RESULTS: Progressive ectasia developed from 1 week to 27 months after LASIK. This necessitated the wearing of hard contact lenses or penetrating keratoplasty. One eye improved for some months after photorefractive keratectomy retreatment. Two eyes in 1 patient and 1 eye in a second patient had latent keratoconus before surgery. CONCLUSION: Laser in situ keratomileusis can cause permanent weakening and ectasia of the cornea even in eyes with low myopia.- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
4/68. Gas-permeable scleral contact lens therapy in ocular surface disease.PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease.methods: The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was stevens-johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjogren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting.CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.- - - - - - - - - - ranking = 1.5keywords = wear (Clic here for more details about this article) |
5/68. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens.PURPOSE: To report treatment of persistent corneal epithelial defects unresponsive to other therapies by extended wear of a fluid-ventilated gas-permeable scleral contact lens.methods: In this retrospective study, 14 eyes of 13 consecutive patients referred for the treatment of persistent corneal epithelial defects that failed to heal with conventional therapies or developed epithelial defects after penetrating keratoplasty for persistent corneal epithelial defects were fitted with an extended-wear gas-permeable scleral lens. These included seven eyes of six patients with stevens-johnson syndrome and seven eyes of seven patients who did not have stevens-johnson syndrome. Twelve eyes had undergone recent penetrating keratoplasty. All 14 eyes were fitted with a gas-permeable scleral contact lens designed to avoid the intrusion of air bubbles under its optic. An antibiotic and corticosteroid were added to the lens fluid reservoir or instilled before each lens insertion in 12 of 14 eyes. The lenses were worn continuously except for brief periods of removal for purposes of cleaning, replacement of the lens fluid reservoir, and examination and photography of the cornea.RESULTS: Five of the seven persistent corneal epithelial defects associated with stevens-johnson syndrome healed. The persistent corneal epithelial defects of four of these eyes re-epithelialized within 7 days, and a fifth healed in 27 days of gas-permeable scleral lens extended wear. A sixth persistent corneal epithelial defect that failed to heal initially re-epithelialized after a subsequent penetrating keratoplasty and gas-permeable scleral lens extended wear. The seventh eye healed after 3 days of gas-permeable scleral lens extended wear, but the persistent corneal epithelial defect subsequently recurred. Three of seven non-stevens-johnson syndrome persistent corneal epithelial defects re-epithelialized within 36 hours, 6 days, and 36 days, respectively. Of the six (six of 14) persistent corneal epithelial defects that failed to heal with a gas-permeable scleral lens extended wear, one subsequently healed after multiple amniotic membrane grafts. Microbial keratitis occurred in four eyes (four of 14) and graft failure in one eye, all of which required repeat penetrating keratoplasty.CONCLUSION: Extended wear of an appropriately designed gas-permeable scleral contact lens was effective in promoting the healing of persistent corneal epithelial defects in some eyes that failed to heal after other therapeutic measures. re-epithelialization appears to be aided by a combination of oxygenation, moisture, and protection of the fragile epithelium afforded by the scleral lens. However, microbial keratitis represents a significant risk.- - - - - - - - - - ranking = 5.5keywords = wear (Clic here for more details about this article) |
6/68. Phakic-pseudophakic bullous keratopathy following implantation of a posterior chamber IOL in the anterior chamber to correct hypermetropia.There is an increasing demand for refractive surgery stemming from a heightened awareness among patients wearing spectacles or contact lenses. Cosmetic or occupational reasons prompt patients to seek the alternative option of refractive surgery.- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
7/68. Use of human fibrin glue and amniotic membrane transplant in corneal perforation.PURPOSE: To repair corneal perforation using human fibrin glue (HFG) and amniotic membrane transplant (AMT). methods: Three patients in whom central corneal perforations, approximately 2 mm in diameter, occurred after ocular or systemic disease were successfully cured using HFG and AMT. The technique consists first of using a high-viscosity sodium hyaluronate viscoelastic material to restore anterior chamber depth followed by a debridement of the ulcer. The perforation site is filled with the HFG to corneal surface level. The so-formed plug is then secured with an AMT to avoid its extrusion. An extended-wear bandage contact lens and topical antibiotics were used in these patients for 3 weeks. RESULTS: Total reepithelialization was observed after an average of 15 postoperative days. The AMT dissolved within 8 weeks to uncover a whitish scar formed within the perforation sites. No complications were observed in any patients. After a follow-up period of 195-325 days, all corneas remained stable; there was no infection or ulcer recurrence, but some corneal scar thinning was observed in all three cases. CONCLUSION: The described surgical approach using HFG and AMT allowed a successful repair of corneal perforations with a diameter of 2 mm associated with significant loss of stroma. This method may be a good alternative to delay penetrating keratoplasty for treating corneal perforations, especially in acute cases in which graft rejection risk is high. eal- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
