Pub Date : 2020-03-01DOI: 10.1097/ICL.0000000000000644
A. Sağlık, I. Koyuncu, A. Soydan, Ferdağ Sağlık, Ataman Gönel
OBJECTIVES This study examined changes in the levels of organic acids, which are important tear metabolites, after corneal collagen crosslinking (CXL) treatment for keratoconus. METHODS This prospective, nonrandomized, interventional case series included a single eye from 24 patients who were scheduled to receive CXL treatment (Dresden protocol) for progressive keratoconus. Before CXL treatment and at 6 months after treatment, tears were collected in capillary tubes. The patients were separated into four groups as males, females, and ages 18 years younger and >18 older. The organic acid profiles of the tear samples were analyzed using mass spectrometry. RESULTS An evaluation was made of 12 females and 12 males with a mean age of 19.20±4.06 years (range: 12[FIGURE DASH]27 years). The greatest percentage increase in organic acids after CXL treatment was observed for N-acetyl-L-aspartic acid (66% increase). The organic acid showing the greatest decrease was 3-OH butyric acid (61% decrease). A decrease of 46% was found (P=0.263) in the lactic acid/malic acid ratio. CONCLUSION Metabolomic studies of tears could facilitate a new and objective process in the follow-up period or in the determination of prognosis after CXL treatment for diseases such as keratoconus, which has a multifactorial etiology.
{"title":"Tear Organic Acid Analysis After Corneal Collagen Crosslinking in Keratoconus.","authors":"A. Sağlık, I. Koyuncu, A. Soydan, Ferdağ Sağlık, Ataman Gönel","doi":"10.1097/ICL.0000000000000644","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000644","url":null,"abstract":"OBJECTIVES\u0000This study examined changes in the levels of organic acids, which are important tear metabolites, after corneal collagen crosslinking (CXL) treatment for keratoconus.\u0000\u0000\u0000METHODS\u0000This prospective, nonrandomized, interventional case series included a single eye from 24 patients who were scheduled to receive CXL treatment (Dresden protocol) for progressive keratoconus. Before CXL treatment and at 6 months after treatment, tears were collected in capillary tubes. The patients were separated into four groups as males, females, and ages 18 years younger and >18 older. The organic acid profiles of the tear samples were analyzed using mass spectrometry.\u0000\u0000\u0000RESULTS\u0000An evaluation was made of 12 females and 12 males with a mean age of 19.20±4.06 years (range: 12[FIGURE DASH]27 years). The greatest percentage increase in organic acids after CXL treatment was observed for N-acetyl-L-aspartic acid (66% increase). The organic acid showing the greatest decrease was 3-OH butyric acid (61% decrease). A decrease of 46% was found (P=0.263) in the lactic acid/malic acid ratio.\u0000\u0000\u0000CONCLUSION\u0000Metabolomic studies of tears could facilitate a new and objective process in the follow-up period or in the determination of prognosis after CXL treatment for diseases such as keratoconus, which has a multifactorial etiology.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82553510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/ICL.0000000000000651
Duygu Gulmez Sevim, K. Gumus, Metin Unlu
OBJECTIVES To investigate the correlation between the clinical grading of the severity of meibomian gland dysfunction (MGD) and meibomian gland area (MGA) loss detected using Sirius meibography in the upper and lower eyelids and to correlate these parameters with dry eye signs and symptoms. METHODS One hundred thirty eyes of 130 volunteer patients were enrolled. Meibomian gland dysfunction was defined as the presence of signs consistent with meibomian gland terminal duct obstruction and categorized between grades 1 and 4. Upper and lower MGA loss percentages were evaluated using Sirius meibography by two blinded examiners. Patients were categorized into two groups (positive and negative for MGD) based on their Ocular Surface Disease Index (OSDI) scores (≥15 and <14, respectively) and MGD grades (≥1 and 0, respectively). RESULTS The MGA loss percentage and ocular surface test results of the MGD group were greater than in the non-MGD group in both eyelids (P=0.001). Meibomian gland dysfunction grade and MGA loss for the lower eyelid was greater than that of the upper eyelids (P=0.002 and P<0.001, respectively). The OSDI score, tear film break-up time, and lissamine green staining were all significantly correlated with MGD grade and MGA loss in both eyelids (P<0.001). For the average measures of the MGA loss percentage in each scan, the intraclass correlation value was found as 0.994 (95% confidence interval [CI]: 0.992-0.995) for reader 1 and 0.988 (95% CI: 0.982-0.992) for reader 2. CONCLUSIONS Our findings suggest that Sirius meibography, a noncontact imaging device, is a reliable tool for evaluating meibomian gland structure in patients with MGD and non-MGD of various ages and regardless of sex.
