scholarly journals Transepithelial Photorefractive Keratectomy with Crosslinking for Keratoconus

2013 ◽  
Vol 7 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Achyut N Mukherjee ◽  
Vasilis Selimis ◽  
Ioannis Aslanides
Keyword(s):  
Contact Lens ◽  
Contact Lenses ◽  
Corneal Thickness ◽  
Single Step ◽  
Photorefractive Keratectomy ◽  
Spherical Equivalent ◽  
Visual Rehabilitation ◽  
Postoperative Assessment ◽  
Ethical Approval

Purpose: To analyse visual, refractive and topographic outcomes of combining transepithelial photorefractive keratectomy (tPRK) with simultaneous corneal crosslinking for the visual rehabilitation of contact lens intolerant keratoconus patients. Methods: Patients with topographically significant keratoconus, limited corrected vision and intolerant of contact lenses were prospectively recruited, subject to ethical approval and consent. All patients underwent single step aspheric tPRK and sequential crosslinking. Preoperative vision, refraction, corneal topography and wavefront were assessed, with postoperative assessment at 1, 3, 6, and 12 months. Results: 22 eyes of 14 patients were included in the pilot study. Mean age was 32 years (SD 6.8, range 24 to 43). Mean preoperative unaided vision was 1.39 LogMAR (SD 0.5) best corrected 0.31 LogMAR (SD 0.2). Mean preoperative spherical equivalent was -2.74 Diopters (D) (SD 4.1 range -12.25 to +7.75), and mean cylinder -2.9 D (SD 1.2, range 0 to -5.5). Mean central corneal thickness was 461um (SD 29, range 411 to 516). Vision improved postoperatively; unaided 0.32 LogMAR (SD 0.4), best corrected 0.11 (SD 0.13) (P=<0.005). Mean postoperative cylinder was -1.4D (SD1.2), significantly reduced (p<0.005). Maximum keratometry (Kmax) was stable throughout postoperative follow up. (p<0.05). Conclusions: Non topographic transepithelial PRK with simultaneous crosslinking improves vision, and may offer an alternative to keratoplasty in contact lens intolerant keratoconus. Further comparative studies to topographic PRK techniques are indicated.

scholarly journals Comparison of the efficacy of lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy

2021 ◽  
Vol 10 (2) ◽  
pp. 43-49
Author(s):  
Nancy M. Lotfy ◽  
Tariq Alasbali ◽  
Abdulrahman M. Alsharif ◽  
Saeed M Al- Gehedan ◽  
Sabah Jastaneiah ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pain Score ◽  
Contact Lens ◽  
Contact Lenses ◽  
Corneal Thickness ◽  
Photorefractive Keratectomy ◽  
Epithelial Defect ◽  
Silicone Hydrogel ◽  
Corneal Epithelial Defect ◽  
Significant Difference

Background: At completion of transepithelial photorefractive keratectomy (t-PRK) surgery, the eye is usually fitted with a bandage contact lens to reduce discomfort and promote epithelial healing. This study aimed to compare the outcomes of eyes fitted with lotrafilcon B versus comfilcon A, silicone hydrogel bandage contact lenses after t-PRK for the correction of low to moderate myopia, with or without astigmatism. Methods: In this comparative, prospective study, patients with myopia < -6 D with or without astigmatism (< 1.75 D), who underwent t-PRK between January and June 2018, were randomly allocated to the lotrafilcon B and comfilcon A groups. Preoperative characteristics, including age, sex, eye treated, uncorrected visual acuity (UCVA), best-corrected visual acuity, mesopic pupil size, central corneal thickness, and refractive error were recorded. Postoperatively, pain score, UCVA, and corneal epithelial defect size on days 1, 4, and 7 were compared between the two groups. Results: Twenty-nine eyes were included in each group. Demographic characteristics and preoperative measurements were similar between the two groups. UCVA was significantly improved on day 7 as compared to day 1 in the comfilcon A group (P = 0.03), but remained the same in the lotrafilcon B group (P = 0.70) as on day 1 postoperatively. There was no significant difference in UCVA between the two groups at any follow-up visits (all P > 0.05). The pain score on the first postoperative day was significantly higher in the lotrafilcon B-fitted eyes than in the comfilcon A group (P < 0.001), but was significantly reduced in both groups compared to day 1 (both P < 0.001). The epithelial defect in the comfilcon A group was significantly greater than in the lotrafilcon B group (P < 0.001) at day 1 postoperatively, with significant improvement in both groups (both P < 0.001). Conclusions: Healing responses were better with lotrafilcon B than with comfilcon A bandage contact lenses. The patients had a greater mean pain score with lotrafilcon B than with comfilcon A lenses on the first postoperative day, yet the final outcome was comparable between the two groups. We did not encounter any postoperative complications related to contact lens wear. How to cite this article: Lotfy NM, Alasbali T, Alsharif AM, Al-Gehedan SM, Jastaneiah S, Al-Hazaimeh A, Ali H, Khandekar R. Comparison of the efficacy of lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 1-7. https://doi.org/10.51329/mehdiophthal1420

scholarly journals Silicone Hydrogel Miniscleral Contact Lenses after Corneal Collagen Crosslinking for Post-LASIK Keratoectasia

