Viscoat黏弹剂联合软性角膜接触镜治疗角膜中央穿孔

目的 探讨Viscoat黏弹剂联合软性角膜接触镜治疗角膜中央穿孔的临床疗效.方法 收集我院眼科就诊的6例角膜中央穿孔患者的临床资料,角膜穿孔的直径均不超过2.0 mm,行角膜局部清创并在前房内注入Viscoat,然后予以配戴软性角膜接触镜,随访2～3个月,记录患者主观感觉、视力、裂隙灯检查、眼压、活体共聚焦显微镜、角膜内皮细胞计数等以判断疗效.结果 所有病例均达到治愈,治疗时长为1～2个月;最佳矫正视力提高至0.6～0.8,角膜内皮细胞计数为(3415.5±279.5)个·mm-2,角膜未留明显瘢痕,无严重并发症发生.结论 对于直径≤2.0 mm的外伤性角膜中央穿孔可通过应用Vis-coat黏弹剂联合软性角膜接触镜治疗,预后良好,并且减轻了患者的经济负担.     

LASIK后角膜瓣皱褶和折叠的处理

目的 探讨准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)后早期角膜瓣皱褶和折叠的有效处理方法.方法 对LASIK术后11例角膜瓣皱褶的原因及处理进行回顾性分析.所有的患者需经手术重新复位,在显微镜下采用去离子水冲洗角膜瓣加戴角膜接触镜24 h.术后观察角膜瓣状况、屈光变化、裸眼视力和最佳矫正视力.结果 经过处理的所有患者裸眼视力均达到或超过术前最佳矫正视力.角膜透明,未见明显皱褶,角膜瓣位置正常,无上皮植入.结论 角膜瓣皱褶和折叠是LASIK术后较严重的并发症.早期诊断和正确快速的处理是获得最佳视力的关键.用去离子水重新复位角膜瓣并佩戴角膜接触镜治疗LASIK术后早期角膜瓣皱褶和折叠是安全简单有效的方法.     

Diagnosing glaucoma in pediatric aphakia.

BACKGROUND: Cataracts pose a serious threat to the visual system in infants and children, requiring prompt surgical intervention and rehabilitation to optimize visual development. Glaucoma is a serious complication following cataract surgery in infants and can lead to loss of vision. Early diagnosis of glaucoma, however, can be quite challenging in these patients. CASE REPORTS: Three cases are presented in which comeal edema was the initial presenting sign that led to the diagnosis of glaucoma during routine contact lens follow-up examinations for pediatric aphakia. CONCLUSION: The contact lens practitioner, during the course of management of aphakic infants and children, should always be suspicious of glaucoma as a complication of cataract surgery, and the presenting sign may be corneal edema.     

Contact lens induced keratitis associated with contact lens wear

PURPOSE: To evaluate clinical characteristics, risk factors, management and outcome of contact lens induced keratitis (CLIK) associated with contact lens wear. METHODS: The study comprised all consecutive patients presenting with contact lens related presumed microbial keratitis during a 12-month period at our department. Detailed demographic data, type of contact lens, duration of lens wear, wearing schedule and lens hygiene were derived from a self-administered questionnaire. Severity of ulcer, corneal scrapings, treatment and final outcome were evaluated. RESULTS: 27 patients with CLIK, some of which may have been sterile peripheral infiltrates, due to contact lens wear were detected. In the majority of the cases patients had used disposable soft contact lenses (89%) and most of them had a daily wearing schedule (78%). 51.8% patients cleaned their lenses regularly. 6 (22%) applied no disinfection since their lenses were disposable on removal. In 3 of our cases with CLIK, penetrating keratoplasty had to be performed. CONCLUSION: Disposable contact lenses seem to have been a predisposing factor for contact lens induced keratitis also when used on a daily wear schedule. Insufficient contact lens care products and/or manufacturing characteristics may be responsible for CLIK, which is also observed in otherwise compliant contact lens users. In 3 of our patients with CLIK keratoplasty became necessary, indicating that contact lens induced keratitis may result in severe corneal complications.     

Intraocular contact lens tamponade to facilitate penetrating keratoplasty in perforated corneas

Penetrating keratoplasty in the presence of a perforated cornea is a relatively common and difficult surgical problem. In the worst scenario, there may be extrusion of ocular contents during trephination. Two cases of perforated corneas are presented in which a new technique was used to close the perforation and normalize intraocular pressure. This involves inserting a soft contact lens through a paracentesis into the anterior chamber. An ophthalmic viscosurgical device is then injected behind the contact lens, opening it, and allowing it to tamponade the perforation. This stabilizes the anterior chamber and allows a stable operating environment. This has not been described previously.     

Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases.

