Eye & Contact Lens-Science and Clinical Practice最新文献

Abstract: Dry eye in Sjögren disease is characterized by lacrimal gland dysfunction, often resulting in decreased lacrimal fluid secretion, tear film thinning, epithelial cell damage, and ocular surface inflammation. Beyond lacrimal gland impairment, corneal nerves play a crucial role in the disease, with patients exhibiting a spectrum of symptoms depending on structural and functional nerve abnormalities. Two phenotypes are recognized in patients with Sjögren disease: one with diminished symptoms despite worsening clinical signs (neurotrophic aspect), and another with heightened symptoms such as hyperalgesia or photoallodynia that are disproportionate to clinical findings (neuropathic aspect). A comprehensive understanding of corneal nerve status may enable more personalized treatment approaches.

Objectives: To examine rates of erroneous or expired prescription facsimile (FAX) requests submitted for passive verification (PV) at one practice site in Cleveland, OH.

Methods: One thousand six hundred and eight PV FAX requests between January 1, 2019, and January 1, 2023, were collected from a county hospital (Metrohealth) in Cleveland, OH. These requests were grouped into separate categories detailing the errors in the requests and analyzed compared with previous data gathered at this site.

Results: Of 1,608 requests, 681 (42.4%) were expired, 165 (10.3%) were not under the direct care of the ophthalmologist to whom the request was directed, and 159 (9.9%) did not have a proper fitting completed or were incorrect. The overall rate of erroneous prescriptions was 62.5%, up from 59.0% in a previous study completed at the same site.

Conclusion: Passive verification still presents high rates of erroneous prescription verification. Amendments to the Contact Lens Rule have not improved previous erroneous rates at this site. With loopholes for third party vendors such as a short time window for the provider to review the prescription, PV errors remain.

Objective: To report the indications and outcomes associated with a double layered dehydrated amniotic membrane (AM) disc in managing ocular surface disorders.

Methods: A retrospective chart review was conducted of all patients treated with a double layered 9-mm dehydrated AM at a tertiary care clinic from July 2022 to November 2023. Primary outcomes included changes in uncorrected visual acuity (UCVA) from baseline to first and last follow-up. Secondary outcomes included changes in clinical signs and presence of complications.

Results: Ten cases were included (7 male, 70.0%), median age 50 years (interquartile ranges [IQR] 40-69), with median follow-up of 12.9 months (IQR 8.1-20.4). Indications included limbal stem cell deficiency (n=5), persistent epithelial defect (n=4), and aphakic bullous keratopathy (n=1). All patients showed clinical improvement, and the membrane was successfully integrated in nine eyes (90.0%) at first follow-up. Mean UCVA improved from 1.69 ± 0.62 logMAR at baseline to 1.22 ± 0.69 logMAR at first follow-up ( P =0.002) and to 0.98 ± 0.70 logMAR at last follow-up ( P =0.001). No complications occurred over the duration of follow-up.

Conclusions: The double layered dehydrated AM disc was associated with significant improvements in clinical signs and visual acuity, supporting its use as an effective in-office treatment for selected cases.

Abstract: We report on the management of a patient with bilateral central toxic keratopathy (CTK) and infective keratitis in one eye after bilateral photorefractive keratectomy (PRK). A 27-year-old woman presented with bilateral central corneal opacification, thinning and reduced vision within a week of PRK. The uncorrected distance visual acuity was 20/100 in the right eye and 20/60 in the left eye. The central pachymetry was 296 μm in the right eye and 262 μm in the left eye. Clinical diagnosis of CTK was made. Initial treatment included oral doxycycline and vitamin C. Subsequent evaluation at 3 weeks post-PRK showed infiltrate in the left eye, which revealed atypical mycobacteria on microbiological tests. The left eye was treated with topical azithromycin 1% for 2 months with a favorable response. The central pachymetry in the right eye improved significantly in 3 months. At 4 months, the central pachymetry in the right eye restored to 420 μm, which was stable till the last follow-up of 1 year. The central pachymetry in the left eye improved to 373 μm in 8 months, which remained stable till 1-year follow-up. At 1 year, the best corrected visual acuity was 20/20 and 20/25 in the right and left eyes, respectively. Bilateral CTK associated with infective keratitis in one eye can be effectively treated with medical therapy. Central toxic keratopathy may be self-limiting, requiring supportive management. Prompt recognition of coexisting infection and timely management leads to good visual outcomes.

Objectives: To compare the visual performance and subjective satisfaction of four daily disposable multifocal contact lenses (MCLs) in presbyopic subjects. Likewise, a comparative analysis of the performance of symmetrical and asymmetrical near addition designs was performed.

Methods: Twenty presbyopic participants were enrolled in this randomized crossover study evaluating short-term visual performance. The assessed outcomes included distance, intermediate, and near visual acuity (VA), defocus curves, contrast sensitivity function (CSF), stereopsis, and patient satisfaction measured by a visual analogue scale (VAS).

Results: Significantly better distance VA was found for BioTrue compared with MyDay ( P =0.018). By contrast, near VA was significantly more limited with BioTrue compared with the rest of contact lenses ( P ≤0.036). No significant differences in CSF were found between MCLs ( P >0.05). Asymmetrical designs showed better stereopsis than symmetrical designs ( P ≤0.018). VAS scale showed a nonsignificant trend to better scores for symmetrical designs for distance vision, and the opposite for near vision ( P >0.05).

Conclusions: Daily disposable MCLs demonstrated satisfactory short-term performance, although design differences should guide individualized selection to optimize visual outcomes. Notably, asymmetrical lens designs did not compromise stereopsis and may offer superior near VA compared with symmetrical alternatives.

Objectives: This study exemplifies the implementation of the US ophthalmic high-energy visible (HEV) band scheme by characterizing the light transmission properties of two ACUVUE OASYS contact lenses (CLs) and comparing their filtering profiles to seven different commercially available "blue blocking" spectacle lenses (SLs) from various manufacturers.

Methods: Ultraviolet/visible/near infrared scanning spectrophotometers were used to acquire spectral transmittance for the CLs and SLs. Luminous transmittance was calculated from these spectra using the relevant weight functions for photopic conditions and daylight illumination.

Results: ACUVUE OASYS MAX 1-Day (AOMAX) blocked more light than ACUVUE OASYS 1-Day (AO1D) in the HEV3 and HEV2 ranges, whereas both lenses transmitted light in the HEV1 band. AOMAX filtered light similarly to four SLs and filtered less in the HEV2 and more in the HEV3 band than the other three SLs. All lenses presented luminous transmittance values higher than 80%, placing the lenses in the "clear or very light tint" category.

Conclusion: The US HEV band scheme is a useful tool for characterization and comparison of the optical devices studied and should be considered when reporting clinical or technical results involving light in the 380 to 500 nm range.

Purpose: This study investigated the relationship between changes in summed relative corneal refractive power (CRP) and changes in relative peripheral refraction (RPR) in the retina of myopic children undergoing orthokeratology.

Methods: A prospective self-controlled study was conducted involving myopic children aged 8 to 12 years who were fitted with four-zone reverse-geometry orthokeratology lenses for 3 months. Corneal topography and peripheral refraction were measured at baseline, 1-, and 3-month follow-up visits. Changes in the summed relative CRP within the 4-, 5-, and 6-mm zones centered on the corneal geometrical center and ΔRPR across the annular regions and quadrants were derived. Partial correlation and multiple regression models were used to examine the relationship between changes in summed relative CRP and the changes of RPR.

Results: Seventy-eight of 85 participants completed the study. After adjusting for baseline spherical equivalent and treatment zone decentration, statistical correlations were found between changes in summed relative CRP within the central 5-mm zone and changes in RPR (ΔRPR) in specific regions (r=-0.24 to 0.45). Multiple regression analysis identified ΔSum5N (defined as changes in summed relative CRP in the nasal quadrant within a 5-mm diameter circular area centered at the corneal geometric center) as the strongest predictor of ΔRPR-T (defined as the ΔRPR in the temporal region of the peripheral retina) (adjusted R2=0.50), with each 1.0 D increase in ΔSum5N corresponding to a 0.179 D decrease in ΔRPR-T.

Conclusion: Changes in summed relative CRP may help predict ΔRPR after orthokeratology. Regional increases, especially in the nasal and inferior cornea, are linked to larger myopic shifts in peripheral defocus, especially on the temporal side. Further investigation is required to establish robust association.

Purpose: To evaluate the antibacterial and antibiofilm activity of tea tree oil (TTO) against a multidrug-resistant (MDR) Pseudomonas aeruginosa isolate, used as a representative model of the primary pathogen associated with contact lens-related keratitis.

Method: TTO was tested for minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-kill kinetics against P. aeruginosa. Biofilm (BF) formation and eradication assays were conducted using crystal violet (CV) and MTT viability tests on biofilms grown on CL surfaces. Cytotoxicity was evaluated in vitro using murine cone photoreceptor cells (661W).

Results: TTO showed strong antibacterial activity against MDR P. aeruginosa, with MIC and MBC values of 3.5 and 7 mg/mL, respectively. It inhibited biofilm formation and eradicated mature biofilms on silicone hydrogel contact lenses, outperforming commercial multipurpose solutions (P<0.05). Cytotoxicity assays in 661W cells revealed a narrow therapeutic window, as effective concentrations were close to cytotoxic levels.

Conclusions: TTO shows strong antibacterial and antibiofilm activity against MDR P. aeruginosa, outperforming commercial solutions in biofilm reduction. Although the narrow margin between effective and cytotoxic concentrations limits direct ocular use, its incorporation into contact lens care solutions appears promising for safe and effective prevention of microbial keratitis.

Purpose: To explore changes in corneoscleral thickness among myopic children undergoing overnight orthokeratology (Ortho-k) and assess potential associations with axial elongation.

Methods: This prospective study included myopic children receiving Ortho-k lens treatment with regular follow-ups in 6 months. Corneo-scleral cross-sectional images were obtained using a SPECTRALIS optical coherence tomography device. Measurements of anterior scleral thickness were taken at nasal (SS-N), temporal scleral spur (SS-T), and 1 mm away from these locations (SS-N1 and SS-T1).

Results: A total of 24 children (38 eyes) with a mean age of 10.3±2.2 years were included. The mean thickness was 643±48.0 μm at SS-T, 611±50.7 μm at SS-N, 515±44.6 μm at SS-T1, and 506±37.5 μm at SS-N1. Boys exhibited significantly greater scleral thickness at SS-N1 and SS-T1 compared with girls (P=0.01). After 6 months of Ortho-k use, significant thinning was observed at SS-T (from 643±48.0 μm to 616±44.0 μm; P=0.001) and SS-N (from 611±50.7 μm to 593±54.8 μm; P=0.015) compared with baseline values. However, the scleral thickness at 1 mm from the SS remained stable. No significant correlation was found between axial elongation and scleral thickness. A subgroup of monocular Ortho-k wearers found that SS-T and SS-N values decreased in eyes with monocular lens-wearing but remained stable in the untreated eyes.

Conclusions: A significant reduction in corneo-scleral thickness was observed after six months of Ortho-k lens wear. These changes warrant further investigation to confirm their implications and underlying mechanisms.

Abstract: This report presents two rare cases of presumed epithelial keratitis secondary to ocular tuberculosis (TB), highlighting an unusual clinical presentation that may be underrecognized. Two male patients from a TB-endemic region presented with unilateral, chronic epithelial keratitis in a semicircular pattern, with mild anterior stromal infiltration and reduced corneal sensitivity. Both were unresponsive to standard topical and systemic treatments including antivirals and corticosteroids. Diagnostic evaluation included Mantoux testing and systemic screening. Mantoux tests were positive in both patients, and one exhibited radiological evidence of latent pulmonary TB. Initiation of systemic antituberculosis therapy led to complete epithelial healing within 30 to 60 days in both cases. Each patient developed localized stromal scarring without neovascularization, and no recurrence was observed during follow-up periods of 6 months and 4 years, respectively. The absence of neovascularization, despite the chronicity of keratitis, may be a distinguishing clinical feature from herpetic keratitis. These cases illustrate a potentially underdiagnosed manifestation of ocular TB and suggest that tuberculosis should be considered in the differential diagnosis of refractory epithelial keratitis, especially in endemic regions or in patients with epidemiological risk factors. A Mantoux test with induration of 10 mm or greater, even in BCG-vaccinated individuals, may support the diagnosis in the appropriate clinical context. Antituberculosis therapy may be both therapeutic and diagnostic in such cases.