Biomedical subjects

Yaniv Barkana

Publications and source records attributed to Yaniv Barkana.

At least 19 recordsLinked to original sources

PubMed2006

Comparison of different techniques of anterior chamber depth and keratometric measurements.

PURPOSE: To compare measurements of anterior chamber depth (ACD) and corneal curvature obtained with the Pentacam to other commonly used devices. DESIGN: Prospective, nonrandomized clinical trial. METHODS: Measurements of ACD and keratometry were prospectively obtained in 22 eyes of 11 subjects with the Pentacam compared with measurements of the ultrasound (US) A-scan and IOLMaster (ACD), and with those of automated keratometry (AK) and IOLMaster (keratometry) at the Assaf Harofeh Medical Center. RESULTS: The mean interdevice differences in keratometry for Pentacam vs AK, Pentacam vs IOLMaster, and AK vs IOLMaster were -0.046 diopters, -0.471 diopters, and -0.424 diopters, respectively. Measurements of keratometry by the IOLMaster differed statistically significantly from those of Pentacam (P < .01) and AK (P < .01). For measurement of keratometry, 95% limits of agreement were -1.321 to 1.229 diopters for the Pentacam and AK, -1.478 to 0.536 diopters for the Pentacam and IOLMaster, and -1.026 to 0.178 diopters for the AK and IOLMaster. The mean interdevice differences in ACD for the Pentacam vs US, Pentacam vs IOLMaster, and US vs IOLMaster were 0.103, 0.099, and -0.004 mm, respectively. Measurements of ACD by the Pentacam differed statistically significantly from those of US (P < .05) and IOLMaster (P < .01). For measurement of ACD, 95% limits of agreement were -0.197 to 0.404 mm for the Pentacam and US, -0.169 to 0.367 mm for the Pentacam and IOLMaster, and -0.332 to 0.324 mm for the US and IOLMaster. CONCLUSIONS: For some clinical applications, measurements of ACD and corneal curvature with the tested machines may differ greatly and therefore may not be interchangeable.

Anterior Chamber↗

PubMed2006

Angle closure in highly myopic eyes.

PURPOSE: Patients with angle-closure glaucoma and high myopia are uncommon. We evaluated the clinical characteristics of all patients with angle closure and high myopia in our database and propose possible mechanisms for angle closure in these atypical patients. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Our database of 17938 patients was searched for patients with myopia of spherical equivalent of more than -6.0 diopters and angle closure. Data recorded included age at time of initial consultation, gender, slit-lamp examination results, gonioscopy results, biometric parameters, ultrasound biomicroscopy results (from 1993 onward), clinical diagnosis, and therapy. RESULTS: Twenty patients (11 females, 9 males) were identified. Mean age at the time of consultation was 52.9+/-19.3 years. Angle-closure diagnoses included primary pupillary block (9 patients), pupillary block in an eye with keratoconus (1 patient), pupillary block secondary to a pupillary membrane associated with retinopathy of prematurity (1 patient), plateau iris configuration and syndrome (3 patients), phacomorphic glaucoma in Weill-Marchesani syndrome (2 patients), malignant glaucoma secondary to a scleral buckle (2 patients), miotic-induced angle closure (1 patient), and Marfan syndrome (1 patient). CONCLUSIONS: Angle closure can occur in eyes with high myopia. Causes of angle closure other than relative pupillary block are more common than in the general angle-closure glaucoma population. Careful gonioscopy accompanied by biometry and ultrasound biomicroscopy can lead to the correct diagnosis and individualized management in these eyes.

Adult↗

PubMed2006

Effect of eye testing order on automated perimetry results using the Swedish Interactive Threshold Algorithm standard 24-2.

OBJECTIVE: To evaluate whether the order of eye testing affects the mean deviation (MD) or the test reliability of visual field testing using the Swedish Interactive Threshold Algorithm (SITA) standard 24-2. METHODS: Consecutive patients with manifest or suspect glaucoma with 2 prior sets of SITA standard 24-2 test results performed on the right eye first were enrolled. A subsequent test was performed on the left eye first. For each eye, the MD and the test reliability indexes (> or = 20%) were compared among the 3 successive examinations. RESULTS: Forty-seven patients (29 women and 18 men; mean +/- SD age, 70.6 +/- 11.9 years) were enrolled. The MD +/- SD was -5.83 +/- 5.43 dB OD and -5.46 +/- 4.86 dB OS. There was no statistically significant difference in the MD or the test reliability among the 3 test results for either eye. Fixation loss was responsible for the unreliable fields in almost all cases. CONCLUSIONS: Among this cohort of patients experienced with automated perimetry in a glaucoma subspecialty practice, changing the order of eye testing using the SITA standard 24-2 did not have a significant effect on the MD or the test reliability. Intereye fatigue may not be clinically significant with this algorithm. Fixation loss remains a problem with the use of this algorithm.