{"title":"Reliable, Noncontact Imaging Tool for the Evaluation of Meibomian Gland Function: Sirius Meibography.","authors":"Duygu Gulmez Sevim, K. Gumus, Metin Unlu","doi":"10.1097/ICL.0000000000000651","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000651","url":null,"abstract":"OBJECTIVES\u0000To investigate the correlation between the clinical grading of the severity of meibomian gland dysfunction (MGD) and meibomian gland area (MGA) loss detected using Sirius meibography in the upper and lower eyelids and to correlate these parameters with dry eye signs and symptoms.\u0000\u0000\u0000METHODS\u0000One hundred thirty eyes of 130 volunteer patients were enrolled. Meibomian gland dysfunction was defined as the presence of signs consistent with meibomian gland terminal duct obstruction and categorized between grades 1 and 4. Upper and lower MGA loss percentages were evaluated using Sirius meibography by two blinded examiners. Patients were categorized into two groups (positive and negative for MGD) based on their Ocular Surface Disease Index (OSDI) scores (≥15 and <14, respectively) and MGD grades (≥1 and 0, respectively).\u0000\u0000\u0000RESULTS\u0000The MGA loss percentage and ocular surface test results of the MGD group were greater than in the non-MGD group in both eyelids (P=0.001). Meibomian gland dysfunction grade and MGA loss for the lower eyelid was greater than that of the upper eyelids (P=0.002 and P<0.001, respectively). The OSDI score, tear film break-up time, and lissamine green staining were all significantly correlated with MGD grade and MGA loss in both eyelids (P<0.001). For the average measures of the MGA loss percentage in each scan, the intraclass correlation value was found as 0.994 (95% confidence interval [CI]: 0.992-0.995) for reader 1 and 0.988 (95% CI: 0.982-0.992) for reader 2.\u0000\u0000\u0000CONCLUSIONS\u0000Our findings suggest that Sirius meibography, a noncontact imaging device, is a reliable tool for evaluating meibomian gland structure in patients with MGD and non-MGD of various ages and regardless of sex.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81853046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/ICL.0000000000000663
M. Roda, C. Ciavarella, G. Giannaccare, P. Versura
OBJECTIVES The purpose of this review is to briefly outline current scientific evidence on the potential role of tear analysis and ocular surface evaluation in diagnosis and monitoring of neurodegenerative diseases, especially Alzheimer disease, Parkinson disease, and glaucoma. METHODS A systematic computerized search in the electronic databases PubMed, MEDLINE, and the Cochrane Collaborations was conducted to find eligible articles which their main topic was to investigate the tear and ocular surface in neurodegenerative diseases. After a first screening of titles and abstracts and a full-text review, 26 articles met the inclusion criteria (1 about the neurodegenerative diseases, 3 about the Alzheimer disease, 11 about the Parkinson disease, 11 about glaucoma, and 1 about amyotrophic lateral sclerosis). RESULTS The ocular surface picture seems to be altered in the setting of neurodegenerative diseases with specific characteristics according to each disease. They seem to be associated with reduced corneal sensitivity and abnormal tear function, and each one presents the expression of specific biomarkers in tears. CONCLUSIONS The study of tears and ocular surface appears to be a new and noninvasive promising way to assist in the diagnosis and monitoring of neurodegenerative diseases.
