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Abstract Introduction: Multipurpose solutions (MPS) for soft contact lenses (SCL) play an essential role in inhibiting potentially pathogenic agents. Their antimicrobial effectiveness is assessed in vitro and their safety in vivo, with clinical trials that include a combination of different solutions and lens materials. The objective is to assess the biocompatibility of a new SCL MPS produced in Colombia that contains polyhexamethylene biguanide (PHMB) and to determine its antimicrobial activity. Materials and Methods: This was a crossover study with 25 subjects who did not wear lens and who were fitted with different combinations of five SCL materials with either MPS or control physiological saline solution (CS). Corneal thickness, conjunctival hyperemia, corneal staining, and comfort were assessed after two hours of wearing SCL. Antimicrobial effectiveness was measured using ISO 14729 standard assays. Results: When considering SCL material, there was a statistically significant difference between the new MPS and the CS for Comfilcon A (p < 0.05). There was no statistical or clinically significant difference for corneal thickness or corneal staining between the combination of lens material and new MPS with the CS (p > 0.05). After two hours of lens insertion, comfort scores were higher than 7.8. The MPS reduced bacteria colony forming units (CFU) in over 3 log, and fungal CFU in over 1.0 log. Conclusions: The new MPS met the antimicrobial standards of ISO 14729, is considered safe and biocompatible with the ocular surface and retains high comfort levels.
Resumen Introducción: las soluciones multipropósito (SMP) para lentes de contacto blandos (LCB) desempeñan un papel esencial en la inhibición de agentes potencialmente patógenos. Su efectividad antimicrobiana se evalúa in vitro, y su seguridad, in vivo, con ensayos clínicos que incluyen una combinación de diferentes soluciones y materiales para lentes. El objetivo es evaluar la biocompatibilidad de una nueva SMP producida en Colombia que contiene polihexametileno biguanida (PHMB) y determinar su actividad antimicrobiana. Materiales y métodos: estudio cruzado con 25 sujetos no usuarios de lentes, que fueron adaptados con cinco combinaciones diferentes de materiales de LCB con una nueva SMP o solución salina fisiológica de control (CS). El grosor corneal, la hiperemia conjuntival, la tinción corneal y la comodidad se evaluaron después de dos horas de uso del LC. La efectividad antimicrobiana se midió utilizando ensayos estándar ISO 14729. Resultados: considerando el material del LCB, solo hubo una diferencia estadísticamente significativa entre la nueva SMP y el CS para el Comfilcon A (p < 0.05). Tampoco hubo diferencias estadísticamente o clínicamente significativas para el grosor corneal o la tinción corneal, entre la combinación del material del lente y la nueva SMP con el CS (p > 0.05). Después de dos horas de uso del lente, las puntuaciones de confort fueron superiores a 7.8. La SMP redujo las unidades formadoras de colonias (UFC) de bacterias en más de 3 log, y las UFC fúngicas en más de 1.0 log. Conclusiones: la nueva SMP cumplió con los estándares antimicrobianos de ISO 14729, y se considera segura y biocompatible con la superficie ocular, con altos niveles de confort.
Resumo Introdução: as soluções multipropósito (SMP) para lentes de contato macias (LCM) apresentam um papel essencial na inibição de agentes potencialmente patógenos. Sua eficácia como agente antimicrobiano se valia in vitro, e sua segurança, in vivo, como ensaios clínicos que incluem uma combinação de diferentes soluções e materiais para lentes. O objetivo é avaliar a biocompatibilidade de uma nova SMP produzida na Colômbia a base de polihexametileno biguanida (PHMB) e determinar seu potencial antimicrobiano. Materiais e métodos: estudo cruzado com 25 indivíduos não usuários de lentes, que foram adaptados com cinco combinações diferentes de LCM como uma nova SMP ou solução salina fisiológica como controle (CS). A espessura da córnea, a hiperemia conjuntival, a coloração da córnea e a comodidade, foram avaliadas após duas horas de uso da LCB. A eficácia antimicrobiana foi medida com ensaios padrão ISO 14729. Resultados: considerando o material da LCB, houve apenas uma diferença estatisticamente significativa entre a nova SMP e o CS, paro o Comfilcon A (p <0.05). Não houve diferença estatisticamente ou clinicamente significativa para a espessura da córnea ou a coloração da córnea, entre a combinação do material da lente e a nova SMP com o controle CS (p > 0.05). Após duas horas de uso, as pontuações de conforto foram superiores a 7,8. A SMP reduziu as unidades formadoras de colônias (UFC) de bactérias em mais de 3 log, e as UFC fúngicas em mais de 1.0 log. Conclusões: a nova SMP cumpriu com os padrões antimicrobianos ISO 14729, é considerada segura e biocompatível com a superfície ocular, com altos níveis de conforto.
