Rose-K contact lens for keratoconus

Aim: To report clinical experience and the comparative value of axial and instantaneous topography data in fitting Rose-K design contact lenses in moderate and severe keratoconus. Materials and Methods: Thirty-eight eyes (of 23 patients) with keratoconus were fitted with Rose-K design contact lenses and followed up for at least six months or more. Visual acuity with habitual vision correction available was measured. Axial and instantaneous topography maps for each eye were recorded. Contact lens wear comfort was graded on a ten point rating scale every three months. Results: Fourteen (100%) moderate keratoconus eyes (average Sim K 48.61 ± 1.24D) and 23 of 24 (96%) of severe keratoconus eyes (average Sim K 60.88 ± 5.31D) were successfully fitted with the Rose-K lenses. Final fit contact lenses in severe keratoconus had statistically significant steeper base curves compared to average axial corneal curvature than in moderate keratoconus eyes. Average simulated corneal curvature on axial maps predicted final fit contact lens base curves significantly better than on instantaneous maps. Thirty-three of the 37 eyes fitted with contact lenses maintained wear comfort over average follow up period of 13 ± 3.5 months. Conclusions: Rose-K design rigid contact lenses are successful in visually rehabilitating 100% of moderate and 96% of severe keratoconus eyes. Most patients (90%) maintained contact lens wear comfort. Corneal curvature on axial maps is a better predictive of base curve of final fit contact lens

Low dose Mitomycin-C in severe vernal keratoconjunctivitis: A randomized prospective double blind study

<b>Purpose:</b> To study the efficacy and safety of low dose topical Mitomycin C (MMC) in severe Vernal keratoconjunctivitis (VKC). <b> Design:</b> Placebo controlled double masked randomized clinical trial. <b> Materials and Methods:</b> Twenty-eight patients with severe VKC were randomly assigned to receive either topical MMC (0.01&#x0025;) (n=17) or distilled water (n=11) three times daily for a period of two weeks. Signs and symptoms were recorded on day of presentation and at the end of treatment period (2 weeks). Mann Whitney test was used to analyze the signs and symptoms in the two groups. <b> Results:</b> No statistically significant difference was observed in terms of severity of symptoms at presentation. At two weeks patients in the MMC group showed significant decrease in tearing, foreign body sensation, discharge, hyperemia, punctate keratitis, limbal edema and trantas spots. No adverse effect of MMC was observed. <b> Conclusion:</b> Short term low dose topical MMC is an effective and safe drug to control acute exacerbations in patients of severe VKC refractory to conventional treatment

Long-term outcomes of single monocular resection–recession in adult sensory strabismus and factors affecting the postoperative drift

Purpose: The purpose of our study was to analyze the clinical characteristics and outcome of horizontal strabismus surgery in patients having sensory strabismus and to analyze the factors that affect the postoperative drift in these patients over a follow-up of three years. Methods: This was a retrospective case series. Patients aged ≥18 years, having low vision (visual acuity ≤20/60) in one eye, and undergoing horizontal strabismus surgery (standard recess–resect procedures) in the same eye were recruited. All patients were advised patching of the good eye six weeks prior and continued for six weeks post strabismus surgery. We excluded patients who had paralytic disorders, motility defects, or those with chronic systemic conditions. Patients with a minimum follow-up of three years were recruited. Results: The study included 56 patients whose mean age was 22.9 ± 4.93 years. Exotropia (n = 38; 67.8%) was more common than esotropia (n = 18; 32.1%). Preoperative visual acuity was 1.1 ± 0.85 (range perception of light to 6/18p). The cause of low vision was amblyopia (n = 30; 53.5%) followed by trauma (n = 22; 39.2%). The mean preoperative distance deviation was 57.7 ± 15.5 PD in the primary position (range: 20–65 PD). The success rate of exotropia (78.9%) was more than esotropia (52.9%) at three years. Two patients with esotropia were overcorrected. All patients with exotropia showed an exotropic drift with time. Conclusion: The motor alignment after a single recession–resection procedure was satisfactory at the long-term in our cohort of sensory strabismus. The duration or extent of visual impairment had no relation to the postoperative outcome

ProTon tonometer determination of intraocular pressure in patients with scarred corneas

Purpose: To evaluate the measure of intraocular pressure (IOP) in patients with scarred corneas obtained from the affected and non-affected areas. Materials and Methods: Eighteen patients with small maculo-leucomatous corneal opacity following microbial keratitis were prospectively included in the study. Goldmann applanation tonometry was done first on the non-affected corneal surface. ProTon tonometry (PT) was then carried out on the same eye, to obtain IOP measurements from the non-affected (PT1) and the affected area (PT2) of the cornea. The IOP measurements were compared using a two-tail paired t test. Results: The mean of IOP measurements of PT 2 and PT1 was 22 mm of Hg (SD &#x00B1; 5.2) and 14.8 mm of Hg (SD &#x00B1; 5.4), respectively. The higher reading of PT2 was statistically significant ( P P = 0.86) from the PT1 readings of 14.8 mm of Hg (SD 5.4). Conclusion: In patients with maculo-leucomatous corneal opacity, determination of IOP by ProTon tonometer varies from the affected to the non-affected area. The ProTon tonometer overestimates the level of IOP when it is applied to a leucomatous corneal opacity