{"title":"Biomarkers in Tears and Ocular Surface: A Window for Neurodegenerative Diseases.","authors":"M. Roda, C. Ciavarella, G. Giannaccare, P. Versura","doi":"10.1097/ICL.0000000000000663","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000663","url":null,"abstract":"OBJECTIVES\u0000The purpose of this review is to briefly outline current scientific evidence on the potential role of tear analysis and ocular surface evaluation in diagnosis and monitoring of neurodegenerative diseases, especially Alzheimer disease, Parkinson disease, and glaucoma.\u0000\u0000\u0000METHODS\u0000A systematic computerized search in the electronic databases PubMed, MEDLINE, and the Cochrane Collaborations was conducted to find eligible articles which their main topic was to investigate the tear and ocular surface in neurodegenerative diseases. After a first screening of titles and abstracts and a full-text review, 26 articles met the inclusion criteria (1 about the neurodegenerative diseases, 3 about the Alzheimer disease, 11 about the Parkinson disease, 11 about glaucoma, and 1 about amyotrophic lateral sclerosis).\u0000\u0000\u0000RESULTS\u0000The ocular surface picture seems to be altered in the setting of neurodegenerative diseases with specific characteristics according to each disease. They seem to be associated with reduced corneal sensitivity and abnormal tear function, and each one presents the expression of specific biomarkers in tears.\u0000\u0000\u0000CONCLUSIONS\u0000The study of tears and ocular surface appears to be a new and noninvasive promising way to assist in the diagnosis and monitoring of neurodegenerative diseases.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79664930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.1097/ICL.0000000000000649
A. Srirampur, D. Macha
{"title":"The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex Folliculorum Blepharitis.","authors":"A. Srirampur, D. Macha","doi":"10.1097/ICL.0000000000000649","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000649","url":null,"abstract":"","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90350435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000678
C. Arıcı, Pınar Sultan, Burak Mergen, Bulent Buttanri, Cezmi Doğan
OBJECTIVES To evaluate the effect of corneal subepithelial infiltrates (SEIs) on tear film function and best-corrected visual acuity (BCVA) after persistent epidemic keratoconjunctivitis (EKC) and to compare the findings with controls. METHODS In this prospective, cross-sectional study, 38 patients with EKC and 42 healthy volunteers were enrolled. While patients with SEIs after EKC made up groups 1a (first involved eye) and 1b (second involved eye), healthy controls made up group 2. Best-corrected visual acuity, corneal subepithelial infiltrate scoring (CSIS), Fantes score, tear breakup time (TBUT), Schirmer test, and ocular surface disease index (OSDI) scores were measured. The Oxford grading system was used to score corneal staining. RESULTS The mean Fantes score was 1.8±0.8 for group 1a and 1.3±1.1 for group 1b (P=0.03). The mean CSIS was 2.9±1.3 for group 1a and 1.9±1.7 for group 1b (P=0.005). But there was no significant difference in terms of the mean BCVA, TBUT, Schirmer, OSDI, and Oxford grading (P=0.66, 0.9, 0.9, 0.9, and 1.0, respectively) between group 1a and group 1b. The mean BCVA, TBUT, Schirmer, and OSDI values were worse in group 1a and group 1b in comparison to group 2 (P=0.001). CONCLUSIONS We showed that the first involved eyes of patients with SEIs may be affected more significantly, but this difference may not have a clinical reflection on the difference in tear film functions between two eyes. However, compared with the healthy eyes, tear film function and BCVA were equally compromised in both eyes of the patients with SEIs irrelevant to the involved eye.