BACKGROUND--Microbial corneal infection is the most serious complication of contact lens wear. Contact lens cases are a recognised potential source of pathogens associated with corneal ulcers. METHODS--This survey established the incidence of protozoal, bacterial, and fungal contact lens case contamination in 101 asymptomatic daily wear cosmetic contact lens wearers from a domiciliary contact lens practice. RESULTS--Eighty two (81%) contact lens cases were found to be contaminated, with 19 (19%) sterile. Of all contact lens cases, 78 (77%) grew bacteria, 24 (24%) fungi, and 20 (20%) protozoa. Acanthamoeba spp were isolated from eight (8%) contact lens cases. Fifty six (55%) contact lens cases yielded mixed bacterial contamination. This is the first contact lens case survey in which hydrogen peroxide disinfection was the major method of contact lens disinfection (75% of subjects) and no home made saline was used. All the contaminating organisms were shown to possess the enzyme catalase that breaks down hydrogen peroxide to oxygen and water. The polymicrobial nature of the biofilms found in many contact lens cases is illustrated electron micrographically. CONCLUSION--Based on data from this and previous studies, the authors conclude with recommendations for contact lens wearers: (1) regular scrubbing of contact lens case interior to disrupt biofilms; (2) exposure of contact lens case to very hot water (> or = 70 degrees C) will kill Acanthamoeba contaminants; (3) allow contact lens case to air dry between uses; (4) if hydrogen peroxide disinfection is preferred, use a two step system; (5) replace contact lens case regularly.     

羊膜移植联合亲水性软性角膜接触镜治疗早期眼烧伤

目的 观察羊膜移植联合亲水角膜接触镜治疗早期眼烧伤的临床疗效.方法 21例（21眼）早期眼烧伤患者,采用羊膜移植并佩戴亲水性软性角膜接触镜治疗,术后随访3月.结果 所有患眼术后症状均有不同程度缓解;20例眼表基本稳定,视力不同程度提高;2例角膜云翳;l例眼结膜表层重建,但发生角膜斑翳.无严重眼部并发症发生.结论 羊膜移植联合亲水性角膜接触镜治疗各种早期眼烧伤安全、有效,值得在临床上广泛推广使用.     

Gas permeable contact lenses in the management of problem cases and in prolonged wearing time

The continuous improvement of contact lenses (copolymers with high gas permeability) makes better care possible in problem cases. They can also be used for continuous wear. The present authors report upon 104 cases in which a contact lens made of P3, was tested. This is a hard, flexible contact lens with a DK value of 33, which is produced without additional treatment of the surface.     

Positive pressure during penetrating keratoplasty can be solved with a modified graft‐over‐host technique

Purpose: To describe a modified graft‐over‐host (MGOH) surgical technique which was used to prevent serious complications in cases of positive vitreal pressure during penetrating keratoplasty (PKP) and to compare the endothelial cell density (ECD) loss and clinical outcome between eyes undergoing MGOH or standard PKP. Methods: In the proposed MGOH technique, the donor graft is sutured over the recipient cornea as soon as signs of positive pressure are noticed, even before cutting the recipient cornea, and the surgery is continued by consecutive cutting of the recipient and continuous suturing of the donor cornea, quadrant by quadrant. Donor grafts were prospectively followed up for the graft clarity, ECD loss and the amount of astigmatism. Results: Of 220 cases scheduled for standard PKP in years 2009–2011, eight were operated by MGOH technique. Despite the fact that the donor cornea is situated over the recipient almost throughout the whole MGOH procedure, the ECD loss is equal between eyes operated on by MGOH technique and standard PKP, and none of the grafts had primary graft failure. The only disadvantage was an increased amount of astigmatism that was not as significant once the sutures were taken out. Conclusion: Modified graft‐over‐host technique seems to be a safe and effective method to prevent complications during PKP complicated by positive vitreal pressure.     

Clinicopathological analysis of 719 pediatric and adolescents’ ocular tumors and tumor-like lesions: a retrospective study from 2000 to 2018 in China

AIM: To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique. METHODS: A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occured, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule. RESULTS: After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occured in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule. CONCLUSION: The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.     

Akanthamöbenkeratitis bei Kontaktlinsenträgern in der Patientenpopulation der Augenklinik Debrecen

Background

With increasing numbers of contact lens wearers, Acanthamoeba infections are also more frequent all over the world and also in Hungary. Despite improved diagnostic and therapeutic possibilities it can still cause serious visual loss. In this study the symptoms, signs, diagnostics and treatment options for Acanthamoeba keratitis (AK) in patients treated in our department are presented and compared to the literature.

Patients and methods

Between 2001 and 2006 a total of 11 patients were treated in our department for Acanthamoeba keratitis.

