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Kohji Nishida - One of the best experts on this subject based on the ideXlab platform.
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acute hydrops with a 180 degree massive edematous cavern demonstrated by three dimensional view of anterior segment optical coherence tomography in a patient with pellucid marginal Corneal Degeneration a case report
BMC Ophthalmology, 2018Co-Authors: Andrew Winegarner, Yoshinori Oie, Kohji NishidaAbstract:Pellucid marginal Corneal Degeneration is a non-inflammatory disorder complicated by severe inferior Corneal thinning. The central portion of the cornea, consequently, appears to protrude outwards, decreasing vision by means of an irregular stigmatism. Additionally, acute hydrops can occur in case of Descemet’s membrane rupture. A 41-year-old Japanese woman presenting with severe visual loss in the left eye was examined and observed to have had full thickness Corneal perforation as well as a Descemet membrane rupture with massive edema in the Corneal stroma. Anterior segment optical coherence tomography-based Corneal topography revealed a distorted crab claw sign indicating pellucid marginal Corneal Degeneration. The Descemet membrane rupture allowed acute hydrops to occur which was especially noteworthy given the scale of edema present within the stroma, rotating 180 degrees along the limbus, causing a smiley-face like lesion. We visualized it via a gonioscopic three-dimensional optical coherence tomography to build a three-dimensional video. Patient history revealed a previous acute hydrops in the right eye as well, which was ultimately treated with anterior lamellar keratoplasty, suggesting the pellucid marginal Corneal Degeneration had a classic bilateral involvement, which was also characterized with bilateral acute hydrops. This appears to be a very rare and interesting presentation of bilateral pellucid marginal Degeneration, wherein not only acute hydrops formed bilaterally, but the cavity within the cornea stroma was exceptionally large with an unusual shape. Using the gonioscopic three-dimensional optical coherence tomography imaging, we were able to easily visualize the massive intrastromal cavern, and appropriately planned the crescent-shaped anterior lamellar keratoplasty. The 3d video constructed using this data is particularly elucidative compared to 2d images. As such, we recommend utilizing 3d imaging in cases where more conventional topography is not as explanatory with respect to precise nature of deformation.
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Acute hydrops with a 180-degree massive edematous cavern demonstrated by three dimensional view of anterior segment optical coherence tomography in a patient with pellucid marginal Corneal Degeneration, a case report
BMC, 2018Co-Authors: Andrew Winegarner, Yoshinori Oie, Kohji NishidaAbstract:Abstract Background Pellucid marginal Corneal Degeneration is a non-inflammatory disorder complicated by severe inferior Corneal thinning. The central portion of the cornea, consequently, appears to protrude outwards, decreasing vision by means of an irregular stigmatism. Additionally, acute hydrops can occur in case of Descemet’s membrane rupture. Case presentation A 41-year-old Japanese woman presenting with severe visual loss in the left eye was examined and observed to have had full thickness Corneal perforation as well as a Descemet membrane rupture with massive edema in the Corneal stroma. Anterior segment optical coherence tomography-based Corneal topography revealed a distorted crab claw sign indicating pellucid marginal Corneal Degeneration. The Descemet membrane rupture allowed acute hydrops to occur which was especially noteworthy given the scale of edema present within the stroma, rotating 180 degrees along the limbus, causing a smiley-face like lesion. We visualized it via a gonioscopic three-dimensional optical coherence tomography to build a three-dimensional video. Patient history revealed a previous acute hydrops in the right eye as well, which was ultimately treated with anterior lamellar keratoplasty, suggesting the pellucid marginal Corneal Degeneration had a classic bilateral involvement, which was also characterized with bilateral acute hydrops. Conclusion This appears to be a very rare and interesting presentation of bilateral pellucid marginal Degeneration, wherein not only acute hydrops formed bilaterally, but the cavity within the cornea stroma was exceptionally large with an unusual shape. Using the gonioscopic three-dimensional optical coherence tomography imaging, we were able to easily visualize the massive intrastromal cavern, and appropriately planned the crescent-shaped anterior lamellar keratoplasty. The 3d video constructed using this data is particularly elucidative compared to 2d images. As such, we recommend utilizing 3d imaging in cases where more conventional topography is not as explanatory with respect to precise nature of deformation
