Rigid Gas Permeable Contact Research Articles

Factors Affecting Long-Term Compliance with Rigid Gas-Permeable Contact Lens Wear in Patients with Keratoconus.

The purpose of the study was to investigate the factors affecting long-term compliance with rigid gas-permeable contact lens (RGPCL) wear in patients with keratoconus (KC). A total of 189 patients with KC (374 eyes) were included in the study, and were divided into two groups: the compliant group and the non-compliant group. Corneal topographic measurements, refractive results, and RGPCL parameters were compared between the two groups. A vision-related quality of life questionnaire was completed by all of the patients. The results demonstrated that patients diagnosed with bilateral KC were more compliant with RGPCL wear than patients diagnosed with unilateral KC (p = 0.0167). There were no significant differences between the compliant and non-compliant groups in terms of their corneal topographic measurements, refractive results, RGPCL parameters, or corneal cross-linking surgery history (all p > 0.05). In contrast, KC patients’ subjective experience with RGPCL wear—including visual acuity (p = 0.006), overall satisfaction (p < 0.001), quality of life (p < 0.001), and good adaptation during the short-term (p < 0.001)—had a significant effect on the long-term compliance with RGPCL wear. In conclusion, patients’ subjective experiences, rather than their ocular biometrics, significantly influence their long-term compliance with RGPCL wear.

Clinical evaluation of flat peripheral curve design with aspherical-curve and multi-curve hard contact lenses for keratoconus.

Aspherical- and multi-curve rigid gas-permeable hard contact lenses (HCLs) have a flattened curve in the peripheral zone and are mostly used for patients with keratoconus who cannot wear glasses, soft contact lenses, or spherical HCLs. In this retrospective study, a total of 95 eyes of 77 patients who used aspherical- or multi-curve HCLs (mean age: 40.0 ± 11.0 years) were evaluated. This study examined the types of aspherical- and multi-curve HCLs, best-corrected visual acuity (BCVA) values before and after wearing HCLs, the association with the Amsler-Krumeich classification, duration of wear, corneal/conjunctival disorder, and the frequency of changing HCLs. There were 78 eyes that used aspherical-curve HCLs and 17 that used multi-curve HCLs. BCVA significantly improved from 0.42 logMAR to 0.06 logMAR after wearing either form of HCL. The Amsler-Krumeich classification showed that aspherical-curve HCLs were commonly used for patients with stage 2 keratoconus, and multi-curve HCLs were commonly used for stage 4 patients. The BCVA values were worse when the disease stage was more severe (stages 3 and 4) regardless of HCL type. The mean base curve of the lenses was steeper in multi-curve HCLs than in aspherical-curve HCLs. The more severe the disease stage, the steeper the base curve in both aspherical- and multi-curve HCLs. The duration of wear significantly improved from 2.1 h to 10.2 h, and corneal/conjunctival disorder similarly improved. The mean frequency of changing HCL types was 1.1 times. This study suggests that a flat peripheral curve design with aspherical- and multi-curve HCLs is useful for patients with keratoconus.

Evaluation of Antimicrobial Efficacy of Two Hydrogen Peroxide Systems against Bacteria, Yeast, Mold and Acanthamoeba with Rigid Gas Permeable Lenses

Purpose: To evaluate the antimicrobial efficacy of two hydrogen peroxide systems for cleaning and disinfecting rigid gas permeable (RGP) contact lenses. Both systems are preservative-free, phosphate buffered, 3.0% hydrogen peroxide formulations, containing a surfactant, and one formulation has additionally advanced wetting agent properties. Hydrogen peroxide lens care systems require a case with platinum disc to neutralize the hydrogen peroxide during disinfection.

Bilateral corneal opacities and surface irregularity: role of contact lenses in a case of paraproteinemic keratopathy and multiple myeloma