{"title":"The Impact of Bilateral Subepithelial Corneal Infiltrates on Tear Film After Epidemic Keratoconjunctivitis.","authors":"C. Arıcı, Pınar Sultan, Burak Mergen, Bulent Buttanri, Cezmi Doğan","doi":"10.1097/ICL.0000000000000678","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000678","url":null,"abstract":"OBJECTIVES\u0000To evaluate the effect of corneal subepithelial infiltrates (SEIs) on tear film function and best-corrected visual acuity (BCVA) after persistent epidemic keratoconjunctivitis (EKC) and to compare the findings with controls.\u0000\u0000\u0000METHODS\u0000In this prospective, cross-sectional study, 38 patients with EKC and 42 healthy volunteers were enrolled. While patients with SEIs after EKC made up groups 1a (first involved eye) and 1b (second involved eye), healthy controls made up group 2. Best-corrected visual acuity, corneal subepithelial infiltrate scoring (CSIS), Fantes score, tear breakup time (TBUT), Schirmer test, and ocular surface disease index (OSDI) scores were measured. The Oxford grading system was used to score corneal staining.\u0000\u0000\u0000RESULTS\u0000The mean Fantes score was 1.8±0.8 for group 1a and 1.3±1.1 for group 1b (P=0.03). The mean CSIS was 2.9±1.3 for group 1a and 1.9±1.7 for group 1b (P=0.005). But there was no significant difference in terms of the mean BCVA, TBUT, Schirmer, OSDI, and Oxford grading (P=0.66, 0.9, 0.9, 0.9, and 1.0, respectively) between group 1a and group 1b. The mean BCVA, TBUT, Schirmer, and OSDI values were worse in group 1a and group 1b in comparison to group 2 (P=0.001).\u0000\u0000\u0000CONCLUSIONS\u0000We showed that the first involved eyes of patients with SEIs may be affected more significantly, but this difference may not have a clinical reflection on the difference in tear film functions between two eyes. However, compared with the healthy eyes, tear film function and BCVA were equally compromised in both eyes of the patients with SEIs irrelevant to the involved eye.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83843833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000674
S. Akkaya Turhan, Didem Dizdar Yigit, E. Toker
PURPOSE To determine the impact of optical density changes in postlens fluid on clinical performance and to quantify these changes over time during miniscleral lens wear. METHODS Twenty-three eyes of 13 patients with keratoconus were fitted with a miniscleral lens (scleral Misa lenses; Microlens Contactlens Technology, Arnhem, Netherlands). The lens fit was evaluated using the fluorescein pattern and also through anterior segment optical coherence tomography imaging. The optical density changes were measured using Scheimpflug tomography at 30 min, 1, 2, 3, and 4 hr. High- and low-contrast visual acuity (VA), subjective performance with comfort and vision (5-point Likert scale), and overall satisfaction with the lens (100-mm visual analog scale) were measured before and after lens-wear. RESULTS The mean Snellen high-contrast VA (best spectacle-corrected VA: 0.4±0.2 vs. VA with the scleral lens: 0.8±0.1, P<0.0001) and low-contrast VA (best spectacle-corrected VA: 1.2±0.2 vs. VA with the scleral lens: 1.3±0.2, P=0.019) significantly improved with dispensed scleral lens. Patients reported high scores for comfort (3.8±0.8), vision (3.8±0.6), and overall satisfaction with the lens (68.7±19.1). Compared with preoperative values, optical density significantly increased over time (P<0.0001). High-contrast VA remained stable, whereas low-contrast VA significantly decreased at 2 hr (P=0.035). CONCLUSION This study shows that the optical density of postlens fluid increases over time with miniscleral lens wear, and it has a negative impact on low-contrast VA.