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national survey of pellucid marginal Corneal Degeneration in japan
Japanese Journal of Ophthalmology, 2016Co-Authors: Kohji Nishida, Naoyuki Maeda, Yuichi Ohashi, Jun Shimazaki, Osamu Hieda, Akira Murakami, Kazuo TsubotaAbstract:A national survey was conducted in Japan to analyze the clinical characteristics of pellucid marginal Corneal Degeneration (PMD). A questionnaire was sent to all members of the Japan Cornea Society requesting demographic and clinical findings on PMD patients who had been examined between 2008 and 2010. The presence of band-shaped peripheral Corneal thinning, detected by slit-lamp biomicroscopy or by a pachymetric map, was set as the diagnostic criterion of PMD. Most of the participating facilities relied on either slit-lamp biomicroscopy or Corneal topography as diagnostic tools for the detection of PMD. Data on 347 patients (579 eyes) were returned from the participating facilities for analysis, among which 162 eyes in 84 men and 24 women, with a median onset age of 37 years, met the PMD criteria. Of the 108 patients (162 eyes) with classical PMD, unilateral involvement was found in 25 % of patients (27 eyes). In 17 of the 27 eyes for which topographic findings for the contralateral eye were available, seven eyes were either keratoconus or had a suspected diagnosis of keratoconus. An association with allergic disease was found in 24 eyes (22.2 % of patients). Approximately half of the patients had 1.0 or better spectacle-corrected distance visual acuity, and only 5 % showed 0.1 or worse. The mean keratometric value was 45.7 diopters. On Corneal topography, 100 eyes (61.7 %) showed the topographic “crab-claw pattern,” and the remaining eyes showed other patterns, including inferior steepening (22.2 %) and an irregular pattern (10.5 %). We conducted the largest clinical survey of PMD to date and found a male predominance, a relatively high prevalence of unilateral involvement, and associated allergic diseases.
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characteristics of Corneal topographic and pachymetric patterns in patients with pellucid marginal Corneal Degeneration
Japanese Journal of Ophthalmology, 2014Co-Authors: Mutsumi Fuchihata, Naoyuki Maeda, Ryotaro Toda, Shizuka Koh, Takashi Fujikado, Kohji NishidaAbstract:Purpose To determine the characteristics of the shape of the cornea in patients with pellucid marginal Corneal Degeneration (PMD) and to compare these characteristics to those of eyes with keratoconus and eyes of normal subjects.
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characteristics of ocular higher order aberrations in patients with pellucid marginal Corneal Degeneration
Journal of Cataract and Refractive Surgery, 2008Co-Authors: Yoshinori Oie, Kohji Nishida, Naoyuki Maeda, Tomoyuki Inoue, Ryo Kosaki, Asaki Suzaki, Yoko Hirohara, Toshifumi Mihashi, Yuichi Hori, Takashi FujikadoAbstract:Purpose To evaluate the characteristics of higher-order aberrations (HOAs) in eyes with pellucid marginal Corneal Degeneration (PMCD). Setting Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. Methods Ocular HOAs were measured by aberrometry in 20 eyes with PMCD (PMCD group), 76 eyes with keratoconus (KC group), and 105 normal eyes (control group) with a 4.0 mm pupil. The magnitudes and axes of trefoil, coma, tetrafoil, and secondary astigmatism and the magnitude of spherical aberration were compared between the 3 groups using vector analysis of Zernike terms. Results The mean axes of coma in the PMCD group (85.5 degrees) and KC group (82.5 degrees) were opposite the axis in the control group (253.7 degrees). The magnitude of coma was significantly lower in the PMCD group (0.27 μm ± 0.19 [SD]) than in the KC group (0.70 ± 0.37 μm) ( P P Conclusions Although PMCD and KC are categorized as noninflammatory Corneal thinning disorders, the HOA patterns in the 2 groups differed, possibly due to differences in the positions of the Corneal apex. PMCD and KC may cause distinctively different deterioration in the quality of vision.