Aged↗

PubMed2006

Clinical utility of intraocular pressure monitoring outside of normal office hours in patients with glaucoma.

OBJECTIVE: To determine whether intraocular pressure (IOP) monitoring outside of normal office hours adds clinically useful information. METHODS: We reviewed the records of all patients with glaucoma who were admitted for 24-hour IOP monitoring during 3 years. Applanation IOP was recorded in the sitting position from 7 am until midnight and in the supine position at 6 am. RESULTS: Thirty-two patients (22 women and 10 men) were enrolled (mean +/- SD age, 67.3 +/- 12.1 years). Mean +/- SD 24-hour IOP was 13.0 +/- 2.2 mm Hg. Mean +/- SD peak 24-hour IOP (16.8 +/- 3.2 mm Hg) was significantly higher than peak office IOP (14.7 +/- 3.2 mm Hg) (P<.001). Peak IOP was recorded outside of office hours in at least 1 eye in 22 patients (69%). Mean IOP fluctuation during 24-hour monitoring (6.9 +/- 2.9 mm Hg) was significantly greater than that during office hours (3.8 +/- 2.3 mm Hg) (P<.001). Peak 24-hour IOP was higher than the peak IOP noted during previous office visits in 40 eyes (62%). Results of 24-hour IOP monitoring led to immediate treatment change in 23 eyes (36%). CONCLUSIONS: In glaucoma patients with advanced disease or progression that are disproportionate to known IOP measurements, 24-hour monitoring of IOP may reveal a greater role for pressure-related risk for glaucoma progression than previously suspected and may alter treatment strategies.

Aged↗

PubMed2006

Measurements of optic disk size with HRT II, Stratus OCT, and funduscopy are not interchangeable.

PURPOSE: To assess the interchangeability of optic disk size measurements using slit-lamp funduscopy, optical coherence tomography (OCT-3), and confocal scanning laser ophthalmoscopy (HRT-II) in clinical practice. DESIGN: Prospective nonrandomized clinical study. METHODS: Measurements of vertical disk diameter (VDD) were obtained with the three methods. Disk area was obtained from OCT and HRT printouts. True agreement between methods in measuring VDD was assessed using Bland-Altman graphs and 95% limits of agreement (LoA). Disks were classified as small, average, or large, and agreement between methods in this classification was assessed using kappa statistics. RESULTS: Forty-eight patients were enrolled (mean age 53.4 +/- 14.3 years). VDD (mean +/- SD) was 1.58 +/- 0.15, 1.70 +/- 0.22, and 1.90 +/- 0.24 mm with funduscopy, HRT, and OCT, respectively. Very large LoA were observed: -0.29 to 0.70 mm for OCT and HRT, -0.07 to 0.71 mm for OCT and funduscopy, and -0.29 to 0.53 mm for HRT and funduscopy. There was poor agreement (kappa < 0.4) in classification of disk size as small, average, or large whether disk diameter or area was compared and using two definitions of disk size. CONCLUSIONS: We observed a large range of differences in estimating disk size with HRT, OCT, and funduscopy. This precludes interchangeable use of these measurements in clinical practice, and does not allow simple conversion formulas to be proposed. In addition, there is poor agreement between these methods in classifying disk size as small, average, or large. At present, estimation of both absolute and relative disk size can only be defined separately for each measurement modality.

Anthropometry↗

PubMed2006

Rehabilitation time after simultaneous bilateral photorefractive keratectomy for low to moderate myopia.