8/68. Scleral contact lenses for overnight wear in the management of ocular surface disorders.PURPOSE: To describe the use of overnight wear scleral contact lenses (Scl CLs). The authors describe 7 patients using this modality of contact lens wear. Most of the lenses were made from highly gas-permeable materials, but a long-standing case is also reported when the lenses were made from PMMA, which is impermeable to gases. BACKGROUND: There is a range of therapeutic indications for the use of Scl CLs. The development of rigid gas-permeable (RGP) materials has widened this range. case reports: Seven case reports are presented which describe patients in whom severe ocular surface disease has been managed with overnight-wear Scl CLs. The indications were: corneal exposure, post-radiotherapy complications, Stevens Johnson disease, recurrent erosion and congenital or post-surgical lid defects. CONCLUSION: Scl CLs provide a therapeutic option for a range of complicated corneal and ocular surface conditions for which the treatment by other methods is either unsuitable or less effective. They have several advantages over silicone rubber and hydrogel lenses. The relative ease of handling for some patients allows removal for cleaning, their rigidity gives stability and a high degree of protection to the ocular surface, and the presence of a pre-corneal fluid reservoir optically neutralises an irregular corneal surface. Highly oxygen-permeable materials enable consideration of overnight wear in appropriate circumstances.- - - - - - - - - - ranking = 4keywords = wear (Clic here for more details about this article) |
9/68. A new technique for rigid gas permeable contact lens fitting following penetrating keratoplasty.PURPOSE: To evaluate a new, rigid gas permeable contact lens fitting technique following penetrating keratoplasty. methods: For the correction of postoperative anisometropia or astigmatism, a rigid gas permeable, tetra-curve contact lens with an overall diameter of 12.0 mm and a back optic zone diameter of 8.5 mm was fitted in 36 eyes of 33 patients, 7 months after penetrating keratoplasty. The contact lens back optic zone radius was selected using the videokeratography values over the elevated edges of the transplant wound (with the sutures in place). Graft clarity, visual outcome, and corneal topography were evaluated up to 3 years after surgery at intervals of 6 months. RESULTS: Throughout the follow-up period (range 6-36, mean 19.3 /-sd 11.8 months), all grafts remained clear. Mean contact lens daily wearing time averaged 13.6 ( /- sd 4.7) hours. Mean best-corrected visual acuity improved from 0.36 ( /- sd 0.18) LogMAR with spectacles to 0.11 ( /- sd 0.11) LogMAR with contact lenses (p < 0.0001). One patient was excluded from the study due to a lack of motivation and one had an adverse reaction to the stitches. CONCLUSIONS: To improve the visual performance following penetrating keratoplasty, the described fitting technique, guided by videokeratography, eased selection of the back optic zone radius of the initial trial lens. The large diameter contact lenses with a tetra-curve design were well tolerated in all patients for more than 13 hours daily.- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
10/68. Rigid gas-permeable contact lens fitting in LASIK patients for the correction of multifocal corneas.BACKGROUND: Laser in situ keratomileusis (LASIK) has recently become the most commonly performed refractive surgery procedure. Results are promising in correcting low to moderate myopia. Most complications occur during the surgeon's learning curve. One of the complications is a decentration of the ablated area that causes monocular diplopia and a nocturnal halo phenomenon due to a multifocality of the corneal surface overlying the entrance pupil. The corneal shape is significantly altered after LASIK. We evaluate the efficacy of rigid gas-permeable contact lens designs and fitting techniques used in eight eyes with multifocal LASIK ablations to correct haloes and impaired night vision complaints. methods: We used large-diameter tetra-curved rigid gas-permeable (RGP) contact lenses for visual recovery in eight eyes of seven LASIK patients. We used the power on the transition zone of the corneal topographic map, 0.2 mm outside the ablated refractive area, for selection of the back optic zone radius of the RGP contact lenses. Procedures for lens fitting are described. visual acuity (high-contrast logarithm of the minimum angle of resolution, LogMAR) was measured before- and 6 months after contact lens fitting. RESULTS: Large-diameter tetra-curve RGP lenses with a mean diameter of 11.85 (SD 0.16) mm were successfully used in LASIK patients with multifocal corneas. Mean best spectacle-corrected visual acuity was 0.3 LogMAR (SD 0.19; in Snellen equivalent, 20/40) and improved significantly with the contact lenses to 0.08 LogMAR (SD 0.11; in Snellen equivalent, 20/25, P=<0.01). During the follow-up period of 16.7 months, the average daily wearing time of the lenses was 12.5 h. contact lenses with a standard geometry were not useful due to excessive movement and inadequate centration. CONCLUSIONS: contact lenses with large diameters, in combination with selection of the back optic zone radius 0.2 mm peripheral of the refractive ablation zone, facilitate contact lens fitting to restore best-corrected visual acuity in LASIK patients with multifocal corneas.- - - - - - - - - - ranking = 0.5keywords = wear (Clic here for more details about this article) |
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