Introduction: This report features an interdisciplinary approach to diagnose and manage a case of paraproteinemic keratopathy and multiple myeloma. In addition, it suggests that rigid gas-permeable contact lenses (RGP CLs) may be a viable alternative to corneal surgery to reduce visual symptoms. Patient and clinical findings: A 57-year-old man symptomatic for progressive blur and glare over 2 years presented with an outside diagnosis of corneal dystrophy. An examination revealed bilateral diffuse subepithelial corneal crystals in conjunction with peripheral annular deposits with demarcated ridges. Corneal topography revealed central irregular astigmatism induced by these peripheral corneal opacities. Diagnosis, intervention, and outcomes: A hematological workup confirmed IgG Kappa monoclonal gammopathy and multiple myeloma. Visual rehabilitation for paraproteinemic keratopathy was achieved with RGP CLs, which are expected to maintain stable visual acuity while the patient undergoes systemic chemotherapy. Conclusions: This report emphasizes the value of thoroughly investigating dystrophy-like corneal deposits of unknown etiology as monoclonal gammopathy can have adverse or even fatal systemic implications. To the authors’ knowledge, this is the first study to directly suggest RGP CL as an adaptable and economical means to improve acuity in certain cases of paraproteinemic keratopathy without resorting to surgical intervention.

Study of Myopia Correction Using Nanoporous Polymer Gas Permeable Contact Lenses

Ophthalmic treatments using contact lenses are now used by more and more specialists around the world. Improving contact lens (CL) materials is a condition that is constantly evolving. Contact lens materials are usually composed of polymer hydrogel or silicone hydrogel. The materials used for night contact lenses are gas permeable and they gradual flatten the center of the cornea which decreases the progression of myopia or myopic astigmatism. The aim of this study is to identify, in correlation with the chemical interactions between structural components of contact lenses and their biocompatibility with the surface layer and microtopography of the cornea or sclera, different incidents that occur in patients who have used rigid gas permeable contact lenses. The study was performed on a group of 10 patients who had a follow-up period between 4 and 6 years, who presented regularly for eye examinations. The following clinical parameters were analyzed: ocular refraction before and after wearing night contact lenses, types of contact lens materials, appearance of corneal topography, biomicroscopic examination of the anterior segment of the eye, keratometry, ocular comfort, as well as other incidents regarding this type of lenses. Difficulties caused by wearing contact lenses at night arose due to poor hygiene and maintenance in two cases or due to interruption of lens wear in one case.

Синдром «сухого глаза» при кератоконусе: аспекты этиологии и медикаментозной коррекции

This paper reviews published data on the studies on keratoconus associated with dry eye disease (DED) presentations. Despite the lack of a direct correlation between DED and keratoconus, many studies have demonstrated that keratoconus is associated with DED in more than 80% of cases. The author describes major endogenous and exogenous (inflammatory, immune/allergic, mechanical, neuropathic) factors triggering the development and association of these conditions. Approaches to the medical treatment of disorders resulting from the association of these entities are discussed. The primary management strategy implies tear film and ocular surface protection with tear substitutes based on the sodium salt of hyaluronic acid. In the lack of the effect of tear substitutes or in rigid gas permeable contact lens wearers, gel-based dexpanthenol in high concentrations is recommended. This treatment significantly increases drug bioavailability and prolongs the ocular surface reparation. Scleral contact lenses ensuring intact corneal epithelium and high visual acuity in irregular astigmatism caused by keratoconus are also used for corneal protection and DED therapy. Keywords: keratoconus, keratectasia, dry eye disease, epitheliopathy, tear film. For citation: Averich V.V. Dry eye disease in keratoconus: etiology and medical treatment. Russian Journal of Clinical Ophthalmology. 2022;22(2):122–126 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-122-126.

LENS CARE COMPLIANCE RATES AND PERCEPTIONS AMONG RIGID GAS PERMEABLE CONTACT LENS WEARERS - A PILOT STUDY.

The aim was to estimate compliance rate among rigid gas permeable lens wearers (RGPLW) in lens system care, identify procedures in lens care process with poorest compliance levels, and assess concordance between participant reported practices and their subjectively perceived compliance. The study included outpatient RGPLW managed at Zagreb University Hospital Center in Zagreb, Croatia. They filled out a questionnaire that included demographic data, duration of lens wear, self-evaluation compliance grade, and 14 lens care procedures and wearing habits indicative of compliance. There were 50 patients (mean age 34.6 years, 68% female). Full compliance was found in a single patient. The mean number of non-compliant procedures was 5.48, with 32% of participants non-compliant in more than 50% of the compliance criteria. Critical procedures of the lens care process were infrequent lens case exchange (74%), using tap water for lens (70%), and improper case cleaning (68%). The mean lens case replacement time was 9.8 months (SD 6.76), with only 26% of patients replacing lens case at least once in 3 months. Excessive daily lens wear was associated with greater total number of non-compliant procedures (p<0.0008). RGPLW were aware of their inappropriate lens care only when achieved non-compliance in almost 50% of the procedures. In conclusion, lens wearers were not aware of their extremely low compliance rate in several aspects of lens and lens case maintenance. Study results indicated the key procedures the practitioners should focus on when evaluating subjective and objective compliance and reinforcing care and hygiene education of RGPLW.

