A randomized controlled clinical trial of the effectiveness and safety between aspherical and NUV soft hydrophilic contact lenses for myopia patients / 中华实验眼科杂志

Background The clinical effectiveness of soft corneal contact lens for correction of myopia has been confirmed.Theoretically,aspherical soft hydrophilic corneal contact lens has better visual qualify for myopic eyes,and the lenses have been applied widely.But abnormal tear film,even many cornea and conjuctiva diseases caused by soft contact lens have been reported,so the effectiveness and safety of aspherical soft hydrophilic corneal contact lens are worth concerning.Objective This clinical trail was to compare the effectiveness and safety between aspherical and NUV soft hydrophilic contact lens for myopic eyes.Methods A randomized,double-blind and controlled clinical study was performed under the approval of Ethic Committee of Qingdao Municipal Hospital and informed consent of each patient.One hundred and forty eyes of 70 myopic patients were enrolled in QingdaoMunicipal Hospital from July to October,2012.The subjects were randomized into the trial group and control group using random number table.Aspherical soft hydrophilic contact lenses were worn in the trial group and NUV soft hydrophilic contact lenses were worn in the control group.The characteristics of the lens surface,outcomes and the eye number in different scores of ocular signs and symptoms were assessed before and 15 minutes,1 week,2 weeks and 1 month after wearing lenses.Results The sores of humidity of anterior surface,the sediment in anterior and posterior surface are 0 in both lenses in various time points after wearing.The corrected visual acuity of all the subjects were ≥ 1.0.The eye number of 2-3 scores in various ocular signs was 0 in both groups,but the eye number of 1 score in palpebral conjunctival congestion and limbus congestion were more in the trail group than those in the control group in different time points (all at P＜0.05).There were significant differences in corneal fluorescine staining between the groups in different time points (all at P＞0.05).There was no eye for 2-3 scores of eye symptoms in both groups.The eye number for 1 score in foreign body sensation increased in the target-trail group compared to the control group at various time points (P =0.002,0.006,0.005,0.005).However,there was no statistically significant differences in the eye number for 1 score in visual clearness and stability between the two groups at the follow-up duration (all at P＞ 0.05).Conclusions Aspherical soft hydrophilic corneal contact lens has good outcomes in corrected visual acuity for myopia like NUV soft hydrophilic contact lens,but the wearing of aspherical soft hydrophilic corneal contact lens induces more ocular discomfortableness.

Fabrication and properties of nano-hydroxyapatite/poly(3-hydroxybutyrate) ultrafine-fibrous scaffolds for bone tissue engineering / 中国组织工程研究

BACKGROUND:Poly(3-hydroxybutyrate) is approved as its excel ent biocompatibility, biodegradability and piezoelectric properties, but there are also some deficiencies, such as high breakability and poor hydrophilicity. METHODS:Poly(3-hydroxybutyrate) was mixed with different mass percentages of nanohydroxyapatite (0, 10%, 20%and 30%) to prepare new composite fibrous scaffolds through electrospinning process. The microstructure, group composition, crystal ine phase distribution, thermal properties and surface wettability of the scaffolds were detected. RESULTS AND CONCLUSION:Under the scanning electron microscope, with the increase of nano-hydroxyapatite content, more and more nano-hydroxyapatite particles were distributed evenly on the composite fiber surface;the fiber surface was basical y covered with nano-hydroxyapatite particles at the content of 30%, and the roughness of the fiber surface also increased. Results from differential scanning calorimetry and X-ray diffraction showed that the nano-hydroxyapatite reduced the crystal inity of poly(3-hydroxybutyrate) and the crystal tacticity, and this phenomenon became more evident with the increase of nano-hydroxyapatite content. Additional y, the higher the content of nano-hydroxyapatite content, the lower the contact angle and the higher the hydrophily. These findings indicate that the nano-hydroxyapatite/poly(3-hydroxybutyrate) ultrafine-fibrous scaffold using electrospinning technology can effectively improve the surface wettability and crystal inity of the material as wel as the material hydrophily and brittleness, and the higher the content of nano-hydroxyapatite, the more obvious the effect.

