Eye & Contact Lens最新文献

{"title":"In Response.","authors":"Vijay K Sharma, Hemant S Trehan, Raji Kurumkattil, Sanjay K Dhar","doi":"10.1097/ICL.0000000000000740","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000740","url":null,"abstract":"To the Editor: I have read with great interest the article by Sharma et al.1 on “Management of Post-DALK Recipient Posterior Stromal Scarring: A Novel Approach.” The authors have described a novel and cost effective approach to manage recipient posterior stromal scarring in postdeep anterior lamellar keratoplasty (DALK) patients that allows complete removal of the scarred recipient posterior stromal tissue. However, I would like to point out few concerns. First, it would be interesting to know whether there was any postoperative Descemet stripping endothelial keratoplasty (DSEK) graft detachment or not after the surgery in any of the 10 eyes. As the DSEK lenticule was attached to an irregular surface of the cut DALK under surface, the chances of improper attachment of the DSEK lenticule to the overlying DALK are high. This improper attachment could lead to early graft detachment. Nahum et al.2 have shown that previous keratoplasty graft itself is a high risk for postoperative DSEK graft detachment. Hence, it would be informative to know about this aspect in the article. Second, as there would be an interface between the DALK and DSEK graft, it can result in significant reflectivity of light and result in poor quality of vision. Transplantation of the posterior stroma leads to an increase in corneal thickness, the creation of host–donor interface that can influence postoperative visual performance.3 Hence, analyzing the postoperative aberrations can help to evaluate the quality of vision in these eyes. Also, the problems associated with the interface in lamellar keratoplasty like infections, epithelial ingrowth, interface debris etc have to be kept in mind when contemplating a DSEK instead of a full-thickness penetrating keratoplasty. Third, as there were two grafts from separate donors, the chances of graft rejection would be high.4 As these patients were followed up for only 3 months postoperatively, it would be important to have a longer follow-up to know the long-term prognosis and survival of these grafts. Whether, any perioperative steroids or immunosuppressants were given or not is not elucidated. Fourth, the primary indication for the DALK was not mentioned in the article. One of common reasons for a persistent scar after a DALK would be a recurrence or residual herpes simplex virus (HSV) scar. These eyes if operated and the underlying stroma being excised along with an additional transplant in the form of DSEK would lead to recurrence or reactivation of the HSV infection. In such eyes, it would be important to start prophylactic acyclovir both preoperatively and maintain postoperatively to prevent any recurrence. Finally, the time interval between the primary DALK and subsequent DSEK should have been mentioned. This is important as the residual astigmatism after all the suture removal would guide the surgeon in deciding whether to plan a Penetrating Kertaoplasty when the astigmatism is high versus DSEK when the residual astigmatism is low","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"229-230"},"PeriodicalIF":2.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38447682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Post-DALK Recipient Posterior Stromal Scarring: A Novel Approach.","authors":"Vijay K Sharma,&nbsp;Hemant S Trehan,&nbsp;Raji Kurumkattil,&nbsp;Sanjay K Dhar","doi":"10.1097/ICL.0000000000000701","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000701","url":null,"abstract":"<p><strong>Aim: </strong>Management of recipient posterior stromal scarring following deep anterior lamellar keratoplasty (DALK) by a novel approach.</p><p><strong>Methods: </strong>A side port knife bent at the tip is used to make a linear incision in the host posterior stroma. Plane between host posterior stroma and DALK tissue is separated using a reverse sinskey hook and multiple radial incisions are made using microvitroretinal scissors. The recipient posterior stromal wedges are removed using 20G vitrector with a cut rate of 800 cuts/min. A Descemet stripping endothelial keratoplasty lenticule is inserted into the anterior chamber and apposed to the posterior surface of DALK tissue using air tamponade.</p><p><strong>Result: </strong>This technique was used in 10 patients who showed clearing of the scarring after the surgery with good apposition of the donor graft to the previous DALK tissue. Conclusion: This is a sutureless, relatively simple, inexpensive, and effective novel surgical technique that avoids complications of open sky procedure and can be replicated in any ophthalmologic operation theatre setup.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"163-167"},"PeriodicalIF":2.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37966817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Pulse Capsulotomy During Combined Penetrating Keratoplasty With Cataract Surgery and Intraocular Lens in Small Nondilating Pupil.","authors":"Bhupesh Singh,&nbsp;Sourabh Sharma,&nbsp;Neha Bharti,&nbsp;Sudhank Bharti","doi":"10.1097/ICL.0000000000000734","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000734","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate precision pulse capsulotomy (PPC) in an open-sky procedure and to evaluate its use during triple procedure keratoplasty in small nondilating pupils.