Corneal endothelial polymegethism and pleomorphism induced by daily-wear rigid gas-permeable contact lenses.

PURPOSE: To determine if there are any corneal endothelial cell size and shape changes (and the time course of these changes) in subjects wearing rigid high gas-permeable (RGP) contact lenses for daily wear. METHODS: Ninety-seven eyes of 57 new wearers were fitted with a fluoroperm contact lens material (Persecon92E, oxygen transmissibility (Dk)= 92 x 10(-11)). Prior to lens wear and after 1 week, 1 month, 3 months, 6 months, and 1 year, noncontact endothelial photographs were taken. Maximum cell size/Minimum cell size (Max/Min) was measured as an index of polymegethism and the relative frequency of 5-, 6-, and 7-sided cells was evaluated. RESULTS: An increase in the ratio of Max/Min was present 1 week after lens fitting and increased further over the subsequent year. This study showed significant increase in endothelial polymegethism and in the relative frequency of 7-sided cells, but a significant decrease in the relative frequency of 6-sided cells. CONCLUSIONS: Daily-wear high Dk gas-permeable contact lenses can cause endothelial polymegethism and pleomorphism similar to those caused by soft and hard contact lenses.     

Pseudomonas corneal ulcer after use of extended-wear rigid gas-permeable contact lens

We report a bacterial corneal ulcer that occurred in a patient who had worn extended-wear rigid gas-permeable contact lenses on a 1-week cycle for 9 months. Pseudomonas aeruginosa was cultured not only from the corneal ulcer but also from the contact lens solutions, suggesting that the patient had been noncompliant with care procedures. To our knowledge, this is the first report of a bacterial corneal ulcer associated with use of a rigid gas-permeable contact lens on an extended-wear basis.     

Pseudomonas corneal ulcer associated with disposable soft contact lenses

Disposable contact lenses were developed to reduce the complications associated with cosmetic extended wear contact lenses. We describe two cases of Pseudomonas corneal ulcers that developed in patients wearing disposable soft contact lenses. Patients wearing these lenses remain at risk for infection.     

Permanent-wear of gas-permeable rigid lenses: a new solution for the aphakic patient

The authors reviews his experience during a period of six years with permanent wear gas-permeable hard contact lenses. Problems with dislocation of the lens during sleep was solved by using a diameter of 11 mm. Corneal respiration was maintained due to the oxygen permeability of the new material. A new fitting technique was developed advising daily wear for 8 days post-operatively, extended wear at the 15th day, and the final lens given after 45 days. The results obtained suggests that the technique is a very real alternative to intraocular lens implantation.     

A comparison of multipurpose and conventional 2-step rigid gas-permeable solutions with Paragon corneal refractive therapy lenses

PurposeThis investigation compared 2 commonly used care systems, Boston Advance® care system and Boston Simplus? (Bausch & Lomb, Rochester, New York) multipurpose solution, and the effects of these solutions on unaided daytime vision, care, and handling and comfort with Paragon corneal refractive therapy (CRT)® (Paragon Vision Sciences, Mesa, Arizona) lenses.MethodsEighteen subjects wearing CRT lenses were recruited. Three evaluations were conducted over 2 months. Subjects were randomly assigned a solution and returned for a follow-up visit after 1 month. At the conclusion of the 1-month visit, each patient was reassigned the other solution for the second month. The final visit included an additional questionnaire regarding which solution was deemed the best and worst for unaided daytime vision, comfort, care, and handling.ResultsFrom the responses of the 18 patients, a trend is evident that patients favor Boston Simplus over Boston Advance for comfort, unaided daytime vision, and care and handling. However, the sample size is small in this study; therefore, most of the differences are not significant at the 0.05 level except the preference for care and handling (P = 0.03).ConclusionsPatients preferred Boston Simplus to Boston Advance with corneal reshaping lens wear when evaluated for comfort, unaided daytime vision, and care and handling. The preference of Boston Simplus to Boston Advance for care and handling is very strong and statistically significant, whereas other such advantages of Boston Simplus were not found to be statistically significant in this study. Further confirmation of these results as well as a better understanding of other visual and ocular interactions of Boston Simplus versus conventional solutions, will require using a larger sample in further studies.     

Sarcoidosis-related anterior uveitis in a patient with human immunodeficiency virus.