Trauma ocular por explosão acidental de disco compacto / Ocular trauma due to accidental compact disc outburst

Apesar de rara, a ocorrência de lesão ocular devido à explosão acidental de disco compacto pode ser responsável por graves lesões no globo ocular. No presente artigo é relatado caso de perfuração corneana com trauma cristaliniano causado pela quebra intencional de disco compacto. Trata-se de paciente com 44 anos, sexo feminino, médica, avaliada em caráter de urgência com queixas de BAV, fotofobia, lacrimejamento e sensação de corpo estranho no OD, iniciados após presenciar quebra intencional de disco compacto. Apresentava perfuração corneana central, com sinal de Seidel positivo e lesão de cápsula anterior do cristalino com opacificação cortical anterior subjacente. A AV corrigida no OD era de 0,1. Tratada com lente de contato hidrofílica terapêutica e instilações tópicas regulares de solução antibiótica e hipotensora ocular, evoluiu com cicatrização da lesão corneana e estabilização da opacidade do cristalino. Decorridos 24 meses do trauma, sua refração encontrava-se semelhante aos valores prévios ao acidente e a acuidade visual era de 1,0 (-1).

Despite being rare, ocular injury due to a compact disc burst can be responsible for severe ocular damage. We present in this article a case of corneal perforation in addition to lens trauma caused by intentional compact disc break. A 44 year old female physician was examined complaining of visual acuity decrease, light sensitivity, tearing and foreign body sensation on OD after watching a compact disc being broken intentionally. In the first examination, she had a corneal perforation with aqueous humor leakage, anterior lens capsule lesion and anterior cortical opacity. The visual acuity was 0.1. She was treated with a therapeutic soft contact lens and the regular use of topical antibiotic and hypotension solutions, evolving with the healing of the corneal injury and lens opacity stabilization. Twenty four months later, the OD refraction was similar to that measured before the trauma and the visual acuity was 1.0 (-1).

Avaliação da ação antimicrobiana de soluções multiuso para desinfecção de lentes de contato hidrofílicas, in vitro / Antimicrobial efficacy assessment of multi-use solution to disinfect hydrophilic contact lens, in vitro

OBJETIVO: Avaliar a influência da ação antimicrobiana das soluções multiuso para desinfecção de lentes de contato hidrofílicas. MÉTODOS: Duas soluções multiuso denominadas solução A (poliquaternário-1 a 0,001 por cento e miristamidopropil dimetilamina a 0,0005 por cento) e solução B (poliaminopropil biguanida a 0,0001 por cento) foram testadas em lentes de contato hidrofílicas contaminadas com Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) e Candida albicans (ATCC 10231) para verificar a quantidade de redução do crescimento dos microrganismos após o enxágue com as soluções. Foram seguidas as instruções preconizadas pelos fabricantes. RESULTADOS: Houve redução de 90 por cento do crescimento de Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus e Candida albicans. Não houve crescimento de Klebsiella pneumoniae. CONCLUSÃO: As soluções testadas neste trabalho mostraram redução do número de microrganismos testados.

PURPOSE: To evaluate the efficacy of disinfecting solutions in hydrophilic contact lenses (CL). METHODS: Two multi-use solutions denominated solution A (0.001 percent polyquaternium-1 and 0.0005 percent myristamidopropyl dimethylamine) and solution B (0.0001 percent polyaminopropyl biguanide) were used. The solutions were tested in hydrophilic contact lenses infected with Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) and Candida albicans (ATCC 10231) and the decrease in microorganisms growth after the hydrophilic contact lenses were cleaned with the respective solutions was verified. The manufacture's instructions were followed. RESULTS: A decrease of 90 percent of Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus, Candida albicans and a decrease 100 percent of Klebsiella pneumoniae was observed. CONCLUSION: The solutions decreased the amount of microorganisms tested.

Lentes de contato terapêuticas e as vantagens dos materiais de alto Dk: [revisão] / Therapeutic contact lenses and the advantages of high Dk materials: [review]

As lentes de contato terapêuticas são úteis para o tratamento de uma série de doenças da superfície ocular. Suas principais finalidades são: reduzir a dor; proteger a córnea; facilitar e manter a cicatrização epitelial; restaurar a câmara anterior e liberar medicamentos na superfície ocular. Há uma variedade de tipos e materiais, sendo que a escolha depende da doença a ser tratada, tempo de uso e necessidades fisiológicas do olho doente. Doenças como a ceratopatia bolhosa, erosão recorrente do epitélio corneano, olho seco e defeitos epiteliais pós-operatórios, além de várias outras doenças que afetam a superfície ocular podem ser tratadas com a utilização das lentes de contato terapêuticas. Elas não devem ser utilizadas em processos infecciosos ou em pacientes que estão impossibilitados de retornar para acompanhamento regular. A adaptação, controle e manutenção adequados das lentes de contato terapêuticas são fundamentais para prevenir complicações, como: neovascularização corneana, conjuntivite papilar gigante ou ceratite infecciosa. O controle e manutenção foram facilitados com o advento das lentes de contato terapêuticas de silicone-hidrogel. Essas lentes permitem trocas menos freqüentes devido a sua maior oxigenação e, em casos selecionados, aceleram a reepitelização corneana.

