Therapeutic Contact Research Articles

Design and characterization of α1-antitrypsin variants for treatment of contact system–driven thromboinflammation

AbstractThe contact system produces the inflammatory peptide bradykinin and contributes to experimental thrombosis. C1 esterase-inhibitor (C1INH) deficiency or gain-of-function mutations in factor XII (FXII) cause hereditary angioedema, a life-threatening tissue swelling disease. C1INH is a relatively weak contact system enzyme inhibitor. Although α1-antitrypsin (α1AT) does not naturally inhibit contact system enzymes, a human mutation (M358R; α1AT-Pittsburgh) changes it into a powerful broad-spectrum enzyme inhibitor. It blocks the contact system, but also thrombin and activated protein C (APC), making it an unattractive candidate for therapeutic contact system blockade. We adapted the reactive center loop of α1AT-Pittsburgh (AIPR/S) to overcome these obstacles. Two α1AT variants (SMTR/S and SLLR/S) strongly inhibit plasma kallikrein, activated FXII, and plasmin. α1AT-SMTR/S no longer inhibits thrombin, but residually inhibits APC. In contrast, α1AT-SLLR/S residually inhibits thrombin, but no longer APC. Additional modification at the P1′ position (S→V) eliminates residual inhibition of thrombin and APC for both variants, while retaining their properties as contact system inhibitors. Both α1AT-SMTR/V and -SLLR/V are superior to C1INH in reducing bradykinin production in plasma. Owing to their capacity to selectively block contact system-driven coagulation, both variants block vascular occlusion in an in vivo model for arterial thrombosis. Furthermore, both variants block acute carrageenan-induced tissue edema in mice. Finally, α1AT-SLLR/V, our most powerful candidate, suppresses epithelial leakage of the gut in a mouse model of colitis. Our findings confirm that redesign of α1AT strongly alters its inhibitory behavior and can be used for the treatment of contact system-mediated thrombosis and inflammation.

The Two Most Common Ways Post-operative Eye Patch Are Therapeutic Contact Lenses (TCL) and Overnight Bandaging With Tight Bandage Patch: This Study is Designed to Determine the Most Effective Post-operative Care to Relief the Patient's Discomfort After Pterygium Excision Surgery

The Two Most Common Ways Post-operative Eye Patch Are Therapeutic Contact Lenses (TCL) and Overnight Bandaging With Tight Bandage Patch: This Study is Designed to Determine the Most Effective Post-operative Care to Relief the Patient's Discomfort After Pterygium Excision Surgery

Evaluation of a programming algorithm for deep brain stimulation in dystonia used in a double-blind, sham-controlled multicenter study

BackgroundProgramming deep brain stimulation in dystonia is difficult because of the delayed benefits and absence of evidence-based guidelines. Therefore, we evaluated the efficacy of a programming algorithm applied in a double-blind, sham-controlled multicenter study of pallidal deep brain stimulation in dystonia.MethodsA standardized monopolar review to identify the contact with the best acute antidystonic effect was applied in 40 patients, who were then programmed 0.5 V below the adverse effect threshold and maintained on these settings for at least 3 months, if tolerated. If no acute effects were observed, contact selection was based on adverse effects or anatomical criteria. Three-year follow-up data was available for 31 patients, and five-year data for 32 patients. The efficacy of the algorithm was based on changes in motor scores, adverse events, and the need for reprogramming.ResultsThe mean (±standard deviation) dystonia motor score decreased by 73 ± 24% at 3 years and 63 ± 38% at 5 years for contacts that exhibited acute improvement of dystonia (n = 17) during the monopolar review. Contacts without acute benefit improved by 58 ± 30% at 3 years (n = 63) and 53 ± 31% at 5 years (n = 59). Interestingly, acute worsening or induction of dystonia/dyskinesia (n = 9) correlated significantly with improvement after 3 years, but not 5 years.ConclusionsMonopolar review helped to detect the best therapeutic contact in approximately 30% of patients exhibiting acute modulation of dystonic symptoms. Acute improvement, as well as worsening of dystonia, predicted a good long-term outcome, while induction of phosphenes did not correlate with outcome.Trial registrationClinicalTrials.gov NCT00142259.

Cornea-Stroma-Mimicking Films Derived from Cellulose Nanocrystal Templating Fibrous Collagen as Therapeutic Contact Lenses

Multilayered films were fabricated from the dilute mixtures of collagen (Col) and dialdehyde cellulose nanocrystals (DAC) with various oxidation degree (OD%) via vacuum filtration. The anisotropic nanocrystal was able to template the alignment of collagen fibrils to mimic the collagen plywood of cornea stroma. DACs possessed good crystallinity and uniform size after the periodate oxidation. With increasing OD% from 0% to 56.6%, C/DC (Col/DAC) films showed an increase in transparency but a decrease in water content and oxygen permeability. C/DC films in the wet and dry state performed with opposite trends in the mechanical properties including modulus, stress, and strain with the increase of OD%. With increasing Col-DAC ratio from 0.2 to 5.0, C/DC films displayed an increase in water content and mechanical properties but a decrease in transparency. Drug-laden film displayed a sustained release of the anti-inflammatory agent in artificial lacrimal fluid (ALF) within 1 week. It also showed an improved bioava...