{"title":"Impact of Changes in the Optical Density of Postlens Fluid on the Clinical Performance of Miniscleral Lenses.","authors":"S. Akkaya Turhan, Didem Dizdar Yigit, E. Toker","doi":"10.1097/ICL.0000000000000674","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000674","url":null,"abstract":"PURPOSE\u0000To determine the impact of optical density changes in postlens fluid on clinical performance and to quantify these changes over time during miniscleral lens wear.\u0000\u0000\u0000METHODS\u0000Twenty-three eyes of 13 patients with keratoconus were fitted with a miniscleral lens (scleral Misa lenses; Microlens Contactlens Technology, Arnhem, Netherlands). The lens fit was evaluated using the fluorescein pattern and also through anterior segment optical coherence tomography imaging. The optical density changes were measured using Scheimpflug tomography at 30 min, 1, 2, 3, and 4 hr. High- and low-contrast visual acuity (VA), subjective performance with comfort and vision (5-point Likert scale), and overall satisfaction with the lens (100-mm visual analog scale) were measured before and after lens-wear.\u0000\u0000\u0000RESULTS\u0000The mean Snellen high-contrast VA (best spectacle-corrected VA: 0.4±0.2 vs. VA with the scleral lens: 0.8±0.1, P<0.0001) and low-contrast VA (best spectacle-corrected VA: 1.2±0.2 vs. VA with the scleral lens: 1.3±0.2, P=0.019) significantly improved with dispensed scleral lens. Patients reported high scores for comfort (3.8±0.8), vision (3.8±0.6), and overall satisfaction with the lens (68.7±19.1). Compared with preoperative values, optical density significantly increased over time (P<0.0001). High-contrast VA remained stable, whereas low-contrast VA significantly decreased at 2 hr (P=0.035).\u0000\u0000\u0000CONCLUSION\u0000This study shows that the optical density of postlens fluid increases over time with miniscleral lens wear, and it has a negative impact on low-contrast VA.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86508094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000679
Angelica C. Scanzera, Sneha Bontu, C. Joslin, T. McMahon, M. Rosenblatt, Ellen Shorter
OBJECTIVES To describe indications for scleral contact lens (ScCL) evaluation, previous treatments, and outcomes of patients prescribed ScCL at a tertiary referral center. METHODS This retrospective study reviewed 133 patients evaluated for ScCL between January 1, 2010, and December 31, 2015, at the University of Illinois at Chicago (UIC) Contact Lens Service. Patient demographics, ocular history, indications for evaluation, previous treatments, presence of punctate epithelial erosions, number of lenses ordered, follow-up visits, best-corrected visual acuity before ScCL, and visual acuity with ScCL were evaluated. Patients were categorized based on primary indication for ScCL evaluation as ocular surface disease (OSD) or corneal irregularity (CI). The primary outcome was visual acuity. RESULTS Visual acuity improved from logarithm of the minimal angle of resolution 0.3±0.4 at presentation to 0.1±0.2 with ScCL in all eyes (n=223, P=0.0001), and from 0.3±0.5 to 0.1±0.2 (n=164, P=0.001) in the OSD group and 0.5±0.4 to 0.2±0.2 (n=59, P=0.0001) in the CI group. Seventy percent of patients were evaluated for bilateral ScCL evaluation. Indication for ScCL evaluation was OSD in 71% (n=95) of patients, with 20% having a secondary diagnosis of CI. Corneal irregularity was the primary diagnosis in 29% of patients (n=38), with 50% having a secondary diagnosis of OSD. CONCLUSIONS Ocular surface disease was common in this tertiary referral patient population and was a primary or secondary indication for ScCL evaluation in 85.7% (n=114) of patients evaluated for ScCL. Scleral contact lenses improved visual outcomes in patients with both primary diagnoses of CI and OSD.