Toric Lenticule Implantation for Correction of Traumatic Hyperopia and Astigmatism

PURPOSE: To describe the preliminary corrective results of treating hyperopia and hyperopic astigmatism with toric lenticule implantation. METHODS: A 23-year-old man presented with corneal scars and aphakia in the right eye. Manifest refraction was +10.00 −1.25 × 165° and plano in the right and left eyes, respectively. Owing to the patient's rigid gas permeable contact lens intolerance and other factors, an allogenic toric lenticule from a donor eye with a refractive power of −8.50 −1.25 × 5° was implanted. The lenticule (refraction = +9.75 −1.25 × 95°) was transferred onto the exposed stromal bed of the recipient's eye and aligned to the marking axis (refraction = +9.75 −1.25 × 165°). The correction index was calculated using the online Alpins Statistical System for Ophthalmic Refractive Surgery Techniques vector calculator. RESULTS: At 6 months postoperatively, refraction of the right eye was +3.00 −0.25 × 160°. Anterior corneal surface curvature and astigmatism changed from 42.90 diopters, 2.30 @ 48.00 to 49.10 diopters, 1.50 @ 90.00. Optical coherence tomography showed smooth attachment of the lenticule to the stromal layer with visible boundaries. CONCLUSIONS: Toric lenticule implantation was beneficial in treating traumatic hyperopia and hyperopic astigmatism. Further studies are required to assess the effectiveness of this technique. [ Journal of Refractive Surgery Case Reports . 2022;2(1):e1–e5.]

Effects of rigid high gas-permeable contact lens wear on progression in patient with keratoconus

Wearing Rigid High Gas-Permeable Contact Lens (RGPCL) is a primary method of vision rehabilitation in keratoconus eyes. The aim of the study is to investigate the effects of using RGPCL on the topographical variations at the keratoconus progress. All patients had undergone ophthalmic examination including corneal topography, and their medical history and keratoconus characteristics were documented. Fifty-one eyes of those who wore RGPCL without any problems and 42 eyes of those who did not wear any lenses were evaluated retrospectively. It was accepted that the follow-up period was terminated when patients received any treatment or change lenses. The mean follow-ups were 36.5±12.7 and 38.4±14.6 months in the control and lens-wearing samples, respectively. The changes in topographic indices were compared from the baseline to the final visit. The difference between spectacle-best corrected visual acuity was not significant in both groups from baseline to final visit (p&gt;0.05). In the RGPCL wearing group, apical keratometric power ( Kmax ) increased from mean 51.86±3.70 diopter (D) to 52.54±3.85 D at the sagittal map in the following period, but this difference was not significant (p&gt;0.05). Similarly, in the control group, Kmax increased from mean 52.14±2.51 D to 52.94±3.02 D, and this difference was not significant (p&gt;0.05). Lens-wearing and control group mean keratometry values increased from 47.36±1.7 D and 47.17±1.65 D to 47.94±2.05 D and 47.74±1.76 D, respectively (p&gt;0.05). Pachymetry at the thinnest corneal point decreased significantly in both groups from baseline to final visit (p=0.008, p=0.01). In conclusion, the comfortable usage of RGPCL has no effect on the progression of keratoconus.

Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus.

The aim of this study was to evaluate the efficacy of a new-generation hybrid contact lens for improving visual outcomes and vision-related quality-of-life performance in patients with keratoconus who had intolerance or treatment failure of conventional correction methods such as the use of soft silicone-hydrogel or rigid gas-permeable contact lenses. Twenty-eight patients with keratoconus (42 eyes) were enrolled in this prospective cross-sectional study. Airflex (Swisslens) lenses were fitted in the patients' eyes in accordance with the manufacturer's instruction. Ophthalmologic examinations, including manifest refraction, best-corrected distance visual acuity, slit-lamp biomicroscopy, and National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) assessment, were performed at baseline and the 6-month visit. An adequate fit was achieved in 39 eyes (92.9%) of 26 patients. Six eyes of 3 patients were excluded from the study owing to discontinuation of lens wearing. The mean age of the successful wearers was 20.3 ± 4.9 years. The mean best-corrected distance visual acuity was statistically significantly improved from 0.62 ± 0.30 to 0.11 ± 0.06 logMAR with the Airflex hybrid contact lenses (p<0.001). The mean overall composite NEI-VFQ-25 score statistically significantly increased with the Airflex hybrid contact lenses at the 6-month visit as compared with that at baseline (from 77.1 ± 16.3 to 90.9 ± 7.3, p=0.036). Statistically significantly better scores were obtained with the Airflex hybrid contact lenses in all the NEI-VFQ-25 subscale items (all p<0.05). No significant adverse effects were observed. New-generation hybrid contact lenses can be used as an effective alternative for correction of irregular astigmatism in patients with keratoconus who have intolerance or treatment failure of conventional methods. Significant improvement in vision-related quality-of-life in patients with keratoconus can be achieved with these lenses.

