Transcorneal tube extrusion in a child with a Baerveldt glaucoma drainage device.

We describe a clinical scenario in which a child was treated for glaucoma and aqueous misdirection with surgical placement of a tube shunt. The child then suffered extrusion of the tube through the cornea, a rare complication of such procedures. This complication has only been seen in children, and thus, young patients with tube shunts need careful and frequent monitoring, especially during the first year of the post tube shunt period to ensure that they have not developed this complication.     

Contact lens induced severe epithelial disruption

The authors describe a patient with bilateral severe disruption of the epithelium while wearing MMA/VP70 contact lenses. Withdrawal of the contact lenses and the contact lens care system resulted in complete recovery. Later on Boston IV contact lenses with another care system were fitted successfully.     

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.     

Phacoemulsification in patients with Baerveldt tube shunts

PURPOSE: To investigate the effects of phacoemulsification in glaucomatous eyes with functioning Baerveldt tube shunts. SETTING: Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. METHODS: This retrospective analysis followed 9 eyes of 8 patients with functioning Baerveldt tube shunts who had clear corneal phacoemulsification. Intraocular pressure (IOP), number of glaucoma medications, corneal thickness, visual acuity, and additional glaucoma surgery were measured. RESULTS: The mean follow-up was 21 months +/- 3 (SD) (range 17 to 25 months). The mean change in IOP and the number of glaucoma medications used did not significantly change at 1 month (P>.19), 1 year (P>.17), or the last follow-up (P>.17). At the last examination, 2 eyes had IOP increases of 2 to 4 mm Hg, 3 eyes had no change, and 4 eyes had decreases of 4 to 7 mm Hg. Intraocular pressure increased in 1 eye at 8 months and required a tube shunt revision. No eye developed corneal decompensation. Visual acuity improved in 8 eyes; the mean improvement was 4 +/- 3 Snellen lines. CONCLUSION: In most cases, phacoemulsification in glaucomatous eyes with a functioning Baerveldt tube shunt improved vision and maintained control of IOP.     

Contact lens induced giant papillary conjunctivitis: a retrospective study

In this retrospective epidemiological study, records from the Contact Lens Department of SUNY College of Optometry were randomly selected and reviewed. An association between contact lens induced giant papillary conjunctivitis (GPC) and a FDA classified sub-category was found. Younger patients were shown to have a higher risk of developing GPC. Gender and tear film break-up time were not found to be associated with the condition. The mean replacement time for hydrogels was 10.8 +/- 9.2 months with no significant differences among contact lens polymer types. The GPC phenomenon was almost exclusively bilateral with a mean onset time of 31.4 months after commencing lens wear. A model for the development of GPC based on tear film interactions with the hydrogel lens surface is presented. A model for the tear film's interaction with the hydrogel contact lens in situ is offered.     

Contact lens complications

Complications associated with contact lenses range from mild to severe and occur with all lens modalities. Contact lens wear can cause a change in corneal physiology, which can lead to epithelial, stromal, and endothelial compromise. Other complications include lens deposition, allergic conjunctivitis, giant papillary conjunctivitis, peripheral infiltrates, microbial keratitis, and neovascularization. Pre-existing conditions can contribute to these complications, or they can occur in association with contact lens wear and care regimens. Patient-related factors, such as alteration of the recommended wearing or replacement schedules and noncompliance with recommended contact lens care regimens for economic reasons, convenience, or in error, contribute to contact lens-related complications and have led to difficulty in accurate determination of complication rates among the various lens wear modalities. Complications may require discontinuation of contact lenses, topical therapy, and changes in contact lens wearing schedules, materials, and care solutions. On initial lens fitting and follow-up evaluations, practitioners should review contact lens replacement and cleaning regimens with patients and discuss complications. To avoid serious complications, patients should be reminded to remove their contact lenses as soon as ocular irritation occurs, and to call their eye care practitioner immediately if symptoms persist.     

Contact lens in keratoconus

Contact lenses are required for the visual improvement in patients with keratoconus. Various contact lens options, such as rigid gas permeable (RGP) lenses, soft and soft toric lenses, piggy back contact lenses (PBCL), hybrid lenses and scleral lenses are availble. This article discusses about selection of a lens depending on the type of keratoconus and the fitting philosophies of various contact lenses including the starting trial lens. A Medline search was carried out for articles in the English language with the keywords keratoconus and various contact lenses such as Rose k lens, RGP lens, hybrid lens, scleral lens and PBCL.