Therapeutic contact lenses are useful in a variety of ocular surface diseases. Their main indications are: to relieve the pain; protect ocular surface; promote corneal healing and epithelial regeneration; seal a leaking corneal wound and deliver ophthalmic drugs on the ocular surface. There are several kinds of lens designs and materials, and their choice is dependent on the specific disease to be treated, the duration of treatment and the physiologic needs of the diseased cornea. Bullous keratopathy, recurrent epithelial erosion syndrome, dry eye and postoperative epithelial defects are amongst their indications. Therapeutic contact lenses should not be indicated in the presence of active infectious keratitis or when the patient is not compliant. Corneal neovascularization, giant papillary conjunctivitis and infectious keratitis are serious complications, which can be prevented by correctly fitting and maintaining the therapeutic contact lenses. Silicon-hydrogel therapeutic contact lenses, due to their higher oxygen permeability, allow extended wear schedules, decreasing the need for frequent lens replacement.

Bilateral Acanthamoeba ulcer in a user of disposable soft contact lenses: a tragic incident or a consequence of the aggressive policy of soft contact lens trading? / Úlcera bilateral por Acanthamoeba em usuária de lentes de contato gelatinosas descartáveis: um incidente trágico ou uma conseqüência da política agressiva de venda de lentes de contato gelatinosas?

This is the report of a case of bilateral Acanthamoeba keratitis in a 19-year-old woman who bought a pair of disposable soft contact lenses in a boutique. She wore this same pair of lenses for 3 months daily without the appropriate care. This led to bilateral corneal transplantation with cataract extraction and also trabeculectomy in the right eye. When last seen, both grafts were crystal clear but the visual acuities were far from satisfactory. She also had bilateral secondary glaucoma, barely controlled by topical medication. Actually, the physical features and the wearing time characteristics of the disposable soft contact lenses created unprecedented difficulties to the medical surveillance of their wearers. Without the right assistance they tend to become careless regarding routine cleaning. They also feel free to buy less expensive lenses, to use saline instead of lens solutions, to violate the limits of wearing time and to extend the use over the sleeping period. Additionally, the aggressive marketing and the wide distribution of these lenses increase the chances that economically or educationally unprepared people will acquire them. The question that remains is: Is the present case an accidental event or an example of what is likely to happen in the future if the indiscriminate selling of disposable soft contact lenses continues to evolve?

Este é o relato de uma paciente do sexo feminino, de 19 anos, com ceratite bilateral por Acanthamoeba, devido ao uso de lentes de contato descartáveis, adquiridas em uma butique. Fez uso do mesmo par de lentes durante três meses, sem os cuidados adequados. Foi submetida a transplante penetrante de córnea e facectomia bilateral, além de trabeculectomia no olho direito. Quando vista pela última vez, os enxertos estavam transparentes, mas a visão de ambos os olhos não era satisfatória. Ela também apresentava glaucoma secundário bilateral, controlado precariamente com medicação tópica. Ocorre que, as características físicas e o regime de uso das lentes de contato gelatinosas descartáveis criam dificuldades adicionais para a vigilância médica dos seus usuários. Sem a assistência correta, eles relaxam com a rotina de limpeza, compram lentes mais baratas, usam soro fisiológico ao invés das soluções adequadas, violam os limites de uso e dormem com as mesmas. Além disso, o "marketing" agressivo e a ampla distribuição dessas lentes aumentam as chances de que pessoas, não preparadas econômica e educacionalmente, venham ter acesso às mesmas. A pergunta que fica é: Seria o presente caso um evento acidental ou um exemplo do que pode acontecer no futuro caso as lentes de contato descartáveis continuem sendo vendidas indiscriminadamente?

