EyePrintPRO therapeutic scleral contact lens: indications and outcomes.

OBJECTIVE: To describe indications and outcomes of patients fitted with the EyePrintPRO therapeutic scleral lens. METHODS: A database search of patients fitted with the EyePrintPRO from 2014 to 2016. Fourteen eyes of 10 patients were reviewed retrospectively. Patient demographics, medical and ocular history, indications for fitting, duration of wear, symptoms, and best-corrected visual acuity (BCVA) were analyzed. RESULTS: Mean age at lens fitting was 49 years (range, 21-67 years). The average duration of wear was 12 months (range, 7-17 months). Indications for fitting included limbal stem cell deficiency, post-photorefractive keratectomy (PRK) decentred ablation, pellucid marginal degeneration, Stevens-Johnson syndrome, keratoconus, dry eye, neurotrophic keratitis, exposure keratitis from facial nerve paralysis, and post-radial keratotomy (RK) symptoms. Mean BCVA was 20/36 (range, 20/20-20/200). After the fitting, mean BCVA was 20/21 (range 20/10-20/60, p = 0.001). Nine patients reported resolution of their blurry vision, and all reported improvement of dry eye, eye redness, and pain symptoms. Six of 7 previous lens wearers reported significantly greater comfort with EyePrintPRO wear and the ability to wear the lens throughout the day; only 2 experienced fogging and needed to clean the lens after 4-6 hours of wear. CONCLUSIONS: A variety of indications for the EyePrintPRO scleral lens exist, and patients experience resolution of major symptoms. The ophthalmologist should be aware that therapeutic scleral lenses, including the EyePrintPRO, exist for patients for whom there is no surgical intervention or who want to delay or obviate the need for surgery.

Keratoconus diagnosis with optical coherence tomography pachymetry mapping.

OBJECTIVE: To detect abnormal corneal thinning in keratoconus using pachymetry maps measured by high-speed anterior segment optical coherence tomography (OCT). DESIGN: Cross-sectional observational study. PARTICIPANTS: Thirty-seven keratoconic eyes from 21 subjects and 36 eyes from 18 normal subjects. METHODS: The OCT system operated at a 1.3 microm wavelength with a scan rate of 2000 axial scans per second. A pachymetry scan pattern (8 radials, 128 axial scans each; 10 mm diameter) centered at the corneal vertex was used to map the corneal thickness. The pachymetry map was divided into zones by octants and annular rings. Five pachymetric parameters were calculated from the region inside the 5 mm diameter: minimum, minimum-median, inferior-superior (I-S), inferotemporal-superonasal (IT-SN), and the vertical location of the thinnest cornea. The 1-percentile value of the normal group was used to define the diagnostic cutoff. Placido-ring-based corneal topography was obtained for comparison. MAIN OUTCOME MEASURES: The OCT pachymetric parameters and a quantitative topographic keratoconus index (keratometry, I-S, astigmatism, and skew percentage [KISA%]) were used for keratoconus diagnosis. Diagnostic performance was assessed by the area under the receiver operating characteristic (AROC) curve. RESULTS: Keratoconic corneas were thinner. The pachymetric minimum averaged 452.6+/-60.9 microm in keratoconic eyes versus 546+/-23.7 microm in normal eyes. The 1-percentile cutoff was 491.6 microm. The thinnest location was inferiorly displaced in keratoconus (-805+/-749 microm vs -118+/-260 microm; cutoff, -716 microm). The thinning was focal (minimum-median: -95.2+/-41.1 microm vs -45+/-7.7 microm; cutoff, -62.6 microm). Keratoconic maps were more asymmetric (I-S, -44.8+/-28.7 microm vs -9.9+/-9.3 microm; cutoff, -31.3 microm; and IT-SN, -63+/-35.7 microm vs -22+/-11.4 microm; cutoff, -48.2 microm). Keratoconic eyes had a higher KISA% index (2641+/-5024 vs 21+/-19). All differences were statistically significant (t test, P<0.0001). Applying the diagnostic criteria of any 1 OCT pachymetric parameter below the keratoconus cutoff yielded an AROC of 0.99, which was marginally better (P = .09) than the KISA% topographic index (AROC, 0.91). CONCLUSIONS: Optical coherence tomography pachymetry maps accurately detected the characteristic abnormal corneal thinning in keratoconic eyes. This method was at least as sensitive and specific as the topographic KISA. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Role of rigid gas-permeable scleral contact lenses in the management of advanced atopic keratoconjunctivitis.

PURPOSE: To describe the use of rigid gas-permeable scleral contact lenses (ScCL) in the treatment and visual rehabilitation of patients with medically controlled advanced atopic keratoconjunctivitis (AKC). METHODS: Retrospective chart review of 10 eyes with medically controlled advanced AKC whose treatment included the use of ScCL for protection of the cornea from the ocular surface environment and visual rehabilitation. Outcomes measured were changes in biomicroscopic findings and visual acuity. RESULTS: Median follow-up period after ScCL fitting was 20.5 months (range, 14-32 months). An improvement in conjunctival hyperemia and corneal epithelial defects was observed in all eyes. Median best-corrected visual acuity before ScCL was logMAR 0.651 (Snellen 20/90; range, 20/45-20/400). After proper ScCL fitting, median logMAR visual acuity was 0.239 (Snellen 20/35; range, 20/20-20/50; P = 0.001). All patients gained at least 1 line of vision after initiation of ScCL, and 9 of 10 eyes experienced an improvement of at least 2 lines of vision. ScCL use was well tolerated by all patients, and no complications or infections occurred as a result of ScCL wear. CONCLUSIONS: Rigid gas-permeable ScCL are useful and safe to use in the management of the ocular surface and in the visual rehabilitation of eyes with medically controlled advanced AKC.