2014 ◽  
Vol 3 (3) ◽  
pp. 127-129
Author(s):  
Boris Severinsky
Keyword(s):  
Contact Lens ◽  
Contact Lenses ◽  
Visual Outcome ◽  
Visual Rehabilitation ◽  
Collagen Crosslinking ◽  
Silicone Hydrogel ◽  
Corneal Collagen Crosslinking ◽  
Corneal Collagen

ABSTRACT Purpose To report successful visual rehabilitation of post refractive surgery keratoectasia shortly after corneal collage crosslinking (CXL) procedure achieved with silicone hydrogel mini-scleral (SHmS) contact lens. Materials and methods A 29-year-old woman attended to our clinic with complaints on decreased vision in her left eye. Twelve years earlier she underwent bilateral laser-assisted in situ keratomileusis (LASIK) procedure for myopia correction. Corneal topography revealed bilateral central keratoectasia with maximal keratometry values of 55.4 Diopter (D) for her right eye and 59.7 D for the left, corneal thicknesses were 422 and 443 respectively. The patient underwent an uneventful CXL procedure in her left eye and was fitted with SHmS lens 5 weeks later. The lens was designed to rest over the patients’ sclera and perilimbal cornea and vault the central cornea with minimal support over it. Results SHmS lens fitting resulted in significant subjective improvement in visual acuity (from 20/200, unaided to 20/25, contact lens corrected). The patient was able to wear the lens upto 10 hours a day with stable contact lens corrected vision. No contact lens related complications, such as edema or neovascularization were observed during 3 months follow-up period. As a result of successful restoration of vision in the CXL-treated eye, the patient was scheduled for the procedure in her other eye. Conclusion SHmS contact lens should be considered as an option for the visual rehabilitation of corneas shortly after collagen corneal crosslinking procedure. This novel contact lens modality made from flexible and highly gas permeable material minimizes contact lens influence on corneal recovery after CXL and provides an excellent visual outcome. How to cite this article Severinsky B. Silicone Hydrogel Mini-scleral Contact Lenses after Corneal Collagen Crosslinking for Post-LASIK Keratoectasia. Int J Kerat Ect Cor Dis 2014;3(3):127-129.

scholarly journals Corneal Thinning after Contact Lens-related Infective Keratitis

2014 ◽  
Vol 3 (2) ◽  
pp. 95-98
Author(s):  
José Salgado-Borges ◽  
Renata Siqueira ◽  
Raquel Almeida ◽  
Filipa Rodrigues ◽  
Matheus Santos ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contact Lens ◽  
Contact Lenses ◽  
Case Reports ◽  
Corneal Thickness ◽  
Corneal Opacity ◽  
Infectious Keratitis ◽  
Visual Rehabilitation ◽  
First Case ◽  
Corneal Thinning

ABSTRACT Purpose To describe two cases of contact lens-related infectious keratitis with secondary corneal thinning. Material and methods Case reports and review of the literature. Results The first case is of a 13-year-old girl, contact lens user, admitted for acute corneal infection in her right eye (OD). Seven years after treatment, she presented with corneal thinning and flattening with uncorrected distance visual acuity of 20/30 OD; thinnest value was 363 µm in OD and 513 µm in the left eye (OS). The second case is a 22-year-old male, cosmetic contact lens user, first presented with severe keratitis in OD. One year after treatment, the eye was quiet with moderate corneal opacity; corneal thickness was 228 µm OD and 561 µm OS. Ectasia was identified due to the protrusion and steepening with an irregular curvature pattern. Rigid gas permeable (RGP) contact lens fitting enabled visual acuity of 20/25 OD. Conclusion Corneal melt with secondary stromal loss and thinning may lead or not to secondary ectasia. Visual rehabilitation is possible with RGP contact lenses despite corneal opacity. The risk of infectious keratitis among contact lenses users should be considered. How to cite this article Almeida R, Rodrigues F, Santos M, Siqueira R, Contarini P, Salgado-Borges J, Ambrosio R Jr. Corneal Thinning after Contact Lens-related Infective Keratitis. Int J Kerat Ect Cor Dis 2014;3(2):95-98.