Endotelite e ceratoneurite herpética / Endothelitis and herpetic keratoneuritis

Relatamos um caso de endotelite que se expressou inicialmente como uma cerato-neurite em pacientes usuários de lente de contato gelatinosa e de inadequado uso de solução salina . Trata-se de uma paciente de 41 anos, branca feminina, que se queixava de intensa dor no olho esquerdo e que ao exame biomicroscópico revelou edema corneano microcístico e ceratoneurite radial. Foram realizadas cultura e biopsia corneana e todos testes foram negativos. O tratamento com excelente resposta terapêutica reduziu o edema da córnea e aliviou a dor ocular consistiu de dexametasona 0,1 por cento tópica sob a forma de pomada e acyclovir oral.

We decribed a case of endothelitis that began with keratoneuritis in patient who wore soft contact lens and saline solution with poor hygiene. A 41 years old ,white female suffered from severe pain in her left eye, with microcystic corneal edema and radial keratoneuritis .Culture and corneal byopsia was made, and all tests were negative.The treatment including topical dexametasona 0.1 percent ophthalmic solution and oral acyclovir successfully controlled the corneal edema and the pain.

Medindo o poder refrativo de lentes de contato gelatinosas personalizadas / Measuring the refractive power of customized soft contact lenses

OBJETIVO: Lentes de contato gelatinosas com curvas-base esféricas têm sido usadas há anos. O cálculo do poder refrativo de lentes deste tipo é fácil, bastando utilizarmos a equação do fabricante de lentes para lentes espessas. No entanto, para projetos de lentes de contato personalizadas, não há ainda métodos confiáveis para medida das aberrações ópticas de ordem mais alta. Esse trabalho foi desenvolvido no laboratório do Centro de Ciências da Visão (Center for Visual Science) da Universidade de Rochester, Nova York, com aparelho óptico que permite realizar medidas precisas de aberrações de ordem baixa e alta de lentes de contato gelatinosas personalizadas. Este é um passo essencial na verificação e obtenção de lentes de contato personalizadas de qualidade, e o instrumento desenvolvido na Universidade de Rochester permite verificar a qualidade de fabricação destas lentes. MÉTODOS: Um aparelho óptico de bancada foi montado em laboratório. Este aparelho consiste de uma célula úmida onde as lentes de contato são depositadas. Consiste também de uma série de lentes e espelhos e um sensor de frente-de-onda de Hartmann-Shack. As lentes de contato personalizadas utilizadas neste projeto foram fabricadas pela empresa Bausch & Lomb. Das dezenas de lentes de contato mensuradas no aparelho, restringimos aqui a apresentar os resultados de uma lente personalizada para ceratocone. RESULTADOS: O erro quadrático médio (EQM) do instrumento foi de 0,04 micrômetro, sendo que o EQM das aberrações induzidas na lente está entre 4 e 6 micrômetros, ou seja, a precisão do aparelho está em torno de 1 por cento. Este valor é mais do que suficiente para medidas precisas destes tipos de lentes de contato, algo até então inviável utilizando-se os sensores ou aparelhos convencionais de aberrometria. CONCLUSÃO: Com o instrumento desenvolvido neste trabalho foi possível realizar medidas precisas de aberrações de alta ordem. Esta tecnologia é importante para o desenvolvimento...

PURPOSE: Soft contact lenses with spherical base curves have been used for many years. The computation of the refractive powers of these lenses is easy, requiring only that one uses the lens maker equation for thick lenses. Nevertheless, for customized contact lenses, there is yet no reliable method for measuring the higher order optical aberrations. In this study we have developed in the Center for Visual Sciences of the University of Rochester an optical apparatus that allows for precise measurement of low and high order aberrations of customized soft contact lenses. METHODS: An optical apparatus was mounted on a conventional optical bench. This apparatus consists of a wet cell where the contact lenses are placed, a series of relay lenses, mirrors, beam splitters, and a Hartmann-Shack sensor. Bausch & Lomb manufactured the lenses used in this study. RESULTS: The root mean square error (RMSE) of the instrument was 0.04 microns. Given that the RMSE of the customized lens is between 4 and 6 microns, i.e., the precision of the instrument is approximately 1 percent. This precision is more than sufficient for the type of measurements necessary for manufacturing customized contact lenses. CONCLUSION: The instrument developed is extremely precise for measuring high order aberrations - up to the 10th order Zernike polynomials, that is, up to the 66th term. This technology is important for the development of new methods of optical corrections for patients that usually do not adapt to normal sphere-cylinder spectacles or that cannot undergo refractive surgery, such as those which have keratoconus, for example.