Results

The mean age of the patients was 30 years and the 8 female and 3 male patients were all contact lens wearers. In six cases the right eye was affected and in five cases the left eye. Poor and improper contact lens hygiene was the cause of infection in all cases and 82% of the infections occurred in the summer period between June and September. In addition to long-term conservative treatment, perforating keratoplasty was performed in six cases. After the therapy the best visual acuity was 0.6, but 4 of the patients had a serious visual loss. Follow-up time ranged from 6 months to 5 years.

Conclusions

Early diagnosis and long-term suitable local therapy are necessary for effective recovery. If the patient wears contact lens and there is severe pain with ring infiltration in the cornea, Acanthamoeba infection should be considered and suitable therapy should be given. Immediately performed perforating keratoplasty does not lead to visual improvement. Prevention by informing the patients about adequate hygiene and use of the cleaning solutions is one of the most important tasks of contact lens specialists.     

A European fitting philosophy for aspheric, high-Dk RGP contact lenses.

Microbial keratitis, the most serious complication of contact lens wear, is most frequently associated with soft contact lenses. Rigid gas permeable (RGP) lens wearers are less often affected. Increased use of high-Dk RGP lenses could reduce the number of cases of microbial keratitis. In Europe, aspheric high-Dk RGP lenses are very popular. This article presents practical guidelines for computer-aided fitting of aspheric RGP lenses. Base curve selection using the keratometer to determine the corneal topography is described. This method, which is inexpensive and time-saving, is suitable for fitting cosmetic contact lenses or lenses used in treating such corneal pathology as keratoconus.     

State of the cornea after early surgery of congenital cataract with subsequent contact correction]

Eighteen cases (28 eyes) with congenital cataracts are analyzed. Transciliary lensectomy technique was used for cataract extraction (the ages of the infants at the moment of surgery varied from 3.5 to 16 months), aphakia was corrected by highly hydrophilic soft contact lenses worn during the daytime. The limbic vessels, corneal epithelium, endothelium, and thickness were examined. No changes in the epithelium were revealed. Only in one case a trend to a moderate dilatation of a limbic vessel in the upper segment was seen in the presence of microphthalmia. Analysis of endothelial morphometry data has revealed a universal tendency in all the cases: cell square increased and their density reduced (by 45 and 19%, respectively) immediately after surgery. Wearing of contact lenses was associated with a somewhat rise of the cell count, this count persisting below the norm by 10% on an average. Corneal thickness increased by 0.05 mm after surgery and by 0.03 mm during lens correction.     

Hyperosmolar Hyperglycemic Nonketotic Coma: A Complication of Short-term Systemic Corticosteroid Use

Hyperosmolar hyperglycemic nonketotic coma is a serious and often lethal clinical biochemical syndrome. We report three cases of ophthalmic problems that were treated with a short course of oral corticosteroids and which resulted in the development of hyperosmolar hyperglycemic nonketotic coma. Two of these cases concerned relatively young, previously healthy patients and had fatal outcomes. The third patient, who was elderly, survived because of early detection and initiation of therapy. All three cases demonstrate that hyperosmolar hyperglycemic nonketotic coma is a serious potential complication of systemic steroidal therapy, even in a short course of treatment such as is often used in ophthalmology.     

Transverse astigmatic keratotomy combined with phacoemulsification and intraocular lens implantation

Transverse astigmatic keratotomy is a surgical technique to correct preoperative corneal astigmatism during cataract surgery. The operative technique is described and the results of my first 40 cases are reviewed. The average keratometric astigmatism for this group before surgery was 2.6 dipoters (D). The average reduction in astigmatism was 1.5 D, which yielded a final residual average astigmatism of 1.1 D after surgery. Cases of substantial astigmatism showed the most improvement. Less improvement was seen in cases of minimal preoperative astigmatism. No increase in net keratometric astigmatism was seen in any of the eyes studied. Minor complications were limited to several small corneal abrasions created by the front-cutting diamond blade and one late temporary wound dehiscence. The only serious complication was one case of corneal macroperforation. Recommendations for handling this complication and future high astigmatism cases are given.     

Contact lenses in the treatment of patients with overcorrected radial keratotomy

Thirty-two eyes of 28 patients who underwent radial keratotomy had a hyperopic overcorrection after the surgical procedure. Anisometropia, with associated aniseikonia and depth perception problems were present in many of these patients. The patients were subsequently fit with contact lenses. Conventional methods of fitting contact lenses in these patients were unsuccessful. A trial lens technique is used with the initial lens having a base curve equal to the preoperative keratometry measurements and the power equal to the preoperative spherical equivalent. Superficial neovascularization developed within the radial incisions in 33% of the eyes fitted with soft contact lenses. Gas permeable contact lenses offered patients the best-corrected visual acuity as well as minimal complications. In addition, the anisometropia was minimized, and fluctuating vision was eliminated in cases in which it was a problem.     