Frequently Experienced Problems in the Early Stages after Prescribing Rigid Gas Permeable Contact Lenses

Prescribing rigid gas-permeable (RGP) lenses involves a series of processes that determine the most appropriate final lens through the trial use of test lenses based on the results of slit lamp microscopy, measuring refraction and corneal curvature, and corneal topography. The final prescription is reached by judging the dynamic lens movement, adequacy of the tear layer around the lens, corrected vision, and quality of vision. Various problems are encountered soon after prescribing lenses, including foreign body sensation, tear hypersecretion, decreased visual acuity, blurring, visual acuity change, redness, dryness, sudden pain, lens centering, and lens fallout. Here, we examine these problems and how to solve them.

Keratoconus and Visual Performance with Different Contact Lenses.

PurposeTo analyze the visual performance in contact lens wearers with keratoconus.MethodsA retrospective study including contact lens (CL) wearers was performed. The current best-corrected visual acuity with contact lens (BCVA-CL) and with spectacles (BCVA-S) correction, contrast sensitivity (CS) (by Metrovision-MonPack3®), analysis of light scattering in the retina and vision break-up time (HD Analyzer®), and corneal tomography (Oculus Pentacam® HR) were evaluated.ResultsThis study included 96 eyes of 59 patients with Keratoconus. Rigid gas permeable contact lenses (RGPCL), hybrid contact lenses (HCL), and silicone hydrogel/hydrogel contact lenses (HGCL) were fitted in 67, 17, and 12 eyes, respectively. Dynamic objective scatter index (OSI) (p = 0.024), minimum OSI (p = 0.037) and maximum OSI (p = 0.040) were significantly better with RGPCL and worse with HGCL. Mean CS in photopic conditions was significantly worse with HGCL and better with HCL (p = 0.006), without differences in mesopic conditions (p = 0.121). RGPCL wearers showed a higher mean K (p = 0.020), and a lower corneal thickness at the thinnest point (p=0.011).ConclusionVisual quality varied significantly with different types of CL. Although RGPCL was fitted in patients with worse Pentacam tomographic parameters, RGPCL was associated with a better dynamic visual quality.

Severe Ocular Complications Associated With Wearing of Contact Lens in Japan.

To examine the severe ocular complications associated with contact lens wearing in Japan. A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens-associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment. Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation. The major cause of serious contact lens-associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.

New treatment algorithm for keratoconus and cataract: small-aperture IOL insertion with sequential topography-guided photorefractive keratectomy and simultaneous accelerated corneal crosslinking.

To describe a new treatment algorithm aimed at optimizing refractive outcomes for patients with keratoconus and cataract. Private practice in Sydney, Australia. Retrospective case series. This procedural approach involves cataract extraction with small-aperture intraocular lens (IOL) insertion, IC-8 IOL (AcuFocus, Inc.), followed by topography-guided photorefractive keratectomy (T-PRK) with simultaneous corneal crosslinking (CXL). Cataract surgery was performed with an initial 2.4 mm clear corneal incision enlarged to 3.5 mm to accommodate IC-8 IOL insertion. Once eyes demonstrated stable corneal tomography and refraction, T-PRK was performed using Schwind excimer laser (500 Hz) with the Vancouver custom topographical neutralization technique, aiming to achieve low myopia. CXL was performed immediately after T-PRK using Optolink hypotonic riboflavin with LIGHTLink-CXL (Lightmed) with 5.4 J total energy delivered at an 18 mw/cm2 irradiance. Outcomes of 4 eyes are reported with all achieving rigid gas-permeable (RGP) contact lens independence, improved corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), and regularization of corneal curvature with cone reduction. The mean CDVA improved from 0.43 preoperatively to 0.07 postoperatively (P = .00), and the mean UDVA improved from 0.81 preoperatively to 0.29 postoperatively (P = .04). Postoperative UNVA ranged from N.8 to N.12. This treatment algorithm demonstrates unique combination of existing corneal and cataract surgical procedures to achieve satisfactory refractive outcomes and RGP contact lens independence in patients with keratoconus and cataract.

Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients

PurposeThis study was conducted to evaluate the effects of long-term use of rigid gas-permeable (RGP) contact lenses on corneal endothelium in keratoconus (KC) patients using non-contact specular microscopy. In addition, the correlation between wearing duration of RGP lenses (years & hours /d) and endothelial morphometric changes in KC patients was performed. This may provide more useful data for clinical application of RGP contact lens. Study designThis study was a prospective, observational, comparative, hospital based, nonrandomized, cross-sectional, and quantitative study. Subjects and methodsThe study included 40 eyes of non-wearer contact lens KC patients (group 1) and 38 KC eyes with a long history of Rose K2 RGP contact lens wearing (group 2). The corneal endothelial morphology such as endothelial cell density (ECD); coefficient of variation of cell area (CV); percentage of hexagonal cells (HEX); and central corneal thickness (CCT) were evaluated in all patients using SP3000P Specular Microscope. ResultsThe study included 40 eyes of non-wearer contact lens KC patients (20 mild KC eyes and 20 moderate KC eyes) and 38 KC eyes with a long history of RGP contact lens wearing (18 mild KC eyes and 20 moderate KC eyes). The mean duration of RGP lenses wearing was 5.67 ± 3.481 years & 12.11 ± 2.698 h/d in mild KC eyes and 7.15 ± 5.294 years &13.65 ± 2.889 h/d in moderate KC eyes. Wearing duration in hours in mild KC eyes showed a significant moderate negative correlation with ECD (r = −0.529, p = 0.024) and a moderate positive correlation with CV (r = 0.565, p = 0.015). In addition, wearing duration in years in moderate KC eyes showed a significant moderate negative correlation with ECD (r = −0.465, p = 0.039) and moderate positive correlation with CV (r = 0.627, p = 0.003). However, wearing duration in hours in moderate KC eyes showed a significant moderate negative correlation with HEX only (r = −0.490, p = 0.028). This study reported significant corneal thinning in contact lens wearer KC eyes in contrast to non-wearer KC eyes. ConclusionThis study documented a significant correlation between a long-term use of Rose K2 RGP using the three-point touch and corneal endothelial morphometric changes in KC patients. In addition, the current study confirmed a significant corneal thinning in RGP contact lens wearer compared to non-contact lens wearer KC patients. Further studies are recommended to evaluate the association between different RGP lens materials with different oxygen permeability transmissibility; different lens design types; different fitting methods; the duration of contact lens wear and the endothelial morphometric changes in KC patients.

The Adhesion Syndrome

Rigid gas permeable contact lenses may adhere to the corneal epithelium. Reports of adhesion have been described with only one type of lens material. This report describes three types of lens materials, lens fitting characteristics and the interactions between the eyelid, cornea and contact lens. Various factors may be responsible for the adhesion phenomenon.

Initial Power of Rigid Gas Permeable Contact Lenses in Patients with Keratoconus.

Purpose:To simplify the fitting process, this study was designed to predict the initial power of contact lenses using the regression model based on manual Javal keratometry data and refractive errors.Methods:In this retrospective study, 121 eyes of 69 patients with keratoconus (KCN) were fitted with a specific trial set of rigid gas permeable contact lenses based on the standard criterion of “three-point touch” over a 7-year period. Power of the cornea was measured using Javal keratometer. Refractive errors and over refraction of patients were diagnosed using Topcon autorefractometer (RM-A2000) and confirmed by Heine beta 2000 retinoscope.Results:The results of multiple linear regression showed the following equation: power of contact lens = −14.368 (constant of the final multiple regression model), +0.475 (spherical refraction), and +0.275 (flatter corneal power).Conclusions:The results of this study revealed that lens power has a significant relationship with the power of the flat corneal meridian and spherical refractive error in KCN patients. The obtained regression model can be used to shorten patients’ chair time and optometric examination for predicting the power of contact lens.

Correction of Ocular Aberrations with Prismatic Rigid Gas-permeable Contact Lenses in Keratoconic Eyes.