Gullapalli N Rao - One of the best experts on this subject based on the ideXlab platform.
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pellucid marginal Corneal Degeneration
Ophthalmology, 2004Co-Authors: M S Sridhar, S Mahesh, Aashish K Bansal, Rishita Nutheti, Gullapalli N RaoAbstract:Abstract Objective To report the clinical features and outcome of patients with pellucid marginal Corneal Degeneration (PMCD). Design Retrospective noncomparative case series. Methods Retrospective chart review of 116 eyes of 58 patients with PMCD seen between 1990 and 2002 at the Cornea Service at L.V. Prasad Eye Institute, Hyderabad, India. The diagnosis of PMCD was based on the presence of Corneal thinning with ectasia of the normal cornea above or below the area of thinning with no evidence of scarring, vascularization, or lipid deposition and typical topographic features whenever topography was performed. A detailed history including the age of presentation, onset of symptoms, systemic diseases, atopy, and relevant family history was reviewed. The visual acuity (VA) at presentation; the location, extent, and degree of thinning; presence of concurrent keratoconus and keratoglobus; and complications, if any, were noted. The mode of visual rehabilitation; surgical procedure, if any; and the final VA achieved were analyzed. Main outcome measures Clinical features, associations, complications, and outcome of treatment. Results There were 45 males (77.6%) and 13 females (22.4%). All cases were bilateral. In one eye, no clinical features of PMCD were seen, but the diagnosis was made based on topographic features of typical PMCD. The age of the patients ranged from 8 to 66 years, with a mean of 34.0±14.8. One patient (1.7%) had associated vernal keratoconjunctivitis (VKC), 1 (1.7%) had Marfan's syndrome, and 1 (1.7%) had ocular hypertension. The degree of astigmatism was 20 D in 6 (6.1%). Typical inferior PMCD was seen in 99 eyes (85.3%), and superior PMCD was seen in 17 (14.7%). The thinning was commonly seen between the 5-o'clock and 7-o'clock positions. In 12 eyes (10.3%), PMCD was associated with keratoconus, and in 15 eyes (12.9%), keratoglobus was associated. Seven eyes (6.0%) had hydrops. Visual acuity improved in 52 eyes (55.3%) with correction, in 40 eyes (42.6%) it remained the same as that of the initial presentation, and in 2 eyes (2.1%) it worsened relative to the initial presentation. Forty-one eyes (35.3%) received spectacles, and 31 eyes (26.7%) were fitted with rigid gas-permeable contact lenses. Five eyes (4.3%) underwent surgery. Lamellar keratoplasty was performed in 3 eyes, and a crescentic lamellar graft was done in 2 eyes. Visual acuity improved in 4 eyes after surgery with a follow-up of 2 to 37 months. The final astigmatism in the operated eyes at the last follow-up ranged from 4 to 11 D. Conclusions Pellucid marginal Corneal Degeneration was seen predominantly in males in this series, and was not strongly associated with VKC. Keratoconus was seen in approximately 10% of the eyes, and keratoglobus in approximately 13%. Superior PMCD was seen in approximately 15% of the eyes. In our study, patients presented with severe astigmatism, and hydrops was a common complication. The majority of patients were treated with spectacles or contact lens. Surgery for PMCD—lamellar keratoplasty and crescentic lamellar keratoplasty, if indicated—usually results in significant residual astigmatism.