{"title":"Prevalence of Ocular Surface Disease and Corneal Irregularity and Outcomes in Patients Using Therapeutic Scleral Lenses at a Tertiary Care Center.","authors":"Angelica C. Scanzera, Sneha Bontu, C. Joslin, T. McMahon, M. Rosenblatt, Ellen Shorter","doi":"10.1097/ICL.0000000000000679","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000679","url":null,"abstract":"OBJECTIVES\u0000To describe indications for scleral contact lens (ScCL) evaluation, previous treatments, and outcomes of patients prescribed ScCL at a tertiary referral center.\u0000\u0000\u0000METHODS\u0000This retrospective study reviewed 133 patients evaluated for ScCL between January 1, 2010, and December 31, 2015, at the University of Illinois at Chicago (UIC) Contact Lens Service. Patient demographics, ocular history, indications for evaluation, previous treatments, presence of punctate epithelial erosions, number of lenses ordered, follow-up visits, best-corrected visual acuity before ScCL, and visual acuity with ScCL were evaluated. Patients were categorized based on primary indication for ScCL evaluation as ocular surface disease (OSD) or corneal irregularity (CI). The primary outcome was visual acuity.\u0000\u0000\u0000RESULTS\u0000Visual acuity improved from logarithm of the minimal angle of resolution 0.3±0.4 at presentation to 0.1±0.2 with ScCL in all eyes (n=223, P=0.0001), and from 0.3±0.5 to 0.1±0.2 (n=164, P=0.001) in the OSD group and 0.5±0.4 to 0.2±0.2 (n=59, P=0.0001) in the CI group. Seventy percent of patients were evaluated for bilateral ScCL evaluation. Indication for ScCL evaluation was OSD in 71% (n=95) of patients, with 20% having a secondary diagnosis of CI. Corneal irregularity was the primary diagnosis in 29% of patients (n=38), with 50% having a secondary diagnosis of OSD.\u0000\u0000\u0000CONCLUSIONS\u0000Ocular surface disease was common in this tertiary referral patient population and was a primary or secondary indication for ScCL evaluation in 85.7% (n=114) of patients evaluated for ScCL. Scleral contact lenses improved visual outcomes in patients with both primary diagnoses of CI and OSD.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"21 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91475972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000675
A. K. Cohen, Despoina Theotoka, A. Galor
OBJECTIVES To report a novel case of Epipremnum aureum toxicity masquerading as bilateral infectious keratitis and review the literature on ocular manifestations of Epipremnum exposure. METHODS Case report and literature review. RESULTS A 70-year-old man with a history of photorefractive keratectomy presented with a 3-day history of bilateral eye pain. The patient reported exposure to plant debris while performing yard work and also water exposure while cleaning his coral fish tanks. Clinical examination revealed bilateral epitheliopathy progressing to frank epithelial defects with underlying stromal necrosis 6 days after exposure. Empiric topical antibiotic drops were initiated, but multiple cultures, corneal biopsy, and confocal microscopy were all negative for an infectious agent. Over a 2-week period, the epithelial defects worsened and a suspicion for a toxic etiology was raised. The patient later recalled rubbing his eyes after exposure to Epipremnum aureum (Golden Pothos/Devils Ivy) sap. He was thus treated conservatively with artificial tears, topical corticosteroids, and amniotic membrane. After 3 months, the epithelial defects resolved, but with corneal scarring, prominently in the left eye and underwent penetrating keratoplasty. Five years after presentation, best-corrected visual acuity with hard contact lenses was 20/25 in the right eye and 20/20 in the left eye. CONCLUSION Epipremnum aureum toxicity is a rare cause of keratitis. It can mimic acanthamoeba keratitis or anesthetic abuse and should be considered in cases of culture negative nonhealing corneal ulcerations. Eliciting a history of plant sap exposure can facilitate appropriate supportive care for this toxic keratitis.