A base-down prism was incorporated on the anterior surface of rigid gas-permeable (RGP) contact lenses to explore potential effects on the residual ocular aberrations after contact lens fitting in keratoconic eyes. This study aimed to evaluate the correction of ocular aberrations with corneal prismatic RGP contact lenses in keratoconic eyes and their impact on visual function. A cross-sectional and randomized study was performed. Seventeen eyes of 17 keratoconus patients (34.6 ± 11.1 years) were evaluated. Two designs (standard and prismatic) of a corneal RGP contact lens (KAKC; Conoptica, Barcelona, Spain) were fitted to the same eye of each patient in a random order: a standard RGP contact lens as control and a prismatic RGP contact lens with a base-down prism of 1.6 prism diopters. Ocular aberrations were measured for a pupil diameter of 3 mm with and without both contact lenses, whereas high-contrast distance visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured under photopic and mesopic conditions. Both contact lenses improved oblique primary astigmatism, defocus, vertical coma, coma-like, and root-mean-square higher-order aberrations compared with the unaided eyes (P < .05). Furthermore, the prismatic RGP contact lenses offered lower values of vertical coma and root-mean-square higher-order aberrations than the standard RGP contact lenses (P < .05). Both designs (standard and prismatic) produced a positive vertical coma of lower magnitude than the negative vertical coma of the unaided eyes. On the other hand, the improvement achieved in all visual function variables was the same for both contact lens designs (P ≥ .05). The prismatic RGP contact lenses corrected higher levels of higher-order aberrations compared with the standard RGP contact lenses. However, both contact lens designs with the same refractive power were equally efficient at improving visual function.

Stage-appropriate treatment of keratoconus

Der Keratokonus (KK) ist eine progrediente kegelförmige Hornhautvorwölbung, die eine parazentrale Verdünnung an der Kegelspitze verursacht und typischerweise beidseitig asymmetrisch auftritt. Nach einer sorgfältigen Anamnese und Einstufung des Schweregrades steht heute eine gezielte stadiengerechte Therapie zur Verfügung. Ist der Brillenvisus nicht mehr ausreichend, werden von einem Spezialisten formstabile sauerstoffdurchlässige Kontaktlinsen (KL) angepasst. Bei Progression und für den Patienten im Alltag nutzbarem Visus empfiehlt sich das Riboflavin-UVA-Crosslinking (CXL), bei herabgesetztem Visus und klarer zentraler Hornhaut sind bei KL-Intoleranz intrastromale Ringsegmente (ICRS) indiziert. Ist das Stadium weiter fortgeschritten, empfiehlt sich die tiefe anteriore lamelläre (DALK) oder perforierende Keratoplastik (PKP). Bei einem akuten Keratokonus ist die PKP kontraindiziert, allerdings verkürzen tiefstromale Nähte zur Readaptation des Descemet-Risses mit Gasfüllung der Vorderkammer den Verlauf erheblich. Fast keine andere Augenerkrankung ist heutzutage einer frühen apparativen Diagnose und stadiengerechten Therapie so gut zugänglich wie der KK.

Miniscleral Contact Lens in Pediatric Age Group: Indications, Safety, and Efficacy.

To report indications, fitting feasibility, and safety of miniscleral design (MSD) lenses in children. Medical records of patients aged <18 years at the time of referral to Contact Lens Clinic of Farabi Eye Hospital, because of inadequate spectacle-corrected visual acuity, rigid gas-permeable or soft contact lens intolerance, and ocular surface disease were reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best-corrected vision with the lens (CCVA), lens parameters, and comfortable daily wearing time (CDWT) were documented. Seventy-two eyes of 52 pediatric patients were fitted with MSD lens over a 9-year period. The indications for MSD lens fitting were keratoconus (29 eyes), corneal scarring from ocular trauma (16 eyes), ocular surface diseases (25 eyes), and postkeratitis corneal scar (2 eyes). The average UCVA and the mean difference between CCVA and BSCVA were 1.20 and 0.55 logarithm of the minimal angle of resolution, respectively, which shows statistically significant improvement. This significant increase in vision was even seen in those who were referred for the management of ocular surface diseases. The mean CDWT for most patients was 10 hr/day. Miniscleral design lens can be used as a safe and helpful modality to provide good vision and comfort in children experiencing ectatic disorders, traumatic corneal scars, and ocular surface diseases.