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superior pellucid marginal Corneal Degeneration
Eye, 2004Co-Authors: M S Sridhar, S Mahesh, Aashish K Bansal, Gullapalli N RaoAbstract:Purpose To report the clinical features and topographic findings of superior pellucid marginal Corneal Degeneration (PMCD). Methods Retrospective chart review of 15 eyes of eight patients of superior PMCD. Detailed history, visual acuity at presentation, degree of astigmatism, slit-lamp examination findings, topographic features, and Orbscan findings were noted where available. Improvement in visual acuity with spectacles or contact lens correction, surgical procedure if any, and final visual acuity were analysed. Results In all, six patients were males and two were females. All cases except one were bilateral. The patients ranged in age from 18 to 48 years. All cases had isolated superior PMCD. One patient was a diagnosed case of vernal keratoconjunctivitis. The visual acuity at presentation ranged from hand motions to 20/25. The degree of thinning varied from 30 to 90%. The extent of thinning was commonly seen between the 10 and 2 o'clock positions. Ectasia was seen below the site of thinning in all the cases of superior PMCD. Topographic features including vertical corridor of reduced power, against-the-rule astigmatism and superior loop cylinder were seen in 10 eyes. Orbscan was carried out in two eyes of one patient and revealed an area of increased elevation in relation to the best-fit sphere superiorly corresponding to the area of ectasia in both the eyes. The visual acuity improved with rigid gas-permeable contact lens in six eyes and the final visual acuity ranged from 20/400 to 20/30. Two eyes were subjected to surgical intervention (peripheral annular graft=1 and lamellar graft=1). Conclusions PMCD can occur superiorly. It should be considered in the differential diagnosis of superior ectatic disorders. The topographic findings, of reduced power in the vertical meridian and superior loop cylinder, are typical of superior pellucid marginal Degeneration. Visual rehabilitation is usually possible with contact lenses, with surgical management required in selected cases.
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management of pellucid marginal Corneal Degeneration with rigid gas permeable contact lenses
The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists Inc, 2002Co-Authors: Viswanadh B Kompella, Murali K Aasuri, Gullapalli N RaoAbstract: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 11 (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.
Yoshinori Oie - One of the best experts on this subject based on the ideXlab platform.
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acute hydrops with a 180 degree massive edematous cavern demonstrated by three dimensional view of anterior segment optical coherence tomography in a patient with pellucid marginal Corneal Degeneration a case report
BMC Ophthalmology, 2018Co-Authors: Andrew Winegarner, Yoshinori Oie, Kohji NishidaAbstract:Pellucid marginal Corneal Degeneration is a non-inflammatory disorder complicated by severe inferior Corneal thinning. The central portion of the cornea, consequently, appears to protrude outwards, decreasing vision by means of an irregular stigmatism. Additionally, acute hydrops can occur in case of Descemet’s membrane rupture. A 41-year-old Japanese woman presenting with severe visual loss in the left eye was examined and observed to have had full thickness Corneal perforation as well as a Descemet membrane rupture with massive edema in the Corneal stroma. Anterior segment optical coherence tomography-based Corneal topography revealed a distorted crab claw sign indicating pellucid marginal Corneal Degeneration. The Descemet membrane rupture allowed acute hydrops to occur which was especially noteworthy given the scale of edema present within the stroma, rotating 180 degrees along the limbus, causing a smiley-face like lesion. We visualized it via a gonioscopic three-dimensional optical coherence tomography to build a three-dimensional video. Patient history revealed a previous acute hydrops in the right eye as well, which was ultimately treated with anterior lamellar keratoplasty, suggesting the pellucid marginal Corneal Degeneration had a classic bilateral involvement, which was also characterized with bilateral acute hydrops. This appears to be a very rare and interesting presentation of bilateral pellucid marginal Degeneration, wherein not only acute hydrops formed bilaterally, but the cavity within the cornea stroma was exceptionally large with an unusual shape. Using the gonioscopic three-dimensional optical coherence tomography imaging, we were able to easily visualize the massive intrastromal cavern, and appropriately planned the crescent-shaped anterior lamellar keratoplasty. The 3d video constructed using this data is particularly elucidative compared to 2d images. As such, we recommend utilizing 3d imaging in cases where more conventional topography is not as explanatory with respect to precise nature of deformation.
