Predicting success with silicone-hydrogel contact lenses in new wearers

Purpose: to evaluate changes in tear metrics and ocular signs induced by six months of silicone-hydrogel contact lens wear and the difference in baseline characteristics between those who successfully continued in contact lens wear compared to those that did not. Methods: Non-invasive Keratograph, Tearscope and fluorescein tear break-up times (TBUTs), tear meniscus height, bulbar and limbal hyperaemia, lid-parallel conjunctival folds (LIPCOF), phenol red thread, fluorescein and lissamine-green staining, and lid wiper epitheliopathy were measured on 60 new contact lens wearers fitted with monthly silicone-hydrogels (average age 36 ± 14 years, 40 females). Symptoms were evaluated by the Ocular Surface Disease Index (OSDI). After six months full time contact lens wear the above metrics were re-measured on those patients still in contact lens wear (n= 33). The initial measurements were also compared between the group still wearing lenses after six months and those who had ceased lens wear (n= 27). Results: There were significant changes in tear meniscus height (p= 0.031), bulbar hyperaemia (p= 0.011), fluorescein TBUT (p= 0.027), corneal (p= 0.007) and conjunctival (p= 0.009) staining, LIPCOF (p= 0.011) and lid wiper epitheliopathy (p= 0.002) after six months of silicone-hydrogel wear. Successful wearers had a higher non-invasive (17.0 ± 8.2. s vs 12.0 ± 5.6. s; p= 0.001) and fluorescein (10.7 ± 6.4. s vs 7.5 ± 4.7. s; p= 0.001) TBUT than drop-outs, although OSDI (cut-off 4.2) was also a strong predictor of success. Conclusion: Silicone-hydrogel lenses induced significant changes in the tear film and ocular surface as well as lid margin staining. Wettability of the ocular surface is the main factor affecting contact lens drop-out. © 2013 British Contact Lens Association

Pulmonary Artery Pulsatility Index Predicts Mechanical Circulatory Support Following Heart Transplantation

The incidence of MCS for early graft dysfunction (EGD) following heart transplantation varies from 2.3% - 28.2%. Low pulmonary pulsatility index (PAPi) is associated with higher mortality in advanced heart failure and cardiogenic shock. We hypothesised that a lower pulmonary pulsatility index following heart transplantation is associated with MCS use for EGD. Methods Two-centre study of consecutive heart transplantation from May 2018 to December 2022. Haemodynamic parameters and Inotropic/Vasoconstrictor data were investigated on admission to intensive care unit (T0) and at six hours later (T6). Results Of the 173 patients included in this study, 24 had MCS for EGD. PAPi in the group that required MCS were lower at T0 (1.21(0.84) vs 1.67(1.23), p=0.001) and T6 (0.77(0.52) vs 1.44(0.82), p=<0.001). There was no significant difference in recipient characteristics, donor characteristics (donor age and sex matching) and operative factors (warm/cold ischaemic time, total ischaemic time, cardiopulmonary bypass time) between the two groups. On multiple variable regression, PAPi at T6 was associated with delayed MCS independent of total donor organ ischaemic time and short term MCS bridge to transplantation (OR 0.1 (0.036-0.276), p= <0.001). ROC analysis showed an AUC of 0.694 for T0 PAPi and 0.832 for T6 PAPi; a cut-off T6 PAPi of 1.22 had sensitivity and specificity of 81% and 65% respectively.Conclusions Lower PAPi at T6 (<1.22) is independently associated with MCS use for severe EGD post-heart transplantation