Ocular prostheses and contact lenses. I--Cosmetic devices.
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Conjunctivitis↗
Biomedical subjects
R J Buckley
Publications and source records attributed to R J Buckley.
Clinical features of atopic keratoconjunctivitis.
The clinical spectrum of ocular disease in 37 patients with atopic keratoconjunctivitis (AKC) is described. Patients typically had a severe blepharoconjunctivitis. Associated corneal scarring, suppurative keratitis, or keratoconus were the major causes of visual loss. Serum and tear samples from these patients were analyzed to quantify total and specific IgE antibodies. The results were compared as a case control study with results from samples from 55 patients with other forms of atopic disease and 16 nonatopic volunteers. Although the mean values for total and specific IgEs in the serum of patients with atopic disease were markedly higher than the values from nonatopic controls (P less than 0.00002), a difference between the disease groups could not be demonstrated (P greater than 0.05). There were also differences between both the total IgE (P = 0.0002) and pollen-specific IgE (P = 0.015) in tears from patients with atopic disease and nonatopic controls, but not for house dust mite or cat dander-specific IgEs. These results suggest that clinical differences between groups of patients with chronic allergic external eye disease are not associated with specific patterns of IgE production.
Adolescent↗
Diffractive bifocal contact lenses in aphakia and pseudophakia. A pilot study.
Diffractive bifocal contact lenses function by diverting incident light to two focal points. Light from near objects is focused by diffraction while that from distant objects is focused by conventional refraction. Both processes occur simultaneously throughout the full aperture of the lens. Fourteen aphakic and pseudophakic contact lens wearers were fitted with diffractive bifocal lenses and observed for an eight week period. Six (42.8%) were satisfied with the visual result. Five subjects (35.7%) discontinued lens wear complaining of poor quality of near vision. We conclude that these lenses may help selected aphakic patients to discard their reading glasses but the low acceptance rate suggests that this type of optic is probably not suitable for implantation as an intraocular lens.
Accommodation, Ocular↗
Distinguishing features of the iridocorneal endothelial syndrome and posterior polymorphous dystrophy: value of endothelial specular microscopy.
The literature suggests that posterior polymorphous dystrophy (PPD) may show features such as iridocorneal adhesions, glassy membranes, and pupillary ectropion which are typically ascribed to the iridocorneal endothelial (ICE) syndrome. This complicates diagnosis. PPD, unlike ICE, is familial, and ICE, unlike PPD, is usually progressive and frequently complicated by glaucoma: thus it is important to distinguish between them. To determine whether this could be achieved by specular microscopy, since the posterior corneal surface is abnormal in both conditions, 57 cases of ICE and 44 of PPD were repeatedly examined and photographed with the specular microscope. Progressive and/or static morphological features of the corneal endothelium and Descemet's membrane were found that were specific for each condition. Specular microscopy can thus provide a definitive diagnosis of ICE or PPD even in uncertain cases.
Corneal Diseases↗
Surgery to improve contact lens wear 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 that gives rise to contact lens related abrasions. These nebulae do not flatten when contact lens wear is discontinued. We describe a simple technique of superficial keratectomy to remove proud nebulae in which the resulting defect healed quickly under a therapeutic hydrogel lens. In all of the six cases described patients were able to resume contact lens wear within one month of the procedure. One case was lost to follow-up. Of the remaining five (follow-up 3-9 months), all achieved comfortable wearing times of 8 hours or more and visual acuities of 20/40 or better. One patient developed a recurrent epithelial defect that resolved on discontinuing lens wear for one week. Corneal transplantation was thus avoided.
Contact Lenses↗
Electric arcing and contact lenses.
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Burns, Electric↗
Sclerokeratitis after keratoplasty in atopy.
The authors report a series of five markedly atopic patients in whom a severe sclerokeratitis developed within 1 to 4 weeks of keratoplasty. The onset was acute with discomfort, photophobia, hyperemia, and mucus production. This resulted in early loosening of sutures and was associated with microbial keratitis in two cases and graft rejection in one. The inflammatory reaction was controlled with high-dose oral steroids and did not recur when the treatment was terminated. Serum IgE levels were elevated in all these patients (range, 421-8434 kU/l). Binding of this IgE onto the surface of mast cells in the conjunctiva with subsequent degranulation may be involved in the pathogenesis of the induced inflammation. Principal recommendations include the use of interrupted sutures and early immunosuppression with high-dose oral steroids at the onset of this condition together with the control of risk factors for microbial keratitis.
Adolescent↗
Post keratoplasty dimensional and refractive change in contact lens and spectacle corrected cases.
Two groups of patients who had corneal transplantations for keratoconus were analysed retrospectively. One group had been visually corrected with corneal contact lenses and the second group had worn spectacles or used no optical correction. The reduction in post graft corneal astigmatism with time following removal of sutures was examined by the method of regression in groups. The results showed that the reduction in corneal astigmatism was significantly greater in the contact lens wearing group.
Astigmatism↗
Development of the gas-permeable impression-moulded scleral contact lens. A preliminary report.
Although superceded by corneal hard and soft contact lenses for the correction of simple refractive error, the scleral lens still has numerous medical applications in modern ophthalmological practice. However, a major problem with scleral lenses has been the limited wearing time due to corneal occlusion and consequent hypoxia. We present two alternative methods for the production of moulded gas permeable scleral contact lenses.
Contact Lenses↗
Intrascleral neurilemmoma.
The case of an anteriorly situated, intrascleral, neurilemmoma in an 11-year-old girl is reported. Only two similar cases have been described in the literature, and the diagnosis was made only after detailed histological examination, including electron microscopy and specialised staining techniques, to differentiate a neurilemmoma (schwannoma) from a neurofibroma.
Child↗
Prospects for contact lens wear in aphakia.
The success rate and complications for contact lens wear in 366 aphakic patients were evaluated retrospectively over a mean follow-up period of 36 months. Successful use of a daily wear contact lens (DWCL) was related to lens handling ability. In unilateral aphakia it was 86 per cent (161/187) for patients under 70 years old but only 27 per cent (19/70) for those over 70 years (p = less than 0.0001). This age related difference did not occur either for the use of a second lens, following successful use of a lens after the first cataract extraction, for which the overall success rate was 89 per cent (55/62) or for simultaneous bilateral lens fitting, which had a success rate of 81 per cent (38/47). Extended wear soft contact lenses (EWSCL) were fitted to patients unable to use DWCLs but only half were successful (21/40). There was no difference in the incidence of complications between daily wear soft and daily wear hard contact lenses or young (up to 44 years), middle aged (45-69 years) and elderly (over 70 years) patients, for the use of all DWCLs. However the risk of a serious complication was six times greater for patients using EWSCL (55 per cent) compared with those using DWCLs (8.8 per cent). DWCLs are a safe and successful method of aphakia correction for patients under 70 years of age. Once the ability to handle a DWCL has been learned, success is maintained when the second eye is fitted. EWSCLs have a high complication rate and a low success rate in patients unable to use DWCLs; other methods of aphakia correction should be considered first in this group.
Adult↗
Vernal keratoconjunctivitis.
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Conjunctivitis, Allergic↗
Congenital neutropenia and low serum immunoglobulin A: description and investigation of a large kindred.
A kindred is described in which neutropenia and low serum immunoglobulin A levels has occurred. The affected members have variable clinical courses which do not appear to relate to the degree of neutropenia. The bone marrows show a maturation delay in granulocyte production, with increased numbers of lymphocytes. In vitro cultures of the bone marrows failed to produce granulocyte colonies. Studies of peripheral blood and bone marrow lymphocyte subpopulations give inconsistent results, although a general increase in T suppressor lymphocytes compared with T helper lymphocytes emerges. A therapeutic trial of corticosteroid and then of lithium carbonate was without effect on one of the patients. The pathogenetic basis for this probably X-linked disorder remains unclear.
Adolescent↗
Pathology and treatment of giant papillary conjunctivitis. II. The British perspective.
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Conjunctivitis, Allergic↗
Spoiled soft contact lenses.
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Benzalkonium Compounds↗
Extended wear hydrogel and daily wear hard contact lenses for aphakia. Success and complications compared in a longitudinal study.
The success and complications of extended wear hydrogel (EWSCL) and daily wear hard contact lens (DWHCL) correction for aphakia were evaluated retrospectively in two comparable groups of unilaterally aphakic patients (64 with EWSCL, 86 with DWHCL). At the end of the follow-up period, 55% of patients in each group were still using contact lenses. Suppurative keratitis occurred in two (3%) patients using EWSCL and none with DWHCL. The relative risk to all patients of a complication developing severe enough to result in a loss of wearing time was 9.8 times higher for the EWSCL users compared with the DWHCL group; this risk increased to 11.4 times for the patients still using lenses at the end of the follow-up period. The EWSCL patients had 1.9 times more visits for routine care and 5 times more unplanned visits to deal with complications than the DWHCL patients.
Aged↗
A cost-effectiveness comparison of the intraocular lens and the contact lens in aphakia.
There is currently interest in the effectiveness and cost of the intraocular lens as compared with other methods of correcting aphakia following cataract extraction. We have undertaken a retrospective review of patients undergoing cataract surgery by the extracapsular method at Moorfields Eye Hospital during the period January 1982 to July 1983. From the total population we selected at random two groups of patients, having their aphakia corrected either by means of a contact lens or an intraocular implant. Patients under the age of 60 years and those with complicating illnesses were excluded from the study. Using case notes, we followed the sample patients from the time of referral until one year after the operation, and recorded a number of clinical and economic variables such as waiting time for operation, length of inpatient stay, incidence of per- and post-operative complications, number of follow-up visits, final visual acuity and (for the contact lens patients) waiting time for lens issue and average daily wearing time. We found that the visual acuities obtained, and the total costs to society, were similar for the two groups.
Aged↗
Perennial allergic conjunctivitis: definition, clinical characteristics and prevalence. A comparison with seasonal allergic conjunctivitis.
Perennial allergic conjunctivitis (PAC) is a perennial form of seasonal allergic (hay fever) conjunctivitis (SAC). Fourteen subjects with PAC were compared with 25 subjects with SAC. All patients met the same criteria for the diagnosis of a Type 1 ocular allergy. In a study of ophthalmic morbidity at an inner city health centre during the summer months the 3-month period prevalence of PAC was 3.5:10,000. In PAC symptoms are present throughout the year although seasonal exacerbations occurred in 79 per cent. Many similarities were found with SAC. PAC showed the same age range, length of history and symptoms as SAC although SAC was more severe. In both, conjunctival cytology showed eosinophils (PAC 43 per cent; SAC 25 per cent) and total IgE levels were raised in the tears (PAC 100 per cent; SAC 96 per cent) and serum (PAC 79 per cent; SAC 78 per cent). However, PAC differed from SAC in several respects: a history of exacerbation on exposure to house dust (PAC 42 per cent; SAC none) and an association with perennial rhinitis (PAC 75 per cent; SAC 12 per cent) were more common in PAC. The largest response on skin prick testing to a panel of antigens was to house dust mite (Dermatophagoides pteronyssinus) and this was more frequent in PAC (PAC 71 per cent; SAC 4 per cent). Dust mite antigen specific IgE was present in the tears of 78 per cent of cases of PAC, in higher levels than in serum indicating local production of IgE, whereas in SAC there were no detectable levels in any of the tears tested.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