Summary We present our experience of scleral lens fitting after refractive failure of corneal reshaping surgery. 100 eyes of 90 patients unsatisfied after corneal reshaping surgery: Lasik (55), PKR (15), Radial keratotomy (10) and intra corneal ring segment implantation (20) are enrolled in this retrospective study. Visual acuity outcomes, quality of life using the contact lens impact quality of life (CLIQ) questionnaire and complications of scleral lens wear are discussed.
SummaryPurposeTo demonstrate the spectacular effect of therapeutic scleral lens in healing severe ocular burns.MethodsRetrospective study of 6 eyes with severe ocular burns, complete limbal stem cell deficiency with limbal ischemia in 360°, corneal anaesthesia and resistant to medical treatment for more than 2 weeks without healing tendancy, presenting large complete corneal and limbal ulcer, fitted with therapeutic scleral lens Misa lens (Microlens*, The Netherlands) for continuous daily wear and filled with saline solution and daily control with fluid exchange.ResultsAll eyes had complete re‐epithelialisation in 1–3 weeks under therapeutic scleral lens alone, The healing proccess began from peripheral conjunctival epithelial cells.ConclusionsTherapeutic scleral lens is magic solution to manage severe ocular burns and may be used as first therapeutic weapon.These cases show that epithelial stem cells are presents in all ocular surface not only limbus.
Purpose To demonstrate the accuracy of slit lamp assessment of relative afferent pupillary defect (RAPD) in patients with asymetric optic neuropathy. Methods 40 eyes of 20 patients with asymetric optic neuropathy and no obvious RAPD in swinging flashlight test were evaluated on slit lamp. The asymetric optic neuropathy was confirmed by fundus examination, retinal nerve fiber layer thikness on OCT, visual field examination, visual potentials and/or brain and orbit MRI. The horizontal pupillary diameter in the affected (or more affeted) eye was measured and compared to the horizontal pupillary diameter of the fellow eye using the width of the slit lamp beam. Both diameters were measured in millimeters and compared. Results There was a quantified anisocoria and RAPD each time when asymetric optic neuropathy was present. In other words, with the same slit lamp beam width (the same light intensity) the affected (or more affected eye) had a larger pupillary horizontal diameter. Conclusions Slit lamp assessment of RAPD is simpler, quicker and more accurate than standard assessment using swinging flashlight test especially when anisocoria is not obvious.
Purpose To demonstrate that hydrops is not a disaster and often evolves favorably especially under surgical treatment. Methods Prospective study of 30 eyes of 30 patients with corneal hydrops who underwent clinical examination with anterior segment photography, corneal topography, ultrasound corneal pachymetry and corneal OCT. All of them underwent in an outpatient setting and under topical anesthesia, anterior chamber air injection, peripheral iridotomy and deep corneal sutures perpendicular to Descemet membrane tear then kept under observation for 1 hour. Patients were asked to stay laying on their backs for 3 days. All patients were able to wear scleral lens after 1 week post surgery. Results Corneal edema decreased dramatically since the first day concomitantly with corneal thickness and average SimK reading. Mean LogMAR with scleral lens was 0.4. Conclusions Proper surgical approach of hydrops can provide a spectacular quick healing with visual improvement avoiding corneal graft.
Scleral lens has a double interest: Thanks to its anterior optically perfect surface without any contact with the cornea nor the limbus, it erases the irregularities of cornea whatever the degree of ectasia. On the other hand, it provides a favorable microenvironment for regeneration of diseased corneal epithelium. We present our short Algerian experience in cases of challenging cornea, typically requiring keratoplasty (expensive, often unavailable and with unpredictable results), fitted with scleral lens: Primary corneal ectasia (stage IV keratoconus, pellucid marginal degeneration, globus), secondary post Lasik ectasia, failure of corneal reshaping surgery (Lasik, PKR, radial keratotomy and intracorneal ring segment implantation), irregular corneal graft and traumatic or post infectious corneal scar. We present the functional outcome and the quality of life of these patients. Therapeutic scleral lenses have a magical result, we illustrate it with trophic ulcer cases of various etiologies, resistant to conventional treatment and who healed very quickly under scleral lens wear alone. Finally, we present our pilot study on total UV filter scleral lens to protect ocular surface of children with Xeroderma Pigmentosum. Commercial interest
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