Advances in Non-surgical Treatment Methods in Vision Rehabilitation of Keratoconus Patients

Visual acuity decreases due to progressive irregular astigmatism in keratoconus (KC). Although glasses can be useful in the initial stages of vision rehabilitation, contact lenses (CL) are needed in many patients due to irregular astigmatism. Although rigid gas permeable (RGP) CLs provided the patient with a better visual acuity than glasses, their effects on corneal tissues and caused comfort problems. Although soft CL produced for KC have solved some of these problems, they could not increase visual acuity as much as RGPs in advanced stage KC. For this reason, new searches for vision rehabilitation and comfort in KC have continued. In this context, piggyback contact lenses (PBCL) have been used in vision rehabilitation. Hybrid CLs have gained popularity due to the fact that PBCLs cause corneal neovascularization and giant papillary conjunctivitis. Scleral CLs have been developed for limited benefit in some patients with advanced KC. Scleral CLs provided good vision rehabilitation. The biggest problem of scleral CLs is the application and removal difficulty. All these CL modalities try to improve the quality of life and delay surgical procedures by increasing the level of vision in patients with KC.

The structure of soft contact lens users and the incidence of papillary conjunctivitis in the analyzed groups according to the data of “Krugozor” ophthalmology clinic

Introduction. Vision correction by contact lenses is one of the most common and effective methods for correcting refractive errors in children and adults. Compliance with rules of soft contact lenses (SCLs) wearing is one of the most important conditions for a safe use, while violation of compliance is usually the main cause of complications.Purpose. To study the structure of contact lens wearers by ametropia and lens wearing time as well as to determine the relationship between the incidence of giant papillary conjunctivitis (GPC) with lens wear time and overwear time.Material and methods. A retrospective analysis of 1 000 records (1 000 patients) of patients who underwent vision correction by SCLs in “Krugozor” ophthalmology clinic in the year 2019 was carried out. Mean age of patients was 24.95 ± 8.62 years. Age, type and degree of ametropia, material (hydrogel, silicone hydrogel or biocompatible hydrogel), lens replacement schedule, presence of complications, lens overwear time and daily wear time were taken into account.Results. Most SCLs users are patients between 21 and 30 years old (47%) who have a moderate degree of ametropia (52%). Most of them (46%) preferred monthly replacement SCLs, 29% – bi-weekly replacement SCLs, 9% preferred daily replacement lenses, while quarterly replacement lenses were used by 16%. Only 26.9% of SCL users complied with the instructions for lens wear, while for 29.4% of them lens overwear time amounted to up to 14 days, for 34.1% – up to 28 days, and for 9.6% – more than 1 month. More than half (56%) of patients mainly wore SCLs during 16 hours a day, one in five (22.7%) used SCLs during 12 hours a day, and 12.6% – up to 20 hours a day. 8.7% wore lenses during up to 7 days. The incidence of GPC in patients who did not comply with replacement schedule and were overwearing lenses was significantly higher (38.71%) than in patients who followed the replacement schedule (3.21%).Conclusion. More than half of the users comprised young people with a moderate degree of myopia. The most commonly used SCLs were monthly replacement. It was discovered that only one in four wearers followed recommendations of manufacturers and replaced lenses on time. Lens overwear may lead to a development of a giant papillary conjunctivitis (GPC).

Thelaziasis as an uncommon cause of giant papillary conjunctivitis

Introduction: We report a local human case of Thelazia callipaeda eye infection in a 49-year-old lady with history of fly contact in Hong Kong. Case description: A 49-year-old lady presented with right eye foreign body sensation for one month. She recalled a fly being stuck onto her right upper eyelashes with mascara when she went hiking in a forest trail in Hong Kong. On assessment there were a lot of giant papillae on palpebral conjunctiva. Three living worms crawling on conjunctiva were discovered and removed in total. The worms were identified as Thelazia callipaeda by morphology and molecular sequencing. After removal, her symptoms resolved completely. Conclusion: Human thelaziasis is probably under-reported in many countries. The presence of giant papillary conjunctivitis in non-contact lens wearers should alert clinicians to the possibility of thelaziasis in patients with compatible exposure history in endemic regions. Ophthalmologists should increase their awareness towards this uncommon disease and should not wrongly attributed the symptoms to allergic conjunctivitis.

Tear Inflammatory Molecules in Contact Lens Wearers: A Literature Review

Background: Numerous studies have analysed the effect of using different Contact Lenses (CLs) or care solutions, and suffering discomfort or diseases associated with CL wear on the inflammatory mediator release into the tears. Objective: To summarize the published data on tear inflammatory molecules related to CL use. Methods: A PubMed-NCBI search has been conducted and those publications which carried out original investigations including the analysis of tear inflammatory mediators in CL wearers were selected. Results: Forty-three articles, from 1990 to 2019, have been included. Wearing hydrogel CLs, rigid gas permeable CLs, and special designs for irregular corneas in keratoconus patients (CLs with keratoconic design, hybrid CLs, piggyback fit, and scleral CLs) have been reported to alter the concentration of several molecules in tears. Moreover, there seems to be an effect of the wearing time and schedule, CL materials and designs, and care solutions used. Regarding CL discomfort, its relation with inflammatory mediators is not clear. However, some diseases associated to CL wear, such as giant papillary conjunctivitis, CL induced acute red eye, CL induced peripheral ulcer, and acanthamoeba keratitis have been related to the release of certain inflammatory mediators, which may serve as potential biomarkers. Conclusion: There is evidence suggesting that different aspects of CL wear alter the inflammatory mediator profile in tears, which may indicate an inflammatory state of the lacrimal functional unit. However, more studies need to be carried out to better understand how this inflammatory process works and its repercussion on the different aspects of CL wear.

Epidemiology of contact lens-induced giant papillary conjunctivitis: a retrospective study

Purpose: The purpose of the study is to determine the correlation between the incidence of giant papillary conjunctivitis induced by the use of contact lenses (CLPC) and contact lens material, replacement schedule or wearing time. The emergence of new materials and designs of contact lenses along with modifications in the replacement and wearing schedule have changed the structure of complications in users of soft contact lenses (SCLs). At present, infectious and hypoxic complications are extremely rare; on the other hand, toxic-allergic reactions that arise in users of contact lenses (CLs) have come to the fore. Material and methods. A retrospective cohort clinical study involved 1 668 users of SCL of various materials and with different replacement and wearing schedules. Patients were monitored from 2008 to 2018. Results. As a result of the study, it was found that the CLPC incidence correlate with the wearing time and replacement schedule of the SCLs.