PURPOSE: To evaluate the visual acuity rehabilitation time after simultaneous bilateral photorefractive keratectomy (PRK) using a flying small spot laser. SETTING: Eye Tech Medical Laser, Tel Aviv, Israel. METHODS: In this prospective interventional nonrandomized clinical trial, 42 consecutive eyes (21 patients) with myopia ranging from -0.75 to -5.50 diopters (D) (mean -2.75 D +/- 1.18 [SD]) and astigmatism up to -2.75 D (mean -0.64 +/- 0.55 D) were treated with bilateral simultaneous PRK using the ESIRIS excimer laser (Schwind). Main outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction up to 12 weeks after surgery. Both eyes of each patient were examined at the same follow-up after initial treatment. RESULTS: Within 2 weeks and 1 month of the laser procedure, the UCVA was at least 20/40 in 1 eye in 85.7% of patients (18 patients) and 100% of patients (21 patients), respectively. After 2 weeks, UCVA was at least 20/20, 20/25, and 20/40 in 7.1%, 40.5%, and 80.9% of eyes. The final mean manifest spherical equivalent 12 weeks post laser treatment was -0.10 +/- 0.26 D, with a mean sphere of +0.02 +/- 0.22 D and a mean cylinder of -0.24 +/- 0.37 D. No eye had a BCVA loss during the follow-up. CONCLUSION: Simultaneous bilateral PRK using a flying small spot excimer laser for low to moderate myopia allowed most patients to return to most daily tasks in a couple of weeks without compromising safety.

Adult↗

PubMed2005

Ocular higher-order aberrations in myopia and skiascopic wavefront repeatability.

PURPOSE: To study the distribution of ocular higher-order aberrations (HOAs) in a myopic population and to assess the repeatability of HOA measurements determined by a commercially available skiascopic wavefront sensor. SETTING: Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel. METHODS: Ocular HOAs were examined 3 times across a 6.0 mm naturally dilated pupil in 61 eyes using the Optical Path Difference (OPD)-scan wavefront aberrometer. Root-mean-square (RMS) values of HOAs, total spherical aberration (TSA), total coma (TC), and total trefoil (TT) were analyzed. Correlation analysis was performed to assess the aberration symmetry between right and left eyes. The repeatability of the OPD-scan measurements was assessed by calculating Pearson r correlation coefficients between each pair of measurements and the interclass correlation coefficients between the 3 measurements of each score. RESULTS: The mean RMS values of HOAs, TSA, TC, and TT were 0.347 microm +/- 0.252 (SD), 0.120 +/- 0.174 microm, 0.165 +/- 0.168 microm, and 0.252 +/- 0.157 microm, respectively. The HOAs, TSA, TC, and TT changed slightly and not significantly with increasing refractive error (all P>.05). The RMS level of HOAs and TTR of the 3rd measurement was significantly different from the 1st and 2nd measurements (P<.05), with overall low correlation between the 3 measurements for the HOAs, TSA, TC, and TT. CONCLUSIONS: The ocular wavefront aberrations varied greatly from subject to subject. Ocular HOAs were not correlated with refractive error. The repeatability of HOAs measurements with the OPD-aberrometry was low.

Adolescent↗

PubMed2005

Central corneal thickness measurement with the Pentacam Scheimpflug system, optical low-coherence reflectometry pachymeter, and ultrasound pachymetry.

PURPOSE: To assess the intraoperator repeatability and interoperator reproducibility of central corneal thickness measurements by the Pentacam Scheimpflug imaging system (Oculus) and the optical low-coherence reflectometer (OLCR) pachymeter (Haag-Streit) and to compare them with those of ultrasound (US) pachymetry. SETTING: Assaf Harofe Medical Center Ophthalmology Outpatient Clinic, Zerifin, Israel. METHODS: Repeatability was determined from 10 successive measurements in each of 4 healthy patients. Reproducibility for the Pentacam Scheimpflug system was determined from measurements by 2 operators in each of 24 patients; in these 24 patients, central corneal thickness measurements were compared between the Pentacam and US pachymetry. For the OLCR pachymeter, reproducibility was determined from measurements by 2 operators in each of 16 patients, in whom central corneal thickness was also measured with the Pentacam. RESULTS: Mean coefficient of repeatability was 0.84% for the Pentacam Scheimpflug system and 0.33% for the OLCR pachymeter. For the Pentacam, the coefficient of interoperator reproducibility was 1.10% and the 95% limits of agreement were -10.2 microm to +11.9 microm. Mean difference between Pentacam and US was 6.09 microm. For the OLCR pachymeter, the coefficient of interoperator reproducibility was 0.59% and the 95% limits of agreement were -5.4 microm to +7.0 microm. Mean difference between central corneal thickness values obtained with the OLCR pachymeter and Pentacam Scheimpflug system was 1.7 microm. CONCLUSIONS: Objective, noncontact measurement of central corneal thickness with the Pentacam Scheimpflug system and OLCR pachymeter was convenient and yielded excellent intraoperator repeatability and interoperator reproducibility. Central corneal thickness values obtained with the Pentacam were similar to those obtained with both the OLCR pachymeter and an US pachymeter. Further research is needed to corroborate whether central corneal thickness measurements by the Pentacam and OLCR devices can be used interchangeably and are more clinically useful than US pachymetry.

Biometry↗

PubMed2005

Penetrating keratoplasty for keratoconus: long-term results.

PURPOSE: To study central corneal endothelial cell density and morphology and corneal topography in transplanted corneas for keratoconus 10 to 17 years postoperatively. METHODS: Retrospective, noncomparative case series including all keratoconus patients who underwent penetrating keratoplasty by one surgeon, at the same center, between January 1986 and December 1994. Seventeen patients (22 eyes) met the criteria. Four patients (5 eyes) with unchanged visual acuity during the follow-up period did not agree to return for the last follow-up examination, 1 patient (1 eye) had graft failure, and 3 patients (4 eyes) were lost to follow-up. We reviewed the charts of 9 patients (12 eyes), and collected data including manifest refraction, best corrected visual acuity (BCVA), endothelial cell density, cell morphology, and corneal topography. RESULTS: The mean follow-up period for all eyes evaluated was 13.3 +/- 2.4 years (range 10-17 years). At the last follow-up, 91.7% of eyes achieved BCVA of 20/40 or better, and mean endothelial cell density was 695 +/- 113.6 cells/mm(2). Pleomorphism was detected in 5 eyes. Keratoconus pattern, by corneal topography, was not detected in any eye at the final examination. CONCLUSION: Endothelial cell count 10-17 years post-PKP for keratoconus is very low with pleomorphism and viable grafts, indicating continued endothelial instability.

Adolescent↗

PubMed2005

Reduction of conjunctival bacterial flora by povidone-iodine, ofloxacin and chlorhexidine in an outpatient setting.

PURPOSE: To compare the reduction of conjunctival bacterial flora by povidone-iodine 4%, ofloxacin 0.3%, and chlorhexidine 0.05% for endophthalmitis prophylaxis before corneal suture removal in an outpatient setting. METHODS: In each group of 25 consecutive subjects who presented for outpatient ophthalmic evaluation, one eye was treated with either povidone-iodine 4% (PI), ofloxacin 0.3% (Oflox) or chlorhexidine 0.05% (Chex). The other eye served as a control. Three minutes after treatment, cultures were taken from the inferior conjunctival sac in both eyes. Following incubation at 35 degrees for 48 hours, the numbers of colonies were counted and compared. The difference in the numbers of colonies in each pair of treated and control eyes was assessed for each drug and compared. RESULTS: The reduction in colony-forming units was highly significant for each of the three drugs tested (Wilcoxon signed-ranks test; p < 0.0001). There was no significant difference between percent reduction by the three drugs (Kruskal-Wallis test; p = 0.68). Sterile cultures following preparation by PI, Oflox and Chex were obtained in 52%, 68% and 52%, respectively. CONCLUSIONS: The regimens tested were similarly effective in reducing conjunctival commensals. They may all be considered as options for a quick prophylaxis against infection following suture removal in an outpatient setting.

Anti-Infective Agents, Local↗

PubMed2005

The effect of cataract surgery on postural control.

PURPOSE: Falls are a significant cause of morbidity in the elderly. Because decreased vision is known to be a significant risk factor for falling in this age group, we sought to examine the effect of the removal of cataract, a major cause of visual handicap, on postural stability. METHODS: Postural stability was measured in 23 patients who underwent cataract surgery, before and 1 to 4 months after surgery. Stability indices included Stability Effect, Fourier Spectrum of Postural Sway, and Synchronizations, and, based on these measurements, Falling Index, which had been shown in earlier studies to predict the risk of falling. RESULTS: Visual acuity in the surgical eye significantly improved in all patients after surgery (P < 0.01) and did not change in the fellow eye. Stability improved in most patients (19/23) and Fourier Spectrum of Postural Sway improved in the high-frequency bands (above 0.5 Hz), when viewing with the surgical eye, but not when viewing with the nonsurgical eye (P < 0.05). By Falling Index, before surgery, 12 of 23 patients were at high risk of falling, and only six were at low risk. After surgery, 16 of 23 were at low risk and only three remained at high risk (chi(2) test, P < 0.008). CONCLUSIONS: Cataract surgery significantly improves postural stability. Considering the high cost of treating fall-related injuries in the elderly, the findings may imply that cataract surgery is cost effective in this regard.

Accidental Falls↗

PubMed2004

Neuroprotection in ophthalmology: a review.

Evidence has accumulated that damaged neural cells may not inevitably degenerate, and that in vivo cells which are not directly injured by an insult may be adversely affected by adjacent dying cells. Neuroprotection is a strategy which aims to maximize recovery of injured neural cells and minimize secondary damage to neighboring cells. In this work, we review the current knowledge from neuroprotection research using in vitro and animal models of eye diseases, and clinical data.

Animals↗

PubMed2004

Visual field attention is reduced by concomitant hands-free conversation on a cellular telephone.

PURPOSE: To quantify the central attention-diverting effect of hands-free cellular phone conversation on visual field awareness. DESIGN: Experimental study. METHODS: Twenty male and 21 female healthy participants performed a pretest and baseline Esterman visual field examinations with the Humphrey Systems Visual Field Analyzer II. During the consequent third examination, each participant engaged in a hands-free conversation using a cellular phone. The conversation was the same for all participants. Visual field performance parameters were compared between the second (baseline) examination, and the third (test) examination for each eye. RESULTS: During phone conversation, missed points increased from mean 1.0 +/- 1.5 to 2.6 +/- 3.4 (P < or =.001) in the right eye and from 1.1 +/- 1.53 to 3.0 +/- 3.4 (P <.001) in the left eye. Fixation loss increased from mean 7.8% to 27.4% (P <.0001) and from 7.2% to 34.8% (P <.0001) for the right and left eyes, respectively. Test duration increased by a mean of 0.28 seconds (15%) per stimulus (P <.0001). Approximately half of missed points were inside the central 30 degrees. There was no significant difference in the performance of male and female participants. CONCLUSION: We describe a new model for the quantification of the attention-diverting effect of cellular-phone conversation on the visual field. In the current study, cellular hands-free conversation caused some subjects to miss significantly more points, react slower to each stimulus, and perform with reduced precision. Legislative restrictions on concomitant cellular-phone conversation and driving may need to be based on individual performance rather than a general ban on cellular phone usage.

Adult↗

PubMed2004

Fundus anomalies: what the pediatrician's eye can't see.

BACKGROUND: With increasing workloads for hospital doctors, routine funduscopy may be abandoned. It is not known how often pediatricians perform funduscopy and how skilled they are in performing it. OBJECTIVE: To assess hospital pediatricians' ability to diagnose abnormalities of the ocular fundi and to determine whether a short tutorial can improve their skills. METHODS: Physicians working at the pediatric division of a university-affiliated hospital participated in the study. All participants completed an anonymous questionnaire regarding their experience and skills in performing funduscopy. A pictorial quiz containing 20 fundus pictures of common findings in children was given. After completing the quiz, a 45-minute tutorial on common fundus anomalies was given. At the end of the lecture, the same quiz was given again. The percentage of correct answers for each quiz was scored. RESULTS: Sixteen physicians completed the study (11 pediatric residents and five senior pediatricians). Most participants did not feel competent at performing a fundus examination [mean score on a visual analog scale 1.96; range 0 (not competent at all) to 7]. The mean score for the fundus pictures quiz given before the tutorial was 48% (range 37-58%). The average score of the residents (47%) did not differ significantly from that of the senior pediatricians (42%). After the tutorial the mean grade increased significantly to 60% (P = 0.002). This was true both for residents (63%; P = 0.001) and seniors (55%; P = 0.004). CONCLUSIONS: Our study shows that funduscopy is being neglected by pediatricians. Even a short tutorial may significantly improve the diagnostic value of this test.

Child↗

PubMed2004

Chronic intracranial hypertension with unexplained cerebrospinal fluid pleocytosis.

In a retrospective review of all cases with a diagnosis of idiopathic intracranial hypertension in two academic departments of neurology over a nine-year period, the authors identified six patients with a clinical course typical of idiopathic intracranial hypertension (IIH) except for the finding of cerebrospinal fluid pleocytosis. There were five women and one man with a mean age at presentation of 25.7 years (range, 25-32 yr). All were obese but had no other associated medical conditions or identifiable risk factors for IIH. In five patients, all or most cerebrospinal fluid cells were lymphocytes. Cerebrospinal fluid pleocytosis persisted for several months in all patients. Patients underwent a thorough laboratory and neuroimaging evaluation that did not reveal a primary cause. Medical treatment directed solely at lowering intracranial pressure was effective in five patients; one patient required lumboperitoneal shunting. Ophthalmic manifestations of increased intracranial pressure stabilized or remitted after treatment was withdrawn with a mean follow-up period of 33 months (range, 14-55 mo). Some patients may present with idiopathic chronic meningitis and elevated intracranial pressure that responds to treatment used for IIH.

Acetazolamide↗

PubMed2003

Prediction of visual outcome after penetrating keratoplasty for pseudophakic corneal edema.

OBJECTIVE: To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic corneal edema (PCE) or aphakic corneal edema (ACE) based on preoperative parameters available from the patient history and ocular examination. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-eight patients who underwent 59 PKP procedures for PCE between 1997 and 2000 by two cornea specialists. METHODS: Medical records were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. Variables included age, gender, presence of diabetes or cardiovascular disease, method of intraocular lens (IOL) implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery, and maximal visual acuity reached after cataract surgery. The predictive value of each preoperative variable on post-PKP visual outcome was assessed using both univariate and multiple regression analyses. MAIN OUTCOME MEASURES: Statistical significance for the predictive value of each preoperative variable on post-PKP visual outcome. RESULTS: Best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). The strongest predictor of this outcome was implantation of a bag-fixated or sulcus-fixated IOL at the time of cataract surgery (P = 0.007; odds ratio, 15.8; 95% confidence interval, 1.2-208). Less significant variables included BCVA after cataract surgery, time between cataract surgery and PKP, and gender. CONCLUSIONS: In planning and advising patients with pseudophakic or aphakic corneal edema who are candidates for PKP, the method of IOL implantation during the cataract surgery is the single most significant predictor of visual acuity after corneal transplantation. Bag-fixated or sulcus-fixated posterior chamber IOL was associated with a better visual outcome than anterior chamber IOL, scleral-fixated posterior chamber IOL, or aphakia.

Aged↗

PubMed2003

Methotrexate as a first-line corticosteroid-sparing therapy in a cohort of uveitis and scleritis.

PURPOSE: To evaluate the clinical experience with methotrexate as a first-line corticosteroid-sparing drug in patients with resistant ocular inflammation. METHODS: We retrospectively studied 39 consecutive patients with uveitis (n = 36) or scleritis (n = 3) who were treated with methotrexate following inadequate control with corticosteroids lasting five years. Criteria for initiating treatment with methotrexate and defining outcome were strictly defined. RESULTS: The cohort included 21 females and 18 males, all Caucasians, with a mean age of 26.6 years (range: 3-73 years). Patients were followed up for 21.5 +/- 12.6 months. Treatment was discontinued due to side effects in 10 patients (26%). Of the remaining 29 patients, full or partial control of inflammation was achieved in 23 (79%). Response to treatment was observed after a mean of 2.4 +/- 0.8 months. Ten patients were fully controlled and discontinued methotrexate therapy after a mean of 20.9 +/- 9.2 months, with no recurrence of inflammation. Use of topical and systemic corticosteroids was markedly reduced in responsive patients. CONCLUSIONS: Methotrexate is recommended as a first-line adjunct to or replacement of systemic corticosteroids in the treatment of ocular inflammation.

Adolescent↗

PubMed2003

Scleral contact lenses may help where other modalities fail.

PURPOSE: To describe the vision-correcting and therapeutic benefits of gas-permeable scleral contact lenses (GP-ScCL) in the management of irregular corneal surface disorders and ocular surface diseases. METHODS: The charts of 48 consecutive patients (66 eyes) whose management included the use of GP-ScCL were reviewed. RESULTS: The most common indication for fitting the lenses was keratoconus in patients who had to stop wearing other types of corneal lenses (44 eyes, 74.6%). Other indications included extreme corneal irregularity after penetrating keratoplasty, nonhealing corneal ulcer, postoperative dry eye syndrome following laser in situ keratomileusis (LASIK), severe exposure keratitis and acid burn. Mean follow-up was 17 months (range, 2-96). Mean wearing time of the GP-ScCL was 16.2 hours per day (range, 3-18). Visual acuity of 20/40 or better was achieved in 90.9% of keratoconus patients and in 81.8% of postkeratoplasty patients. A gain of two or more Snellen lines was observed in 94.5% of eyes treated for improving vision. Marked subjective improvement in quality of life was reported by 86% of the patients, mainly as a result of improvement in their visual function and reduction in discomfort. Five patients (seven eyes) failed to wear GP-ScCL. CONCLUSION: GP-ScCL can provide successful and safe visual and therapeutic solutions for ocular conditions when conventional contact lenses and medical treatment have failed and where surgery is undesirable or contraindicated.

Adolescent↗