Late Spontaneous Postradial Keratotomy Corneal Perforation After Scleral Contact Lens Use-Case Report.

PURPOSE: To describe a case of late spontaneous postradial keratotomy corneal perforation after scleral contact lens (SCL) wear for optic correction. SETTING: Tertiary referral center for corneal pathology. DESIGN: Case report. RESULTS: A 64-year-old man presented the consequences of a late radial keratotomy (RK) surgery performed for myopia correction 26 years ago. His ophthalmologic history was a RK in both eyes (BE), previous Lasik surgery in BE and Lasik enhancement in the right eye (RE), and pterygium excision with conjunctival transplantation in RE. To improve visual acuity, SCL were fitted in both eyes. After 8 months of use, on a certain day, when removing the lens from the RE, the patient reported experiencing intense eye pain and reduced visual acuity. On ophthalmologic examination, the RE cornea was perforated in one of the previous RK incisions. An urgent corneal transplant was performed in the RE, followed by cataract surgery in the same eye. CONCLUSION: Corneal instability caused by RK scars and daily manipulation with the SCL use may have led to ocular perforation.

Conjunctival impression cytology evaluation of patients with dry eye disease using scleral contact lenses.

PURPOSE: To evaluate conjunctival impression cytology and HLADR expression changes after wearing scleral contact lenses (ScCLs) for moderate to severe dry eye disease (DED). DESIGN: Prospective interventional case series. METHODS: Forty-one eyes from 25 patients with moderate to severe DED were evaluated for Esclera ScCL treatment. Best-corrected visual acuity (BCVA) and slit-lamp findings were assessed. Impression cytology specimens were obtained from DED patients at the baseline and after wearing ScCLs for 12 months. The impression cytology specimens were analyzed using morphological results score, and HLA-DR positive cells were detected and quantified. The values were compared to assess the IC changes after wearing ScCLs. RESULTS: Forty-one eyes from 25 patients were fitted with ScCLs to manage DED. The underlying diseases were Stevens-Johnson syndrome (22 eyes), Sjogren's syndrome (11 eyes), graft-versus-host disease (2 eyes), dry eye after keratomileusis (2 eyes) and undifferentiated ocular surface disease (4 eyes). The HE-PAS impression cytology score did not differ significantly before and after wearing ScCLs for 12 months in DED patients (p>0.05). The percentage of eyes expressing the HLA-DR antigen in the temporal conjunctiva after wearing ScCL for 12 months significantly increased in patients with Sjogren's syndrome (11.11% to 66.66%; p=0.0498). In groups with Stevens Johnson syndrome and other ocular surface disorders, we did not observe statistically significant differences (p>0.05). CONCLUSIONS: The ScCLs did not change the parameters used to evaluate inflammatory processes, which were measured using conjunctival impression cytology and HLA-DR expression, except in Sjogren syndrome, in which there was an unexpected increase in HLA expression.

The use of ocular anatomical measurements using a rotating Scheimpflug camera to assist in the Esclera® scleral contact lens fitting process.

PURPOSE: To test for associations between Pentacam(®) derived topography variables and to evaluate the predictive power of those variables in relation to scleral contact lens (SCL) fit. SETTING: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo-SP, Brazil. DESIGN: Prospective observational non-randomised, non-comparative study. METHODS: Forty-seven patients (63 eyes) were indicated for the use of Esclera(®) SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam: corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable. RESULTS: In the total group, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm), with p<0.001 each. In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p<0.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p<0.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p=0.003). CONCLUSION: There was a positive correlation between the LSD and ACD, even as LD and ACD in the keratoconus group. Thus, these results suggest that certain Pentacam measurements can be good predictors of the most appropriate Esclera lens to be fitted in keratoconus patients.

Efficacy and tolerability of a gatifloxacin/prednisolone acetate fixed combination for topical prophylaxis and control of inflammation in phacoemulsification: a 20-day-double-blind comparison to its individual components.

OBJECTIVE: To compare the efficacy and tolerability of a fixed combination of 0.3% gatifloxacin and 1% prednisolone(ZypredH) versus the individual components used separately (Zymar® and Predfort® ) for infection prophylaxis and inflammation control after cataract surgery with intraocular lens implantation [corrected]. METHODS: A prospective, randomized, double-blind, parallel-group study of 108 patients who underwent phacoemulsification and intraocular lens implantation was conducted. After random assignment, 47 eyes received the fixed combination of topical 0.3% gatifloxacin/1% prednisolone drops, and 61 eyes received the same doses of the individual components as separate solutions four times a day for 15 days. Baseline and postoperative assessments were made on postoperative days 1, 7, 15, and 20. RESULTS: All objective (best corrected visual acuity, sign of active ocular inflammation, central and incisional corneal edema, the number of cells per high-power field in the anterior chamber, and intraocular pressure) and subjective (eye pain, photophobia, burning sensation, itching, and foreign body sensation) criteria of efficacy were similar in both groups, with no significant differences. Group I included 47 eyes that received the fixed combination of gatifloxacin/prednisolone acetate eye drops and a placebo eye drop solution. Group II included 61 eyes that were treated with 0.3% gatifloxacin and 1% prednisolone acetate eye drops separately. The intraocular pressure was slightly higher in Group II (p<0.05). CONCLUSION: Treatment with the fixed-dose combination of gatifloxacin/prednisolone eye drops was as effective as the non-fixed combination in preventing infection and controlling inflammation after phacoemulsification and intraocular lens implantation.

Efficacy and tolerability of a gatifloxacin/prednisolone acetate fixed combination for topical prophylaxis and control of inflammation in phacoemulsification: a 20-day-double-blind comparison to its individual components

OBJECTIVE: To compare the efficacy and tolerability of a fixed combination of 0.3% gatifloxacin and 1% prednisolone (Zypred®) versus the individual components used separately (Zypred® and Predfort®) for infection prophylaxis and inflammation control after cataract surgery with intraocular lens implantation. METHODS: A prospective, randomized, double-blind, parallel-group study of 108 patients who underwent phacoemulsification and intraocular lens implantation was conducted. After random assignment, 47 eyes received the fixed combination of topical 0.3% gatifloxacin/1% prednisolone drops, and 61 eyes received the same doses of the individual components as separate solutions four times a day for 15 days. Baseline and postoperative assessments were made on postoperative days 1, 7, 15, and 20. RESULTS: All objective (best corrected visual acuity, sign of active ocular inflammation, central and incisional corneal edema, the number of cells per high-power field in the anterior chamber, and intraocular pressure) and subjective (eye pain, photophobia, burning sensation, itching, and foreign body sensation) criteria of efficacy were similar in both groups, with no significant differences. Group I included 47 eyes that received the fixed combination of gatifloxacin/prednisolone acetate eye drops and a placebo eye drop solution. Group II included 61 eyes that were treated with 0.3% gatifloxacin and 1% prednisolone acetate eye drops separately. The intraocular pressure was slightly higher in Group II (p<0.05). CONCLUSION: Treatment with the fixed-dose combination of gatifloxacin/prednisolone eye drops was as effective as the non-fixed combination in preventing infection and controlling inflammation after phacoemulsification and intraocular lens implantation. .