</p><p><strong>Methods: </strong>This single-center retrospective case series study included 10 eyes (from 10 patients) with corneal opacity and poorly dilated pupils who were scheduled to undergo triple procedure keratoplasty. The main outcome measures were capsulotomy performance of the PPC device and intraoperative complications. Secondary outcome measures included postoperative best-corrected visual acuity, intraocular pressure, and other postoperative complications.</p><p><strong>Results: </strong>Complete free-floating capsulotomy was achieved in all 10 eyes. There were no cases of anterior capsule tears or tags. There were no postoperative complications that occurred in association with the PPC device.</p><p><strong>Conclusions: </strong>The PPC device facilitates creation of a smooth, round, and appropriately sized anterior capsulotomy in open-sky surgeries, particularly in presence of small nondilating pupils.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"219-222"},"PeriodicalIF":2.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25501277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Post-DALK Recipient Posterior Stromal Scarring: A Novel Approach.","authors":"Arjun Srirampur","doi":"10.1097/ICL.0000000000000739","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000739","url":null,"abstract":"","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"229"},"PeriodicalIF":2.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38447683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Overnight Orthokeratology OK for Kids?","authors":"Michael J Lipson,&nbsp;Paul Levine","doi":"10.1097/ICL.0000000000000780","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000780","url":null,"abstract":"","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"230-231"},"PeriodicalIF":2.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25501278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurotrophic Keratopathy: Ophthalmology's Diabetic Foot Problem.","authors":"Todd P Margolis","doi":"10.1097/ICL.0000000000000774","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000774","url":null,"abstract":"<p><strong>Abstract: </strong>This article summarizes key elements of the 2020 Harold A. Stein Lecture presented at the Eye and Contact Lens Special Symposium \"Healing the Ocular Surface: What's New for Neurotrophic Keratitis.\" The major point that I made in this talk is that we need to think about neurotrophic keratopathy as ophthalmology's diabetic foot problem; as a chronic condition that is, often best managed by prevention. Neurotrophic keratopathy is not primarily an inflammatory condition, as suggested by the term ‟neurotrophic keratitis.\" The epitheliopathy in this condition is a consequence of the dysregulated epithelial cell migration, differentiation, and homeostasis that occurs with denervation of the ocular surface. Although this epitheliopathy may be complicated by poor lid closure, or rarely, aqueous tear deficiency, most of these eyes are not dry and do not require exogenous lubrication for comfort, prophylaxis, or healing. The use of topical agents in these eyes inevitably leads to unrecognized iatrogenic injury, with poor outcomes because of inherently poor wound healing and delays in seeking medical care. Tarsorrhaphy is a time-honored method of protecting the neurotrophic cornea, shielding the eye from iatrogenic injury. Alternative methods for protecting the ‟at risk\" surface of the neurotrophic cornea include patient education, minimizing topical agents, and the use of protective eyewear.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"136-139"},"PeriodicalIF":2.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25378506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scleral Lens Use in Neurotrophic Keratopathy: A Review of Current Concepts and Practice.","authors":"Emily Witsberger,&nbsp;Muriel Schornack","doi":"10.1097/ICL.0000000000000748","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000748","url":null,"abstract":"<p><strong>Objective: </strong>Neurotrophic keratopathy (NK) is a rare corneal condition characterized by epitheliopathy, which is associated with reduced or absent corneal sensation. The main goal of treatment of this condition is the preservation of ocular surface integrity. Contact lenses provide a nonsurgical and reversible option to provide the necessary corneal protection. The purpose of this review was to summarize the available literature regarding the use of contact lenses in the management of NK, with particular emphasis on the use of scleral lenses.</p><p><strong>Methods: </strong>Literature related to both soft and scleral contact lens use as treatment options for NK was reviewed.</p><p><strong>Results: </strong>As of yet, randomized clinical trials have compared neither the efficacy of contact lens therapy for NK to other therapeutic alternatives nor outcomes of therapy with different contact lens modalities. However, clinical case reports and limited case series have suggested that scleral lenses may be a safe and effective treatment option for NK at any stage of the disease, preserving epithelial integrity and even improving visual function in patients with this condition.