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Acute hydrops with a 180-degree massive edematous cavern demonstrated by three dimensional view of anterior segment optical coherence tomography in a patient with pellucid marginal Corneal Degeneration, a case report
BMC, 2018Co-Authors: Andrew Winegarner, Yoshinori Oie, Kohji NishidaAbstract:Abstract Background Pellucid marginal Corneal Degeneration is a non-inflammatory disorder complicated by severe inferior Corneal thinning. The central portion of the cornea, consequently, appears to protrude outwards, decreasing vision by means of an irregular stigmatism. Additionally, acute hydrops can occur in case of Descemet’s membrane rupture. Case presentation A 41-year-old Japanese woman presenting with severe visual loss in the left eye was examined and observed to have had full thickness Corneal perforation as well as a Descemet membrane rupture with massive edema in the Corneal stroma. Anterior segment optical coherence tomography-based Corneal topography revealed a distorted crab claw sign indicating pellucid marginal Corneal Degeneration. The Descemet membrane rupture allowed acute hydrops to occur which was especially noteworthy given the scale of edema present within the stroma, rotating 180 degrees along the limbus, causing a smiley-face like lesion. We visualized it via a gonioscopic three-dimensional optical coherence tomography to build a three-dimensional video. Patient history revealed a previous acute hydrops in the right eye as well, which was ultimately treated with anterior lamellar keratoplasty, suggesting the pellucid marginal Corneal Degeneration had a classic bilateral involvement, which was also characterized with bilateral acute hydrops. Conclusion This appears to be a very rare and interesting presentation of bilateral pellucid marginal Degeneration, wherein not only acute hydrops formed bilaterally, but the cavity within the cornea stroma was exceptionally large with an unusual shape. Using the gonioscopic three-dimensional optical coherence tomography imaging, we were able to easily visualize the massive intrastromal cavern, and appropriately planned the crescent-shaped anterior lamellar keratoplasty. The 3d video constructed using this data is particularly elucidative compared to 2d images. As such, we recommend utilizing 3d imaging in cases where more conventional topography is not as explanatory with respect to precise nature of deformation
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characteristics of ocular higher order aberrations in patients with pellucid marginal Corneal Degeneration
Journal of Cataract and Refractive Surgery, 2008Co-Authors: Yoshinori Oie, Kohji Nishida, Naoyuki Maeda, Tomoyuki Inoue, Ryo Kosaki, Asaki Suzaki, Yoko Hirohara, Toshifumi Mihashi, Yuichi Hori, Takashi FujikadoAbstract:Purpose To evaluate the characteristics of higher-order aberrations (HOAs) in eyes with pellucid marginal Corneal Degeneration (PMCD). Setting Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. Methods Ocular HOAs were measured by aberrometry in 20 eyes with PMCD (PMCD group), 76 eyes with keratoconus (KC group), and 105 normal eyes (control group) with a 4.0 mm pupil. The magnitudes and axes of trefoil, coma, tetrafoil, and secondary astigmatism and the magnitude of spherical aberration were compared between the 3 groups using vector analysis of Zernike terms. Results The mean axes of coma in the PMCD group (85.5 degrees) and KC group (82.5 degrees) were opposite the axis in the control group (253.7 degrees). The magnitude of coma was significantly lower in the PMCD group (0.27 μm ± 0.19 [SD]) than in the KC group (0.70 ± 0.37 μm) ( P P Conclusions Although PMCD and KC are categorized as noninflammatory Corneal thinning disorders, the HOA patterns in the 2 groups differed, possibly due to differences in the positions of the Corneal apex. PMCD and KC may cause distinctively different deterioration in the quality of vision.
Juha M Holopainen - One of the best experts on this subject based on the ideXlab platform.