Implantation of preserved human amniotic membrane for the treatment of shield ulcers and persistent corneal epithelial defects in chronic allergic keratoconjunctivitis

PURPOSE: To determine whether amniotic membrane implantation is a safe and effective alternative treatment for shield ulcers and persistent corneal epithelial defects associated with ulcers in chronic allergic keratoconjunctivitis (vernal or atopic keratoconjunctivitis). METHODS: Amniotic membrane implantation was performed in four consecutive patients with persistent corneal epithelial defects or vernal plaques unresponsive to conventional medical treatment lasting an average of 18 weeks. Surgery was done under general anesthesia using amniotic membrane as a therapeutic contact lens. RESULTS: A significant decrease in symptoms and complete reepithelialization of the corneal ulcers were observed in all cases within the first 7 days. These remained stable during a mean follow-up of 12 weeks, with no intraoperative or postoperative complications. Early detachment occurred in all cases with no negative consequences on ulcer healing. CONCLUSION: Patients with severe chronic allergic keratoconjunctivitis derive benefits from amniotic membrane implantation used as a therapeutic contact lens in the treatment of persistent corneal epithelial defects and vernal plaques unresponsive to conventional medical treatment.     

Computer assistance in keratoconus lens design

In the past, keratoconus patients have been custom fit with multi-curve spherical contact lenses. Recently it has become possible to commercially manufacture aspherical contact lenses of high-Dk material. A computer assisted fitting technique may be used with these new lenses. We report 90 consecutive keratoconus eyes that were fit with aspherical high-Dk contact lenses using a computer-aided fitting system. Mild and severe grades of keratoconus cases were included, with a 6 to 12 month follow-up time. The combination of new lens geometry and lens material produced a reduction in corneal complications. The asphericity of the lens geometry had a slight negative influence on the visual acuity in mild keratoconus cases, but the visual acuity in the severe keratoconus cases was good. The contact lens material proved acceptably durable, despite the high oxygen transmissibility. We found the computer assisted fitting technique very accurate in determining the initial fitting lens and much faster than the former trial-and-error procedure.     

白内障手术并发症应用玻璃体手术治疗的临床研究

分析总结玻璃体切除术在白内障术中及术后并发症中的应用时机及价值。方法对2004年1月至2013年10月由本文第一作者接诊的81例（81只眼）白内障术中、术后并发症患者适时进行玻璃体切除术,其中包括术后化脓性细菌性眼内炎19例、术中暴发性脉络膜上腔出血4例、术中晶状体后囊破裂导致晶状体核及皮质坠入玻璃体腔28例、人工晶状体脱位于玻璃体腔9例、视网膜脱离21例。结果随访1个月至10年,所有患者适时的进行玻璃体手术后,白内障手术并发症均得到有效控制,大部分患者视力有不同程度提高。结论白内障术中、术后出现的严重并发症及时发现并正确处理,适时行玻璃体切除术是目前最为有效的治疗方法。     

Excimer laser superficial keratectomy for proud nebulae in keratoconus.

Contact lens intolerance in keratoconus may be due to the formation of a proud nebula at or near the apex of the cone. Excimer laser superficial keratectomy was performed as an outpatients with proud nebulae as treatment patients with proud nebulae as treatment for their contact lens intolerance. The mean period of contact lens wear before the development of intolerance was 13.4 years (range 2 to 27 years). Following the development of intolerance, three patients abandoned contact lens wear in the affected eye while the remainder experienced a reduction in comfortable wearing time (mean = 3.75 hours; range: 0-14 hours). All patients had good potential Snellen visual acuity with a contact lens of 6/9 (nine eyes) and 6/12 (one eye). The proud nebulae were directly ablated with a 193 nm ArF excimer laser using a 1 mm diameter beam. Between 100-150 pulses were sufficient to ablate the raised area. Patients experienced no pain during the procedure and reported minimal discomfort postoperatively. In all cases flattening of the proud nebulae was achieved. Seven patients were able to resume regular contact lens wear (mean wearing time = 10.17 hours; range 8 to 16 hours). In three patients, resumption of contact lens wear was unsuccessful because of cone steepness. All patients achieved postoperative Snellen visual acuity of 6/12 or better with a contact lens. Four patients experienced a loss of one line in Snellen acuity. The mean follow up period was 8.3 months (range 2 to 17 months). Excimer laser superficial keratectomy is a useful technique for the treatment of contact lens intolerance caused by proud nebulae in patients with keratoconus. Penetrating keratoplasty is thus avoided.