Subject(s)
Humans , Contact Lenses, Hydrophilic , Hyperemia , Stem CellsABSTRACT
We report the natural course of the accidental injection of trypan blue into the corneal stroma while performing a routine cataract surgery by a resident during a training session. The corneal staining resolved with conservative medical treatment over 7 weeks. This case describes the anterior segment optical coherence tomography (ASOCT) features of corneal staining. It emphasizes on the relatively benign nature of this dye and the follow-up course. Causes that may be responsible for this untoward complication are highlighted with the necessary preventive measures that need to be taken care are also discussed.
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@#The aim of this study was to examine tear stability of contact lens wearers (CLW) in young Malay adults aged 18 and above and to compare the results with non-contact lens wearers (NCLW). Corneal staining and McMonnies Dry Eye Questionnaires (MDEQ) scores between habitual soft CLW and NCLW were also compared. It also aimed to find correlation between tear stability and MDEQ scores. Quasi-experimental and case control study was conducted among 53 participants (53 right eyes) at UiTM Vision Care, UiTM Puncak Alam Campus. Twenty six participants were habitual soft CLW and twenty seven were NCLW. Tear stability was measured using non-invasive tear break-up time (NIBUT) and invasive tear break-up time (TBUT). Corneal staining was measured using Efron Grading Scale and dry eye symptoms evaluated using MDEQ. Mean scores of NIBUT and TBUT for CLW were 5.23 ± 7.3 sec and 2.19 ± 2.41 sec respectively; for NCLW were 8.71 ± 4.33 sec and 3.00 ± 1.69 sec respectively. There were significant differences in NIBUT (Mann-Whitney U, p=0.0001) and TBUT (Mann-Whitney U, p=0.001) between the CLW and NCLW. There was also significant difference in percentage of corneal staining found between the CLW (22.6%) and NCLW (7.5%), (Chi-square, p=0.013). However no significant difference was found in MDEQ scores between the CLW (7.54 ± 3.62) and the NCLW (8.15 ± 3.38) group, (Mann-Whitney U, p=0.42). There were also no correlations found between tear stability and MDEQ scores in the two groups. The results of this study showed NIBUT and TBUT values were significantly higher in NCLW than in CLW and corneal staining was more extensive in CLW. Contact lens practitioners need to be aware of changes in tear stability as results of contact lens wear and take the necessary action to improve on the management of their patients during aftercare consultation.
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@#AIM: To evaluate and compare the clinical performance of 5 kinds of polyhexamethylene biguanide(PHMB)based multi-purpose solutions(MPS)manufactured in China when used with a commercially available silicone hydrogel contact lens in terms of solution-induced corneal staining(SICS), ocular response(corneal staining and ocular hyperemia), corneal infiltrative events(CIE)and ocular comfort.<p>METHODS: This was a prospective, open label, randomized, parallel group clinical trial. Totally 162 participants who were at least 18y old were enrolled and randomized into 5 groups of PHMB-based MPS made in China: Complete<sup>®</sup> MPS, Hydron<sup>®</sup> Aqua-shining moist, Baoshining<sup>TM</sup>, Weicon<sup>®</sup> Fresh, Weicon<sup>®</sup> 2000 MPS(abbreviated as C, H, B, W, and W2). All participants wore balafilcon A contact lenses with monthly disposal(Bausch & Lomb Purevision<sup>®</sup>)in conjunction with the designated MPS on a daily wear for 3mo. Clinical visits were at baseline, 2wk, 1 and 3mo. SICS and CIE were reported as first event incidence per 100 Px-months. Ocular response was graded on 0-4 scale in 0.5 steps(0=none, 4=severe)and ocular comfort was assessed <i>via</i> a numeric rating scale(1-10 in 1-point steps, 1=poor, 10=excellent). Ocular comfort and ocular response variables were analysed using linear mixed model. CIE and SICS were analysed using Fisher's exact test and logistic regression. <p>RESULTS: There were 36(22%)Pxs who dropped out. SICS incidence for each MPS were: H(26.3%),B(20.8%), W(19.4%), W2(13.4%), C(12.8%). The SICS rate of H was significantly different to W2(<i>P</i> = 0.012)and C(<i>P</i> = 0.005). There were no significant differences in ocular response, CIE incidence and ocular comfort between different MPSs(<i>P</i>>0.05). Pxs with SICS had significantly lower comfort during the day and at the end of than those who did not have SICS. <p>CONCLUSION: Differences in SICS incidence were found between MPSs but not for CIE incidence, ocular response or ocular comfort. SICS in PHMB-based MPS was found to be associated with ocular discomfort.
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PURPOSE: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. METHODS: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren's disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. RESULTS: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. CONCLUSIONS: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.