High Dk piggyback contact lens system for contact lens-intolerant keratoconus patients

Tomris Sengor, Sevda Aydin Kurna, Suat Aki, Yelda ÖzkurtFatih Sultan Mehmet Training and Research Hospital, Istanbul, TurkeyBackground: The aim of the study was to examine the clinical success of high Dk (oxygen permeability) piggyback contact lens (PBCL) systems for the correction of contact lens intolerant keratoconus patients.Methods: Sixteen patients (29 eyes) who were not able to wear gas-permeable rigid lenses were included in this study. Hyper Dk silicone hydrogel (oxygen transmissibility or Dk/t = 150 units) and fluorosilicone methacrylate copolymer (Dk/t = 100 units) lenses were chosen as the PBCL systems. The clinical examinations included visual acuity and corneal observation by biomicroscopy, keratometer reading, and fluorescein staining before and after fitting the PBCL system.Results: Indications for using PBCL system were: lens stabilization and comfort, improving comfort, and adding protection to the cone. Visual acuities increased significantly in all of the patients compared with spectacles (P = 0). Improvement in visual acuity compared with rigid lenses alone was recorded in 89.7% of eyes and no alteration of the visual acuity was observed in 10.3% of the eyes. Wearing time of PBCL systems for most of the patients was limited time (mean 6 months, range 3–12 months); thereafter they tolerated rigid lenses alone except for 2 patients.Conclusion: The PBCL system is a safe and effective method to provide centering and corneal protection against mechanical trauma by the rigid lenses for keratoconus patients and may increase contact lens tolerance.Keywords: piggyback contact lens, keratoconus, irregular astigmatis

The Effects of Topical Antiglaucoma Drugs as Monotherapy on the Ocular Surface: A Prospective Study

Purpose. The aim was to compare the effects of antiglaucoma eye drops on the tear functions and ocular surface. Method. Eighty-five eyes of 43 patients with glaucoma were included into this randomized prospective study. Timolol without preservative (1), timolol with benzododecinium bromide (2), latanoprost (3), bimatoprost (4), travoprost with benzalkonium chloride (5), and brimonidine with purite (6) were given to 6 groups. Schirmer I, tear film breakup time (TBUT), staining scores, and impression cytology samples were evaluated before and during 12-month-follow-up period. Results. At the end of 12 months, there was no detected change in Schirmer I and TBUT tests indicating dry eye. Corneal staining scores were higher in groups 1 and 2, while conjunctival staining scores were higher in group 6. Goblet cell count decreased in groups 1 and 5 in superior and inferior, group 2 in superior, and groups 3 and 6 in inferior conjunctiva. Squamous metaplasia grades showed a significant increase in groups 1 and 2 at 3rd, 6th, and 12th month controls (P<0.05). Conclusion. We observed nonserious impact on tear functions and ocular surface with antiglaucoma monotherapy. Beta blockers induced more damage on the ocular surface suggesting the role of the dosing and active substances beside preservatives

Comparing treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting

WOS: 000324152400004PubMed ID: 23483495Purpose: To compare 3 surgical treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting methods. Methods: Seventy-five patients with primary pterygium were included in the study. Snellen visual acuity measurement, grading pterygium, slit-lamp examination, keratometry and anterior segment photography were performed preoperatively. Twenty-eight eyes of 28 patients (group 1) underwent limbal-conjunctival sliding flap transplantation, 22 eyes of 22 patients (group 2) underwent amniotic membrane grafting, and 25 eyes of 25 patients (group 3) underwent primary closing surgery The patients were followed up on the first day and the first week after surgery and then at months 1, 3, 6, and 12. Results: The mean size of the pterygium preoperatively was 3.58 +/- 1.1 mm in group 1, 3.95 +/- 0.90 mm in group 2, and 3.5 +/- 0.87 mm in group 3. The mean follow-up time was 15.07 +/- 13.8 months in group 1, 20.2 +/- 6.7 months in group 2, and 28.04 +/- 9.9 months in group 3. Grade 4 corneal recurrence rate in follow-up was 7.1% in group 1, 27.3% in group 2, and 56% in group 3 (p = 0,00). Mean recurrence times were 4.0 +/- 1,7, 4.4 +/- 3.3, and 4.4 +/- 3.6 months according to groups 1, 2, and 3 (p = 0.963). After the surgery, corneal astigmatism decreased and keratometric values increased significantly in all the groups with no statistically significant difference between the groups (p>0.05). Conclusions: Limbal-conjunctival sliding flap transplantation is an efficient method to manage primary pterygium. It may be a safe and effective initial treatment option to reduce risk of recurrence and postoperative complications of pterygium surgery

Assessment of aberrations and visual quality differences between myopic and astigmatic eyes before and after contact lens application

WOS: 000439920000001PubMed ID: 28058332OBJECTIVE: To evaluate the aberration and visual quality differences between myopic and astigmatic eyes before and after contact lens application by using corneal aberrometer and low-contrast sensitivity chart. METHODS: Eighty eyes of 40 patients were included in this study. Patients were divided into two groups as myopic (40 eyes, n = 20) and astigmatic groups (40 eyes, n = 20). We used aspheric Balafilcon A (Purevision and Purevision Toric Bausch&Lomb, Rochester, USA) lenses for each group. Corneal aberrations and low-contrast sensitivity values were measured and compared for each patient in both groups. RESULTS: There were no statistically significant differences between myopic and astigmatic groups when we compared low-contrast sensitivity values for both on- and off-eyes. Mean total higher-order aberration (HOA) values for off-eye, were 0.29 +/- 0.10 mu m, and 0.33 +/- 0.10 mu m for on-eye in the myopic group, while they were 0.42 +/- 0.14 mu m in off-eye and 0.37 +/- 0.23 mu m in on-eye in the astigmatic group. Off-eye mean coma, irregular astigmatism and total higher-order aberration RMS (root-mean-square) values were significantly higher in the astigmatic group compared to the myopic group (p = 0.006, p = 0.001, p = 0.001) but mean on-eye RMS values were not. CONCLUSION: Myopic and astigmatic patients differ in terms of high-order aberrations and these differences cannot be equalized after contact lens application, but visual quality can be improved in both patients by using contact lenses

Confocal scanning laser tomography of the optic nerve head on the patients with Alzheimer's disease compared to glaucoma and control

WOS: 000345403300005PubMed ID: 25284015The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer's disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 +/- A 0.07 in AD, 0.22 +/- A 0.09 in glaucoma and 0.24 +/- A 0.07 in the control group (p = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control (p 0.05). We observed a negative correlation of the age with RNFL in all of the groups (p < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age

Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature

WOS: 000418055900010PubMed ID: 27874294The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis