2 Fitting hydrophilic bandage contact lenses with special parameters in a megalocornea after PRK
1
Abstracts of the 2011 BCLA Annual Clinical Conference / Contact Lens & Anterior Eye 34, Supplement 1 (2011) S1–S43 S39 CASE REPORTS 1 The contribution of in vivo confocal microscopy in the diagnosis and managementof patients with anterior segment disease Deirdre M Burns 1, *, David G Frazer 1 , Jonathan Jackson 1,2 1 Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, N. Ireland; 2 Centre for Vision and Vascular Science, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, N. Ireland *E-mail address: [email protected] Confocal microscopy is a non-invasive method for examining the living cornea at the microstructural level. This poster presents clinical cases where its use played a role in the management of patients. Case 1: A 50 year old man complained of intermittent blurred vision in his LE in the mornings, after swimming or in cold weather. Slit lamp examina- tion was unremarkable but the IOP was 12mmHg in the RE and 34mmHg in the LE. Possible diagnoses included endothelial dysfunction, Fuch’s endothe- lial dystrophy, trigeminal nerve neuroma, POAG or Posner-Schlossmann syn- drome. Confocal microscopy found no evidence of Fuch’s endothelial dystro- phy and the endothelial cell density (ECD) was within the normal range for both eyes. These findings together with other tests helped establish a diag- nosis of Posner-Schlossman syndrome. Case 2: A 43 year old keratoconic female with previously successful bi- lateral penetrating keratoplasty developed hazy vision and corneal oedema in her RE. Possible diagnoses were graft rejection, endothelial failure or a contact lens-related complication. Confocal microscopy of the RE found ex- tensive polymegathism and pleomorphism and a reduced mean ECD. Graft failure was diagnosed and the patient had a repeat penetrating keratoplasty. Case 3: This 79 year old gentleman had recurrent episodes of herpes sim- plex keratitis (HSK) in his RE. His ophthalmologist suspected corneal en- dothelial failure and was considering corneal transplantation. Confocal ex- amination found a morphologically normal endothelium with a normal mean ECD. This ruled out endothelial failure and will influence the type of graft surgery. 2 Fitting hydrophilic bandage contact lenses with special parameters in a megalocornea after PRK Elsa García 1, *, Gema Álvarez 2 , Mercedes Burgos 1 , Steve Wright 3 1 mark’ennovy Personalized Care, Madrid, Spain; 2 Clinica Baviera, Madrid, Spain; 3 mark’ennovy Personalized Care, UK *E-mail address: [email protected] Megalocornea is a bilateral non progressive inherited developmental anomaly found almost entirely in males, in which the cornea and limbus are enlarged, being histologically normal, with horizontal diameters from 13 to 18 mm. Intraocular pressure values are normal, as well as best corrected vi- sual acuity. A case of a 52 year old man with megalocornea and rapid evo- lution cataract is presented. Cataract extraction in cases of megalocornea is difficult, and complications are frequent. In this case after bilateral lens pha- coemulsification and acrylic intraocular lenses (IOL) implantation, posterior capsule opacification appeared for which bilateral neodymium: YAG was ap- plied. Photorefractive keratectomy (PRK) was necessary for total ametropic correction. PRK is a refractive surgery technique in which the central portion of the epithelium is removed with a dilute alcohol solution. After the laser treatment, the cornea needs to be covered with a therapeutic bandage con- tact lens (CL) until full reepithelialization is achieved. Bandage CLs must fit properly, being large enough to cover the full cornea, well centered and with slight movement. Bandage CLs in megalocorneas should be fitted before PRK to ensure correct fitting and avoid complications. In the present case, optimal fitting was achieved with a special diameter hydrophilic lens (15.50mm) and a steep base curve (8.00mm). Material was 59% GMA Advantage and lens design a bicurve lens. Patient reported excellent comfort tolerance. At the moment of removing the lenses, after one week, a small subepithelial infil- trate was detected in the right eye. It healed after five days with no further complications. 3 Managing post traumatic iris deficiency with a pinhole-design prosthetic contact lens: a case report Hang I Christie Lam*, Wan Sang Chui The Hong Kong Polytechnic University, Hong Kong, China *E-mail address: [email protected] Hand-painted prosthetic contact lenses have been used for providing special eye effects in the movie industry. It is also gaining popularity among the nor- mal population for cosmetic purposes. However, as an optometrist, our in- terest is in the clinical applications; to provide vision and cosmetic improve- ment for those individuals suffering from eye disorder or disfiguration which may lead to clinical and psychological benefits. A 42 year old Chinese male was referred from a local hospital to our Optometry Clinic for contact lens fit- ting due to post trauma iris deficiency in the left eye. Since the iris in the left eye had been removed by surgery, the patient was suffering from poor vision, glare and photophobia. The unaided vision for the problem eye was FC at 2m and the subjective refraction was +3.00/−1.75×150 (with pinhole improved to 0.3). Corneal topography revealed significant irregular astigmatism with sim-K readings of 47.0D×134 and 49.6D×044. A hand-print prosthetic con- tact lens designed with a pinhole was made aiming to reduce the glare and improve vision of the problem eye. 4 Calculating the IOL for keratoconus and cataract: don’t forget the contact lens! Ken Pullum 1, *, Jennifer McMahon 1 , Shreeti Lakhani 2 1 Oxford Eye Hospitals, London and Oxford, UK; 2 Moorfields Eye Hospital, London, UK *E-mail address: [email protected] “Why are there so few older people with keratoconus . . . is their life expectancy less than ‘cornea normals’?” There is no proof of reduced longevity, but it seems true that not many older keratoconics have been attending our clinics over the years. However, recent confirmed sightings and a cluster of keratoconic cataracts suggest an ageing process similar to everyone else. “What is the role for pre-op biometry to choose the power of the IOL?” The power for the IOL for a “cornea normal” is accurately determined from precise biometry measurements of axial length and corneal curvature. Since the keratoconic corneal curvature is asymmetric, its basis for the cal- culation of the optimum IOL power is highly suspect. “So how then?” Straightforward although apparently not obvious is that contact lenses render keratoconus emmetropic before and after cataract surgery, and whether aphakic or pseudophakic. Simple selection of an IOL suitable for an emmetropic eye retains the status quo and avoids a post surgical optical mishap, irrespective of biometry. “How should the contact lens practitioner advice?” This poster shows post surgical alternatives affecting the outcome with regard to the contact lens parameters. The optical power of a rigid contact lens for keratoconus is a function of the back radius plus the underlying ametropia. With the unique appreciation of contact lens design, the con- tact lens practitioner is ideally placed to advise how to calculate the best IOL power to optimise and improve the post surgical contact lens parameters for continued post cataract visual rehabilitation. 5 Piggy-back contact lens fitting using intra-limbal RGP lens in a Chinese patient with rapid keratoconic changes: a case report Jimmy Sung-Hei Tse The Hong Kong Polytechnic University, Hong Kong, China E-mail address: [email protected] A 33 year old female, LKS, was presented to our Optometry clinic for con-
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Transcript of 2 Fitting hydrophilic bandage contact lenses with special parameters in a megalocornea after PRK
Abstracts of the 2011 BCLA Annual Clinical Conference / Contact Lens & Anterior Eye 34, Supplement 1 (2011) S1–S43 S39
CASE REPORTS
1
The contribution of in vivo confocal microscopy in the diagnosis andmanagementof patients with anterior segment disease
Deirdre M Burns1,*, David G Frazer1, Jonathan Jackson1,2
1Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, N.Ireland; 2Centre for Vision and Vascular Science, School of Medicine, Dentistryand Biomedical Sciences, Queen’s University, Belfast, N. Ireland
*E-mail address: [email protected]
Confocal microscopy is a non-invasive method for examining the livingcornea at the microstructural level. This poster presents clinical cases whereits use played a role in the management of patients.
Case 1: A 50 year oldman complained of intermittent blurred vision in hisLE in the mornings, after swimming or in cold weather. Slit lamp examina-tion was unremarkable but the IOP was 12mmHg in the RE and 34mmHg inthe LE. Possible diagnoses included endothelial dysfunction, Fuch’s endothe-lial dystrophy, trigeminal nerve neuroma, POAG or Posner-Schlossmann syn-drome. Confocal microscopy found no evidence of Fuch’s endothelial dystro-phy and the endothelial cell density (ECD) was within the normal range forboth eyes. These findings together with other tests helped establish a diag-nosis of Posner-Schlossman syndrome.
Case 2: A 43 year old keratoconic female with previously successful bi-lateral penetrating keratoplasty developed hazy vision and corneal oedemain her RE. Possible diagnoses were graft rejection, endothelial failure or acontact lens-related complication. Confocal microscopy of the RE found ex-tensive polymegathism and pleomorphism and a reduced mean ECD. Graftfailure was diagnosed and the patient had a repeat penetrating keratoplasty.
Case 3: This 79 year old gentleman had recurrent episodes of herpes sim-plex keratitis (HSK) in his RE. His ophthalmologist suspected corneal en-dothelial failure and was considering corneal transplantation. Confocal ex-amination found amorphologically normal endotheliumwith a normalmeanECD. This ruled out endothelial failure and will influence the type of graftsurgery.
2
Fitting hydrophilic bandage contact lenses with special parameters in amegalocornea after PRK
Elsa García1,*, Gema Álvarez2, Mercedes Burgos1, Steve Wright3
1mark’ennovy Personalized Care, Madrid, Spain; 2Clinica Baviera, Madrid,Spain; 3mark’ennovy Personalized Care, UK
*E-mail address: [email protected]
Megalocornea is a bilateral non progressive inherited developmentalanomaly found almost entirely in males, in which the cornea and limbus areenlarged, being histologically normal, with horizontal diameters from 13 to18 mm. Intraocular pressure values are normal, as well as best corrected vi-sual acuity. A case of a 52 year old man with megalocornea and rapid evo-lution cataract is presented. Cataract extraction in cases of megalocornea isdifficult, and complications are frequent. In this case after bilateral lens pha-coemulsification and acrylic intraocular lenses (IOL) implantation, posteriorcapsule opacification appeared for which bilateral neodymium: YAG was ap-plied. Photorefractive keratectomy (PRK) was necessary for total ametropiccorrection. PRK is a refractive surgery technique in which the central portionof the epithelium is removed with a dilute alcohol solution. After the lasertreatment, the cornea needs to be covered with a therapeutic bandage con-tact lens (CL) until full reepithelialization is achieved. Bandage CLs must fitproperly, being large enough to cover the full cornea, well centered and withslight movement. Bandage CLs in megalocorneas should be fitted before PRKto ensure correct fitting and avoid complications. In the present case, optimalfitting was achieved with a special diameter hydrophilic lens (15.50mm) anda steep base curve (8.00mm). Material was 59% GMA Advantage and lensdesign a bicurve lens. Patient reported excellent comfort tolerance. At themoment of removing the lenses, after one week, a small subepithelial infil-trate was detected in the right eye. It healed after five days with no furthercomplications.
3
Managing post traumatic iris deficiency with a pinhole-designprosthetic contact lens: a case report
Hang I Christie Lam*, Wan Sang Chui
The Hong Kong Polytechnic University, Hong Kong, China
*E-mail address: [email protected]
Hand-painted prosthetic contact lenses have been used for providing specialeye effects in the movie industry. It is also gaining popularity among the nor-mal population for cosmetic purposes. However, as an optometrist, our in-terest is in the clinical applications; to provide vision and cosmetic improve-ment for those individuals suffering from eye disorder or disfigurationwhichmay lead to clinical and psychological benefits. A 42 year old Chinese malewas referred from a local hospital to our Optometry Clinic for contact lens fit-ting due to post trauma iris deficiency in the left eye. Since the iris in the lefteye had been removed by surgery, the patient was suffering frompoor vision,glare and photophobia. The unaided vision for the problem eye was FC at 2mand the subjective refraction was +3.00/−1.75×150 (with pinhole improvedto 0.3). Corneal topography revealed significant irregular astigmatism withsim-K readings of 47.0D×134 and 49.6D×044. A hand-print prosthetic con-tact lens designed with a pinhole was made aiming to reduce the glare andimprove vision of the problem eye.
4
Calculating the IOL for keratoconus and cataract: don’t forget thecontact lens!
Ken Pullum1,*, Jennifer McMahon1, Shreeti Lakhani2
1Oxford Eye Hospitals, London and Oxford, UK; 2Moorfields Eye Hospital,London, UK
*E-mail address: [email protected]
“Why are there so few older people with keratoconus . . . is their life expectancyless than ‘cornea normals’?”
There is no proof of reduced longevity, but it seems true that not manyolder keratoconics have been attending our clinics over the years. However,recent confirmed sightings and a cluster of keratoconic cataracts suggest anageing process similar to everyone else.
“What is the role for pre-op biometry to choose the power of the IOL?”The power for the IOL for a “cornea normal” is accurately determined
from precise biometry measurements of axial length and corneal curvature.Since the keratoconic corneal curvature is asymmetric, its basis for the cal-culation of the optimum IOL power is highly suspect.
“So how then?”Straightforward although apparently not obvious is that contact lenses
render keratoconus emmetropic before and after cataract surgery, andwhether aphakic or pseudophakic. Simple selection of an IOL suitable foran emmetropic eye retains the status quo and avoids a post surgical opticalmishap, irrespective of biometry.
“How should the contact lens practitioner advice?”This poster shows post surgical alternatives affecting the outcome with
regard to the contact lens parameters. The optical power of a rigid contactlens for keratoconus is a function of the back radius plus the underlyingametropia. With the unique appreciation of contact lens design, the con-tact lens practitioner is ideally placed to advise how to calculate the best IOLpower to optimise and improve the post surgical contact lens parameters forcontinued post cataract visual rehabilitation.
5
Piggy-back contact lens fitting using intra-limbal RGP lens in a Chinesepatient with rapid keratoconic changes: a case report
Jimmy Sung-Hei Tse
The Hong Kong Polytechnic University, Hong Kong, China
E-mail address: [email protected]
A 33 year old female, LKS, was presented to our Optometry clinic for con-