</p><p><strong>Conclusions: </strong>Scleral lenses may be effective in reducing the need for surgical intervention and improving the quality of life in patients with NK.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"144-148"},"PeriodicalIF":2.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38544593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of Neurotrophic Keratopathy and a Stage-Based Approach to Its Management.","authors":"Mustafa Safi,&nbsp;Jennifer Rose-Nussbaumer","doi":"10.1097/ICL.0000000000000760","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000760","url":null,"abstract":"<p><strong>Abstract: </strong>Neurotrophic keratopathy (NK) occurs because of disruption of corneal sensory innervation. There are many etiologies that can lead to NK, such as infection, trauma, topical medication use, cornea surgery, and intracranial tumors among others. We review the current available treatment options and provide a stage-based approach to its management.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"140-143"},"PeriodicalIF":2.3,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38627521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy-A Randomized Control Trial.","authors":"Faisal AlDahash,&nbsp;Ahmad AlAmeer,&nbsp;Omar Ben Hussain,&nbsp;Rajiv Khandekar,&nbsp;Abeer Ahmad,&nbsp;Muhammad Ahad","doi":"10.1097/ICL.0000000000000730","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000730","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the corneal re-epithelialization and patient-perceived pain after bandage contact lens (BCL) exchange on day one, after photorefractive keratectomy (PRK).</p><p><strong>Methods: </strong>A randomized controlled trial, of all patients who underwent bilateral transepithelial-PRK (trans-PRK) or bilateral alcohol debridement and PRK (A-PRK), between March and October 2019. One eye of each patient was randomly assigned to BCL exchange on the first postoperative day (exchange group) and the BCL was not exchanged in the fellow eye (control group). Patients were evaluated daily until healing was complete. At each visit, the corneal epithelial defect was measured, and a questionnaire was used to assess pain, photophobia, and excessive tearing. P<0.05 was statistically significant.</p><p><strong>Results: </strong>The study sample was comprised of 56 patients (mean age 27.2±5.7 years). Trans-PRK was performed in 20 (34.5%) and A-PRK in 36 (64.3%) patients. At day 3, 40 (71.4%) eyes of the exchange group healed completely compared with 38 (67.9%) eyes of the control group (P=0.5). At day-1 follow-up, the pain score was 1.87±1.4 in the exchange group and 2.29±1.3 in the control group (P=0.009). The mean pain score was 1.58±1.4 among patients who underwent A-PRK and 2.35±1.2 among patients operated by trans-PRK (P=0.04).</p><p><strong>Conclusion: </strong>The epithelial healing did not vary when BCL was exchanged one day after refractive surgery. However, postoperative pain score after PRK was lower at day 1, when the BCL was exchanged. Compared with A-PRK, trans-PRK group demonstrated a higher pain score in the early postoperative phase.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"113-117"},"PeriodicalIF":2.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38858357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Axial Length Elongation in Japanese Youth With Myopia.","authors":"Motohiro Itoi,&nbsp;Motozumi Itoi","doi":"10.1097/ICL.0000000000000736","DOIUrl":"https://doi.org/10.1097/ICL.0000000000000736","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the correlation between the annual axial length (AL) elongation and associated factors in Japanese youth with myopia.</p><p><strong>Methods: </strong>This retrospective study enrolled patients aged 7 to 21 years with myopia. Axial length was measured using ocular biometry. Refractive errors and curvature radius (CR) were measured using an open-field Binocular Auto Ref/Keratometer without cycloplegia. Subjects were divided into five groups using 3-year age intervals, and the relationship between annual AL elongation and age, spherical equivalent (SE), corneal CR, and sex was evaluated.</p><p><strong>Results: </strong>Four hundred and eighty-two patients (184 male and 298 female subjects) with a mean age of 15.55±4.09 years were included. The annual AL elongation was largest in the youngest group (0.47±0.19) and decreased with age to 0.03±0.04 in the oldest group. The annual change in AL was associated with age and SE (P<0.01) but not with sex or CR (P>0.05). Axial length elongation stratified by age was significantly correlated with SE in the 15 to 18-year-old (R2=0.20, P<0.01) and 19 to 21-year-old (R2=0.37, P=0.01) groups, whereas there was no significant correlation in the 7 to 9-year-old group (R2=0.04, P=0.14), the 10 to 12-year-old group (R2=0.05, P=0.07), and the 13 to 15-year-old group (R2=0.01, P=0.14).</p><p><strong>Conclusions: </strong>In Japanese youth with myopia, AL elongation was largest in the youngest group, decreased with age, especially in the group older than 15 years.</p>","PeriodicalId":502139,"journal":{"name":"Eye & Contact Lens","volume":" ","pages":"104-107"},"PeriodicalIF":2.3,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38226183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}