Corneal topography for rigid gas permeable lens fitting after penetrating keratoplasty.

Computerized videokeratography may facilitate rigid gas permeable (RGP) contact lens fitting in post-penetrating keratoplasty (post-PK) eyes. We used the EyeSys Corneal Analysis System to create topographic maps of 19 post-PK eyes from October 1990 to April 1991. An initial trial lens was selected based on the average keratometric value from two separate topographic color maps. A standard protocol was used to select the initial trial lens on the basis of computer generated topographic keratometry readings. Final lens selection was based on clinical performance. A comparison of the base curve of the initial contact lens selected using computerized videokeratography and the base curve that would have been selected by standard keratometry showed a statistically significant difference (P = 0.02). Three month follow-up data were also evaluated. There was no statistically significant difference between the base curve of the initially dispensed contact lens and the base curve of the lens worn after 3 months. However, modifications in the fit were made in 9 of 19 patients. Two patients were RGP contact lens failures and were refit with SoftPerm lenses.

Corneal topography for selective suture removal after penetrating keratoplasty.

Twenty-nine suture removals from 20 eyes (21 patients) on which penetrating keratoplasty had been performed were analyzed in a nonrandomized consecutive study to evaluate the role of computer-assisted corneal topography in selective suture removal to reduce astigmatism. Topographic guidance for suture removal resulted in a net decrease in refractive and keratometric astigmatism in 21 of the 29 cases. The net reduction in astigmatism averaged 1.4, 0.9, and 1.0 diopters when measured by refraction, keratometry, and topography, respectively. The preliminary choice of sutures to be removed on the basis of refraction, keratometry, and inspection was changed in 20 of the 29 cases when information added by the topographic map was considered. Although many variables of suture removal remain unpredictable, computer-assisted corneal topography is a powerful means of describing corneal power after penetrating keratoplasty and is useful as a guide in selective suture removal for reduction of astigmatism.

Corneal ulcers associated with contact lenses including experience with disposable lenses.

We conducted a retrospective study of corneal ulcers that had been managed on the Cornea Service at Wills Eye Hospital in 1988 and 1989. Forty-four percent (51 of 116) of the ulcers were associated with contact lens use. Pseudomonas was the most often isolated organism (25 of 116, 22%) and was most frequently associated with cosmetic soft contact lenses (16 of 25, 64%). Ulcers associated with disposable contact lenses (five cases) were similar to those associated with conventional extended wear myopic lenses (15 cases). Pseudomonas was the predominant organism with both disposable (four of five, 80%) and conventional extended wear lenses (nine of 15, 60%). Staphylococcus aureus (19 cases) and Staphylococcus epidermidis (19 cases) were the next most frequently isolated organisms and usually occurred in ulcers not associated with contact lenses (29 of 38, 76%). Ulcers were treated 3.3 times more often in people using extended wear than in those using daily wear myopic lenses. Disposable contact lenses have not eliminated the problem of corneal ulcers associated with extended wear contact lenses.

Titanium hemi-great toe implant: a preliminary study of its efficacy.

The purpose of this preliminary study is to evaluate the effectiveness of the titanium hemi-great toe implant. The device is found to be successful in helping to treat painful degenerative joint disease of the first and second metatarsophalangeal joints. The implant's most promising application appears to be use in patients below the age of 50 years manifesting metatarsophalangeal joint dystrophy, with subsequent clinical debilitation, who become surgical candidates.

Pseudophakic bullous keratopathy.

We reviewed the records of all patients with pseudophakic bullous keratopathy (271 eyes, 251 patients) seen during a six-month period to determine predisposing factors, associated problems, current management, and visual outcome. Pseudophakic bullous keratopathy was associated most frequently with anterior chamber intraocular lenses in general (155 of 271), and with Leiske style lenses in particular (100 of 271). It was associated with a visual acuity of 20/200 or less in 206 eyes and a visual acuity of counting fingers or less in 129 of the eyes at the initial examination. Penetrating keratoplasties had been performed in 189 of the eyes. After penetrating keratoplasty, 108 of 189 of the eyes had a visual acuity of 20/200 or less (mean follow-up, 15 months). Visual acuity improved with longer follow-up, and among patients with a minimum follow-up of two years, 23 of 36 eyes had a visual acuity of 20/100 or better. Most grafts were clear (145 of 189). Pseudophakic bullous keratopathy was associated with marked visual loss, which was permanent despite clear grafts in 29 of 92 eyes followed-up for one year or longer.