BACKGROUND: This is the first ophthalmic report--to our knowledge--of an anterior uveitis secondary to sarcoidosis in a patient infected with human immunodeficiency virus (HIV). Other reported causes of uveitis in HIV-infected patients have included HIV, herpes zoster, tuberculosis, syphilis, toxoplasmosis, cryptococcus, rifabutin prophylaxis for mycobacterium, and protease inhibitors such as ritonavir and indinavir. Uveitis secondary to sarcoidosis in the non-HIV population is classically seen in young, female, African-American patients. There are rare reports, found exclusively in the pulmonary literature, of sarcoidosis in HIV-infected patients. CASE REPORT: A 38-year-old African-American male infected with HIV was treated for chronic recurrent anterior uveitis secondary to sarcoidosis. His sarcoidosis was diagnosed 1 month earlier, along with the onset of his uveitis. During the previous 6 years he has been treated with anti-HIV antivirals as well as prophylaxis for opportunistic infections. To date, his infectious disease specialist continues to treat his HIV and systemic sarcoidosis. CONCLUSION: Patients with HIV infection in whom sarcoidosis with secondary uveitis develops are very rare. Management of these patients requires careful use of topical and oral steroidal anti-inflammatories to control ocular and systemic sequelae of sarcoidosis. This case initiates some interesting questions about the immunology of sarcoidosis and its presence in immunocompromised patients. Use of steroids in an immunocompromised patient is clinically complex. Further clinical study is needed to elicit the full clinical significance of sarcoidosis and HIV infection.     

Ocular blood flow in patients infected with human immunodeficiency virus.

PURPOSE: Alterations of ocular blood flow may play a role in the pathophysiology of human immunodeficiency virus (HIV) related retinal microvasculopathy. In this study ocular blood flow was investigated in patients with HIV infection. DESIGN: In a prospective, cross-sectional study ocular blood flow was measured in 37 eyes of consecutive HIV- infected persons and compared with the data of age-matched healthy controls. This sample size was calculated based on an alpha-error of 0.5 and a beta-error of 0.8. METHODS: Macular white blood cell flow, fundus pulsation amplitude, and blood flow velocities in the retrobulbar vessels were measured with blue field entoptic technique, laser interferometry, and Doppler sonography, respectively. Immunologic and ophthalmologic status was evaluated from each patient. RESULTS: Mean CD4+ cell count of the HIV-infected persons was 206.8 +/- 145.6 cells/mm(3). In five patients HIV-related retinopathy was observed. A significant reduction in leukocyte density was seen in HIV infected persons (82.2 +/- 23.4) as compared with the control group (102.0 +/- 28.4; P =.019). The resistive index in the central retinal artery was higher in HIV infected patients (0.77 +/- 0.05) as compared with the controls (0.74 +/- 0.04; P =.04). The other hemodynamic parameters were not different between groups. No correlation of flow parameters and CD4+ cell count or HIV-related retinopathy was observed. CONCLUSIONS: Decreased macular leukocyte density was detected in HIV infected persons. Our study suggests that abnormal retinal hemodynamics in individuals infected with HIV may be involved in the pathogenesis of HIV-related microvasculopathy.     

Syphilitic uveitis in patients infected with human immunodeficiency virus

Background This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV).Material and methods We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003.Results Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment.Conclusion Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.None of the authors has any financial interest in this study.     

Retinal blood flow indices in patients infected with human immunodeficiency virus.

AIMS/BACKGROUND: Abnormal blood flow dynamics are believed to contribute to the development of retinal microvascular disease in patients infected with human immunodeficiency virus (HIV). In this study, the scanning laser ophthalmoscope (SLO) was used, combined with fluorescein angiography, to measure retinal blood flow indices in HIV seropositive patients. METHODS: Arteriovenous passage time (AVP) and perifoveal capillary blood flow velocity (CFV) were measured in 23 HIV infected patients and 23 control subjects with SLO fluorescein angiography. RESULTS: No significant difference in AVP was found between the two groups. However, CFV was significantly reduced in HIV infected patients (p = 0.013). CONCLUSION: Patients infected with HIV show abnormal haemodynamics at the level of the perifoveal capillaries.     

Retinal vascular occlusion in patients infected with human immunodeficiency virus