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peripheral hypertrophic subepithelial Corneal Degeneration clinical and histopathological features
Acta Ophthalmologica, 2014Co-Authors: Petri J Jarventausta, Timo Tervo, Tero Kivela, Juha M HolopainenAbstract:Purpose To refine the diagnostic criteria for peripheral hypertrophic subepithelial Corneal Degeneration (PHSD) and characterize its clinical phenotype, histopathology and immunohistochemical features. Methods Diagnostic criteria were refined on the basis of literature data. Fourteen patients (13 women and one man; median age 52 years, range 33–66) were identified based on these criteria. Keratectomy specimens were evaluated via routine and immunohistochemical stainings. The main outcome measures were symptoms, clinical phenotype, immunological status and histopathologic results. Results We defined the diagnostic criteria of typical PHSD as elevated circumferential and perilimbal subepithelial fibrosis with focal superficial Corneal neovascularization, which were supported by female sex (93%), bilaterality (86%), the centre being in the upper quadrants (81%) and irregular astigmatism of two dioptres or more. The typical symptoms were reduced vision (86%) and the symptoms of ocular surface disease (64%). Light microscopy showed fibrosis with abundant collagen deposition but no inflammation in all patients. An immunohistochemical analysis of nine patients showed uniform staining for vimentin in three distinct types of fibroblasts in variable proportions: keratocyte-like cells that were positive for CD34, myofibroblasts that were positive for smooth muscle actin (SMA) and fibroblasts that were negative for CD34 and SMA. Small numbers of CD68-positive macrophages were also found. Conclusions Peripheral hypertrophic subepithelial Degeneration is characteristic of middle-aged women, in whom it is typically a bilateral idiopathic Degeneration of the cornea associated with ocular surface disease and reduced vision. The fibrotic lesions probably undergo remodelling, inducing changes in Corneal contour. A smouldering low-grade inflammation favouring low TGF-β1 concentrations is postulated as the primary pathological process leading to PHSD.
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peripheral hypertrophic subepithelial Corneal Degeneration characterization treatment and association with human leucocyte antigen genes
Acta Ophthalmologica, 2014Co-Authors: Petri J Jarventausta, Juha M Holopainen, Waldir Neira Zalentein, Riitta Paakkanen, Annika Wennerstrom, Mikko Seppanen, Marjaliisa Lokki, Timo TervoAbstract:. Purpose: To evaluate the efficacy of keratectomy in treating irregular astigmatism caused by peripheral hypertrophic subepithelial Corneal Degeneration (PHSD) and to study the possible underlying immunological risk factors. Materials and methods: Patients (14 eyes) with diagnosed PHSD were treated with superficial keratectomy with or without the assistance of phototherapeutic keratectomy (VisX S4; VisX Inc., Santa Ana, CA, USA). Thirteen patients were subjected to analysis of human leucocyte antigen (HLA) genes, complement C4 gene numbers and total plasma immunoglobulin levels. Immunological risk factors between patients and a control group comprising 150 individuals were compared. Results: The mean preoperative best spectacle corrected visual acuity (BCVA) improved from 0.16 ± 0.22 (LogMAR scale range 0–0.7) to 0.06 ± 0.13 (−0.1–0.4) (p < 0.01). The mean preoperative astigmatism decreased significantly from 3.8 ± 2.1 D (range 1.2–8.2) to 2.1 ± 1.4 (range 0.6–5.0, p = 0.02) based on Corneal topography. The HLA-B*44 allele and the ancestral haplotype (AH) 8.1 were found significantly more often in PHSD patients than in controls (both p = 0.03). No differences in the C4 genes were found. Conclusions: Astigmatism secondary to PHSD can be effectively treated with keratectomy. Peeling of the fibrotic tissue reduced astigmatism and improved visual performance. We suggest that HLA-B*44 allele and AH 8.1 haplotype are immunological factors predisposing to the development of PHSD. The consequent disruption/alteration of the limbal barrier may lead to Corneal peripheral fibrous formation inducing astigmatism.
Stephen C Foster - One of the best experts on this subject based on the ideXlab platform.
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gas permeable scleral contact lens therapy in ocular surface disease
American Journal of Ophthalmology, 2000Co-Authors: Janis Cotter, Perry Rosenthal, Tatiana Romerorangel, Panagiota Stavrou, Stefanos Baltatzis, Stephen C FosterAbstract:Abstract PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease. METHODS: The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjogren syndrome, and inflammatory Corneal Degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active Corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the Corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting. CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.