{"title":"Epipremnum aureum Keratopathy: Case Report and Review of the Literature.","authors":"A. K. Cohen, Despoina Theotoka, A. Galor","doi":"10.1097/ICL.0000000000000675","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000675","url":null,"abstract":"OBJECTIVES\u0000To report a novel case of Epipremnum aureum toxicity masquerading as bilateral infectious keratitis and review the literature on ocular manifestations of Epipremnum exposure.\u0000\u0000\u0000METHODS\u0000Case report and literature review.\u0000\u0000\u0000RESULTS\u0000A 70-year-old man with a history of photorefractive keratectomy presented with a 3-day history of bilateral eye pain. The patient reported exposure to plant debris while performing yard work and also water exposure while cleaning his coral fish tanks. Clinical examination revealed bilateral epitheliopathy progressing to frank epithelial defects with underlying stromal necrosis 6 days after exposure. Empiric topical antibiotic drops were initiated, but multiple cultures, corneal biopsy, and confocal microscopy were all negative for an infectious agent. Over a 2-week period, the epithelial defects worsened and a suspicion for a toxic etiology was raised. The patient later recalled rubbing his eyes after exposure to Epipremnum aureum (Golden Pothos/Devils Ivy) sap. He was thus treated conservatively with artificial tears, topical corticosteroids, and amniotic membrane. After 3 months, the epithelial defects resolved, but with corneal scarring, prominently in the left eye and underwent penetrating keratoplasty. Five years after presentation, best-corrected visual acuity with hard contact lenses was 20/25 in the right eye and 20/20 in the left eye.\u0000\u0000\u0000CONCLUSION\u0000Epipremnum aureum toxicity is a rare cause of keratitis. It can mimic acanthamoeba keratitis or anesthetic abuse and should be considered in cases of culture negative nonhealing corneal ulcerations. Eliciting a history of plant sap exposure can facilitate appropriate supportive care for this toxic keratitis.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"394 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83180458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000671
Amritha D. Kanakamedala, H. Salazar, Giovanni A Campagna, P. Chamberlain, S. Vadapalli, S. Orengo‐Nania, Sumitra S. Khandelwal
OBJECTIVES To document outcomes associated with use of scleral contact lenses (SL) in the veteran population and analyze the medical and demographic factors that affect these outcomes, specifically those involved in contact lens discontinuation. METHODS A retrospective study of consecutive patients first fitted with Jupiter Scleral lenses at the Michael E. DeBakey Veterans Affairs Medical Center between 2010 and 2018. The primary outcome was continuation of SL use at 1 year. Demographic factors and variables such as presence of comorbid diseases, improvement in visual acuity, and daily lens wear time were compared. Logistic regression analysis was used to determine which factors were associated with SL discontinuation. RESULTS One hundred twenty patients with a mean age of 56.7±15.1 years were fitted with SL during the study period. The most common diagnosis was corneal ectasia (55.8%). Sixty-six (55.0%) patients had difficulty with wear, the most common being ocular irritation (20.0%) and mid-day fogging or bubbles (15.8%). Forty-one patients (34.2%) discontinued SL use with a median time from fitting to discontinuation of 5.2 months. The most common reason for SL discontinuation was difficulty with insertion and removal (53.7%). Comorbid neurologic disease had a statistically significant association with discontinuation (odds ratio 4.6, 95% confidence interval 1.3-17, P=0.022). There were statistically significant differences in mean visual acuity improvement (P=0.003) and daily wear time (P<0.001) but not age (P=0.70) between patients who continued and discontinued lens use. CONCLUSIONS Scleral contact lenses are effective for treating a wide variety of ocular diseases and have positive outcomes in veterans. This study aids in understanding patient factors that affect outcomes of SL use in veterans. Further prospective studies are needed to make formal recommendations regarding candidate selection.
目的记录退伍军人使用巩膜隐形眼镜(SL)的相关结果，并分析影响这些结果的医学和人口统计学因素，特别是与停用隐形眼镜有关的因素。方法对2010年至2018年在Michael E. DeBakey退伍军人事务医疗中心连续首次配戴木星巩膜镜片的患者进行回顾性研究。主要结局是1年继续使用SL。比较人口统计学因素和变量，如合并症的存在、视力的改善和每日镜片佩戴时间。采用Logistic回归分析确定哪些因素与SL停药相关。结果120例患者在研究期间安装了SL，平均年龄为56.7±15.1岁。最常见的诊断是角膜扩张(55.8%)。66例(55.0%)患者有磨损困难，最常见的是眼部刺激(20.0%)和中午起雾或起泡(15.8%)。41例患者(34.2%)停止使用SL，从适合到停药的中位时间为5.2个月。SL停药最常见的原因是难以插入和取出(53.7%)。共病神经系统疾病与停药的相关性有统计学意义(优势比4.6,95%可信区间1.3-17,P=0.022)。继续和停止使用晶状体的患者在平均视力改善(P=0.003)和每日佩戴时间(P<0.001)上有统计学意义差异，但在年龄(P=0.70)上无统计学意义差异。结论巩膜隐形眼镜治疗多种眼部疾病效果良好。本研究有助于了解影响退伍军人SL使用结果的患者因素。需要进一步的前瞻性研究对候选人的选择提出正式的建议。