PURPOSE: To describe the clinical features of retinal vascular occlusions (macrovasculopathy) and the proportion of affected patients with human immunodeficiency virus (HIV) infection. METHODS: Retrospective chart review of all HIV-infected individuals with retinal vascular occlusions seen at a single tertiary care clinic between November 1983 and May 1998. RESULTS: Retinal vascular occlusion was found in 38 eyes of 33 (1.3%) of the 2,484 consecutive patients examined. Of the 33 patients, 16 (48.5%) had central retinal vein occlusion, 9 (27.3%) had branch retinal vein occlusion, 4 (12.1%) had hemiretinal vein occlusion, and 1 each (3.0%) had central retinal arterial occlusion, branch retinal arterial occlusion, and combined hemiretinal vein occlusion and branch retinal artery occlusion. One patient (3.0%) had Purtscher-like retinopathy in one eye. Multiple regression analysis revealed that macrovasculopathy was associated with the presence of noninfectious retinal microvasculopathy (odds ratio, 5.76; 95% confidence interval, 2.59-12.80). Vision at the time of diagnosis ranged between 20/20 and no light perception. Twenty-five (75.8%) of the 33 patients had follow-up examinations for a mean period of 9.1 months. Ocular findings during follow-up included capillary dropout in 3 patients (11.5%), posterior pole neovascularization in 4 (15.4%), vitreous hemorrhage in 4 (15.4%), and optic atrophy in 6 (23.1%). Vision at the last eye examination ranged between 20/20 and no light perception and was 20/200 or worse in 15 (39.5%) of 38 eyes. CONCLUSIONS: Patients with HIV infection have a small risk of retinal vascular occlusion, but complications and visual loss are common in affected patients. There is a strong association between noninfectious retinal microvasculopathy and retinal vein occlusions.     

Bilateral Pseudomonas corneal ulcer in a disposable contact lens wearer.

PURPOSE: To describe a case of bilateral corneal ulcers caused by Pseudomonas in a disposable soft contact lens wearer. This case study discusses the role of patient examination, contact lens care instruction, and adequate patient supervision in reducing the risk of serious potential complications. METHODS AND RESULTS: A 17 year old student who had been using disposable soft contact lenses on an extended wear basis for 6 months presented complaining of pain in the left eye. When he was examined, a corneal ulcer with surrounding infiltrate was observed in the superior middle periphery of the left eye. Samples were collected for culture, and treatment with fortified cefalotin and gentamicin was started. After 8 hours the patient returned, now complaining of pain in the right eye. Examination of the right eye revealed a diffused keratitis with a mucopurulent discharge. A culture was taken, and the same treatment was instituted. The laboratory tests revealed Pseudomonas in both eyes. The bilateral corneal ulcers responded to therapy after 1 week of treatment. CONCLUSIONS: We discuss the factors involved in the occurrence of infectious keratitis in contact lens wearers, and stress that even disposable contact lens wear can be associated with serious complications. This case also highlights extended wear as one of the main risk factors for complications in disposable soft contact lens wear.     

Management of pellucid marginal corneal degeneration with rigid gas permeable contact lenses.

PURPOSE: To study the clinical performance of rigid gas permeable contact lenses (RGPCL) in patients with pellucid marginal corneal degeneration (PMCD). METHODS: This retrospective study consisted of 15 patients with clinical PMCD, confirmed by videokeratography (TMS-1, Computed Anatomy, Inc., New York, NY). Information collected from the medical records included patient demographic data, uncorrected visual acuity, refraction, best-corrected spectacle visual acuity, and topographic details, including kerotometry. Twenty-seven of 30 eyes were subjected to several contact lens trials using polymethylmethacrylate (PMMA) contact lenses, using a systematic and consistent approach. After successful contact lens trials, data regarding number of trials, trial time, final contact lens choice parameters, and best-corrected contact lens visual acuity were noted for each patient. During follow-up, visual acuity with RGPCLs, lens fit, and average wearing time were noted. RESULTS: Fifteen patients (30 eyes) with typically inferiorly located pellucid marginal corneal degeneration were included in this study. There were 12 men and 3 women, with a mean age of 39.73 years. Twenty-seven eyes of 15 patients were identified as subjects for multiple contact lens trials, and 24 (88.8%) eyes were successfully fitted with RGPCLs. Best-corrected visual acuity of 6/12 or better with spectacles was achieved in 14 (46.66%) eyes. The average astigmatism was -8.56D, and a majority of the patients with PMCD who were in the contact lens trial had an against-the-rule astigmatism (63.3%). The mean trial time for attempted eyes (i.e., patients with PMCD who successfully underwent the contact lens trials) was 77.7 minutes, and the number of trials required to finalize the choice of contact lenses ranged between 2 and 7. The median base curve for RGP lenses was 7.57, and median diameter was 10.00 mm. Best-corrected visual acuity of 6/12 or better with the final contact lens was achieved in 95.4% of the subjects. After an average follow-up of 22.91 months, one patient was lost to follow-up, and 2 eyes required discontinuation of the contact lenses. The average wearing time among the contact lens wearers at their last follow-up visits was 9.58 hours. Final visual acuity of 6/12 or better was observed in 77.3% of eyes at the end of 22.91 months. CONCLUSION: Large-diameter RGPCLs are better tolerated and lead to significant improvement in visual acuity in inferior PMCD.