scholarly journals Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Waleed Ali Abou Samra ◽  
Amani E. Badawi ◽  
Hanem Kishk ◽  
Ayman Abd El ghafar ◽  
Mohamed M. Elwan ◽  
...  
Keyword(s):  
Contact Lens ◽  
Subjective Evaluation ◽  
Patient Comfort ◽  
Visual Rehabilitation ◽  
Common Cause ◽  
The Mean ◽  
High Degree ◽  
Lens Wear ◽  
Objective And Subjective Evaluation

Objectives. To study the fitting and the visual rehabilitation obtained with a corneoscleral contact lens, namely, Rose K2 XL in patients with irregular cornea.Methods. This prospective study included 36 eyes of 36 patients with irregular cornea fitted with Rose K2 XL. Refractive and visual outcomes and mesopic and aberrometric parameters of fitted eyes were assessed at 2 weeks, 3 months, and 6 months after the initial lens use. Objective and subjective parameters of patient satisfaction and lens comfort were noted. Causes of lens discontinuation and complications were also recorded.Results. Average logMAR VA improved significantly from 0.95 ± 0.09 without correction to 0.04 ± 0.05 six months after lens wear. Similarly, mesopic and aberrometric measures were significantly improved. Statistical analysis of the subjective patients’ responses showed a significant acceptance of the lens by most of them. At the end of follow-up, the mean wearing time was 9.9 ± 2.9 hours per day. The most common cause of wearing discontinuation was persistent discomfort (16.7%) and high lens expenses(16.7%). Self-assessed questionnaire showed statistically significant improvement in nearly all measured subjective parameters.Conclusion. Rose K2 XL lenses provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction.

Corneal Thickness after MyoRing Implantation for Keratoconus

2014 ◽  
Vol 3 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Albert Daxer
Keyword(s):  
Postoperative Period ◽  
Corneal Thickness ◽  
Constant Stimulus ◽  
Vicious Circle ◽  
Cross Linking ◽  
Visual Rehabilitation ◽  
Additional Intervention

ABSTRACT Purpose To analyze the corneal thickness development after MyoRing implantation as a tissue-related indicator of keratoconus progression. Materials and methods Twelve eyes suffering from keratoconus were treated for visual rehabilitation by means of MyoRing implantation into a corneal pocket. The postoperative development of the corneal thickness at the thinnest point was analyzed. Follow-up ranged from 16 to 74 months (mean 37 months). Results Out of the 12 eyes only one eye showed a thinner cornea at the last follow-up 60 months after MyoRing implan-tation compared to the last preoperative data. None of these 12 eyes required an additional intervention like corneal cross-linking, explantation or keratoplasty. Four eyes showed even thickening of the cornea during the postoperative period. Conclusion MyoRing implantation for keratoconus does not only allow visual rehabilitation. It also seems to stop the progression of the disease by creating a new biomechanical equilibrium within the tissue which eliminates a constant stimulus that drives the vicious circle of progression. How to cite this article Daxer A. Corneal Thickness after MyoRing Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2014;3(1):15-19.

scholarly journals Impact of Rigid Gas Permeable Contact Lenses Removal on Anterior and Posterior Corneal Surfaces in Keratoconus Patients

2019 ◽  
Author(s):  
Motohiro Itoi ◽  
Koji Kitazawa ◽  
Hisayo Higashihara ◽  
Chie Sotozono
Keyword(s):  
Contact Lens ◽  
Contact Lenses ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Corneal Surface ◽  
Contact Lens Wear ◽  
Surface Areas ◽  
The Impact ◽  
Lens Wear ◽  
Anterior Posterior

AbstractPurposeTo evaluate the impact of removal of rigid gas-permeable (RGP) contact lenses on the anterior and posterior cornea surfaces of eyes with keratoconus.MethodsEight eyes of 8 patients with keratoconus (KC) (age 34.3 ± 15.3 years; range 19–60 years) were enrolled. Anterior segment optical coherence tomography (AS-OCT) was performed at 1, 5, 10, 20, and 60 minutes after the patients removed their RGP contact lenses. Measurements included anterior and posterior best-fit sphere (BFS); elevation values and corneal surface areas; corneal thickness at the thinnest point; and the anterior-posterior ratio of the corneal surface (As/Ps) between 1 minute and 60 minutes after RGP contact lens removal.ResultsAnterior and posterior elevation values and corneal surface areas showed significant increases, whereas anterior and posterior BFS and central corneal thickness decreased significantly (P < 0.01) between 1 minute and 60 minutes after RGP contact lens removal. No statistically significant differences were found in the As/Ps ratio during the first hour after suspending RGP contact lens wear.ConclusionsWe found that the patients with keratoconus experienced significant changes in both the anterior and posterior corneal shape for 60 minutes after removal of RGP contact lenses.