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Pub Date : 2019-11-29DOI: 10.1097/ICL.0000000000000673
J. Siddireddy, A. Vijay, Jacqueline Tan, M. Willcox
OBJECTIVES To evaluate the effect of microblepharon exfoliation on the number of eyelid bacteria and their lipase activity and the relationship of these to contact lens discomfort. METHODS Thirty experienced contact lens wearers had their eyelid margin physiology, tear properties, and comfort scores assessed. The number, type, and frequency of lower eyelid margin bacteria, and their lipase activity, were measured. Eyelids were treated with a foam cleanser or microblepharon exfoliation. Clinical and microbiological tests were repeated at each visit. Changes and correlations were examined. RESULTS Symptomatic lens wearers had a higher ratio for the number and frequency of gram-positive rods and cocci. Microblepharon exfoliation reduced the number and ratio of gram-positive rods to cocci from baseline for symptomatic wearers that lasted 7 to 10 days after treatment (P<0.05). Numbers of bacteria, the ratio of rods to cocci, and lipase activity correlated with lash contamination (r≥0.385; P≤0.046) and anterior blepharitis (r≥0.359; P≤0.048). Bacterial lipase correlated with meibomian gland secretions (r=0.422; P=0.038) and the tear evaporation rate (r=0.479; P=0.022). Microblepharon exfoliation produced a significant reduction in CLDEQ-8 scores and converted 10 symptomatic into asymptomatic lens wearers. CONCLUSIONS There was dysbiosis in the lid microbiome of symptomatic lens wearers. Microblepharon exfoliation reduced the number, frequency of isolation, and ratio of gram-positive rods and cocci. Bacterial numbers and their lipase production correlated with changes to clinical signs and symptoms. Symptomatic lens wearers could be converted to asymptomatic lens wearers after microblepharon exfoliation.
{"title":"Effect of Eyelid Treatments on Bacterial Load and Lipase Activity in Relation to Contact Lens Discomfort.","authors":"J. Siddireddy, A. Vijay, Jacqueline Tan, M. Willcox","doi":"10.1097/ICL.0000000000000673","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000673","url":null,"abstract":"OBJECTIVES\u0000To evaluate the effect of microblepharon exfoliation on the number of eyelid bacteria and their lipase activity and the relationship of these to contact lens discomfort.\u0000\u0000\u0000METHODS\u0000Thirty experienced contact lens wearers had their eyelid margin physiology, tear properties, and comfort scores assessed. The number, type, and frequency of lower eyelid margin bacteria, and their lipase activity, were measured. Eyelids were treated with a foam cleanser or microblepharon exfoliation. Clinical and microbiological tests were repeated at each visit. Changes and correlations were examined.\u0000\u0000\u0000RESULTS\u0000Symptomatic lens wearers had a higher ratio for the number and frequency of gram-positive rods and cocci. Microblepharon exfoliation reduced the number and ratio of gram-positive rods to cocci from baseline for symptomatic wearers that lasted 7 to 10 days after treatment (P<0.05). Numbers of bacteria, the ratio of rods to cocci, and lipase activity correlated with lash contamination (r≥0.385; P≤0.046) and anterior blepharitis (r≥0.359; P≤0.048). Bacterial lipase correlated with meibomian gland secretions (r=0.422; P=0.038) and the tear evaporation rate (r=0.479; P=0.022). Microblepharon exfoliation produced a significant reduction in CLDEQ-8 scores and converted 10 symptomatic into asymptomatic lens wearers.\u0000\u0000\u0000CONCLUSIONS\u0000There was dysbiosis in the lid microbiome of symptomatic lens wearers. Microblepharon exfoliation reduced the number, frequency of isolation, and ratio of gram-positive rods and cocci. Bacterial numbers and their lipase production correlated with changes to clinical signs and symptoms. Symptomatic lens wearers could be converted to asymptomatic lens wearers after microblepharon exfoliation.","PeriodicalId":12216,"journal":{"name":"Eye & Contact Lens: Science & Clinical Practice","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85503073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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