scholarly journals Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus

2017 ◽  
Vol 6 (2) ◽  
pp. 97-100
Author(s):  
Roberto Soto-Negro
Keyword(s):  
Contact Lens ◽  
Potential Benefit ◽  
Contact Lenses ◽  
Spherical Model ◽  
Future Studies ◽  
Rigid Contact ◽  
The Stability ◽  
Fitting In ◽  
Contact Lens Fitting

ABSTRACT We report the case of a 35-year-old woman diagnosed with keratoconus since she was 18 years old and wearer of corneal rigid contact lenses (CLs). We refitted the case with the fully scleral CL ICD16.5 (Paragon Vision Sciences) for obtaining not only a successful visual restoration, but also a comfortable wear. We initiated the fitting with the spherical model of the CL, but it failed due to instability of the lens. We confirmed the presence of a clear asymmetry in the anterior scleral geometry in both eyes by using the profilometer eye surface profiler (ESP, Eaglet Eye), with a difference between nasal and temporal sagittal heights of 470 and 170 μm in right and left eyes respectively. Although this profile suggested the need for the fitting of a CL with significant peripheral toricity, we followed the manufacturer's guidelines and performed a trial with a CL of moderate peripheral toricity (125 μm of difference between steep and flat meridian). The stability of the CL failed again and finally a CL with a peripheral toricity close to that measured with the profilometer was fitted. With this lens, good visual performance, lens stability, and comfort was obtained and maintained during a 1-year follow-up. This case suggests that fully scleral CLs fitting might be optimized with the use of corneo-scleral profilometers, minimizing potentially the number of trials. This potential benefit should be investigated further in future studies. How to cite this article Piñero DP, Soto-Negro R. Anterior Eye Profilometry-guided Scleral Contact Lens Fitting in Keratoconus. Int J Kerat Ect Cor Dis 2017;6(2):97-100.

scholarly journals Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus

2016 ◽  
Vol 5 (2) ◽  
pp. 71-76
Author(s):  
Igor Kaiserman ◽  
Lily Karmona ◽  
Tzahi Sela ◽  
Oz Franco ◽  
Avi Shoshani ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contact Lenses ◽  
Cross Linking ◽  
Visual Rehabilitation ◽  
Surface Ablation ◽  
Uncorrected Visual Acuity ◽  
Promising Treatment ◽  
Functional Vision ◽  
Collagen Cross Linking

ABSTRACT Purpose In this article, we present the results of eight eyes of patients who underwent combined same-day partial topography-guided surface ablation followed by accelerated collagen cross-linking (CXL) procedure at Care-Vision Laser Centers to achieve stabilization of corneal ectasia and enhance visual rehabilitation in keratoconus. Materials and methods A retrospective nonrandomized review of 8 eyes of 6 patients who underwent the Athens Protocol for progressive keratoconus. Each patient underwent topography-guided ablation followed by CXL procedure. Follow-up Follow-up was done on day 1, day 7, and then at 1, 3, 6, and 12 months. Results There was a rapid and significant improvement in uncorrected visual acuity and best-corrected visual acuity in 100% eyes, a reduction of keratometric values, and symmetry between vertical hemimeridians. Topographic evaluation showed a marked improvement in irregularity. There were no signs of keratoconic progression noted in any of the eyes on last follow-up. No adverse events were reported in any patient. Conclusion Simultaneous surface ablation + CXL seems to be a promising treatment capable of offering patients functional vision and halting progression of the disorder. Precis Simultaneous topography-guided custom ablation treatment and photorefractive keratectomy with CXL offers keratoconic patients intolerant to contact lenses both stabilization of the cornea and improved functional vision with spectacles correction. How to cite this article Karmona L, Sela T, Franco O, Shoshani A, Munzer G, Kaiserman I. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):71-76.

scholarly journals Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty

2013 ◽  
Vol 2 (2) ◽  
pp. 69-72
Author(s):  
Rafael J Pérez-Cambrodí ◽  
Pedro Ruiz-Fortes
Keyword(s):  
Visual Acuity ◽  
Contact Lens ◽  
Contact Lenses ◽  
Anterior Segment ◽  
Successful Outcome ◽  
Imaging Evaluation ◽  
Visual Rehabilitation ◽  
Distance Visual Acuity ◽  
Fitting In ◽  
Contact Lens Fitting

ABSTRACT Purpose To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP). Materials and methods A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting. Results Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and .5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 μm to a postfitting value of 1.57 μm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations. Conclusion The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment. How to cite this article Pérez-Cambrodí RJ, Ruiz-Fortes P, Llorens DPP. Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty. Int J Kerat Ect Cor Dis 2013;2(2):69-72.

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