Has the Kama Sutra Not Made a Difference? Making Psychologists in India Explore Sexual Functioning and Master Sex Therapy

There is no dearth of web-based scientific information on sexuality and related matters, and it is shared in private social groups. Yet there appears to be a resistance on the part of psychologists in India in exploring the sexual functioning of clients. This article explores the possible reasons for the neglect that prevails and the consequences. Since, psychologists who are qualified in helping avoid addressing the sexual concerns of the people, it leads to widespread “malpractice” by the quacks. Neglect in identifying the underlying sexual problems that are manifested as various somatoform disorders and other medically unexplainable symptoms leads to emotional distress of the clients and increases the health costs. Hesitation and the “taboo” of the psychologists hinder the therapeutic contact between the therapists and the clients and, hence, people do not disclose their sexual concerns and problems. Personal discomfort of psychology trainees due to “unfinished business,” inadequate input on the role of sexual functioning and the inadequate exposure to people with sexual concerns may have contributed to this impasse. Supervised training of upcoming psychologists would help improve the quality of sexual life of people of all ages and prevent children and adolescents from sexual abuse. The need for using the ancient Indian masterpiece of sexual science, Kama Sutra, in getting over the taboo is also recommended.

Efficacy of therapeutic soft contact lens in the management of gelatinous drop-like corneal dystrophy

Background/AimsTo investigate the efficacy of therapeutic soft contact lenses (SCLs) in gelatinous drop-like corneal dystrophy (GDLD) management.MethodsThis was a retrospective, consecutive, observational case series, including 20 patients (40 eyes) with...

Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study

BackgroundInvolving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care.MethodsA cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method.ResultsFor service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsThere is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning.This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017).

Toxicity of therapeutic contact lenses based on bacterial cellulose with coatings to provide transparency

Therapeutic contact lenses were developed from bacterial cellulose (BC) by the Institute of Chemistry at Brazil’s São Paulo State University (UNESP). In a previous study, cyclodextrins (CD) and medications such as ciprofloxacin (CP) and diclofenac sodium (DS) were incorporated into the lenses to provide therapeutic properties and control drug release. However, significant opacity was seen in the material inherent to cellulose. In order to achieve full material transparency, the lenses were coated with an organic-inorganic hybrid compound containing aluminum alkoxide and glycidoxypropyltrimethoxysilane (GPTS)(H), or chitosan (Q) nanoparticles. This study evaluated the toxicity of these contact lenses to ensure the safety of these materials for future availability to the medical device industry. Lenses composed of BC and coated with either GPTS (H) or chitosan (Q), incorporating ciclodextrin (CD) to release diclofenac sodium (DS) or ciprofloxacin (CP), were submitted to cytotoxicity assays (XTT and Clonogenic Survival), genotoxicity (Comet Assay) and mutagenicity (Cytokinesis-blocked micronucleus assay) directly in cell culture. Statistical analyses were performed using the Tukey and Dunnett or Kruskal-Wallis and Dunn tests. All of the nanoparticles used in the lense coatings did not show cytotoxic effects by the XTT test (p > 0.05; Dunnett). Only materials associated with diclofenac sodium (BC-H-CD-DS and BC-Q-CD-DS) presented significantly different survival fractions compared to negative control (p < 0.001; Dunnett). Genotoxicity evaluation revealed a genotoxic effect in BC-H-CD-DS (p < 0.05; Dunn). All tested lenses did not present any mutagenic effect. These results indicate that improvements in DS incorporation are needed to eliminate toxicity. We demonstrated promising results in the safety of employing BC lenses functionalized with a drug delivery system permitting the bioavailability of ophthalmic drugs. Further studies utilizing other specific tests, such as corneal lineage are required before safe and efficient ophthalmologic use.

Diclofenac sustained release using an LbL coated silicon based hydrogel

Introduction: Eye drops remain the primary dosage form for ocular therapy because of the easiness of administration by the patient, but they provide low drug bioavailability [1]. Soft contact lenses have been evaluated for several decades as potential drug vehicles for ocular therapy. Nevertheless, their usual low drug uptake prevents the achievement of therapeutic levels [2]. An approach to overcome some limitations of contact lenses is to use the layer-by-layer (LbL) method to form a surface barrier that regulates drug release within the therapeutic window. The main objective of this work was to develop LBL coated therapeutic lenses loaded with the anti-inflammatory drug diclofenac (DCF). Materials and methods: A silicon based hydrogel material (TRIS) was synthesized, loaded with sodium diclofenac (DCF) and coated with different polyelectrolytes by the LbL method. The polyelectrolytes alginate (ALG), chitosan (CHI) and hyaluronic acid (HA) were chosen and genipin was used as cross-linking agent. The coating consisted in a triple layer of ALG/CHI/HA. DCF release kinetics was evaluated in sink conditions in NaCl solution. Uncoated and coated hydrogels were submitted to the chorioallantoic membrane test (HET-CAM test) for potential ocular irritation. The hydrogel-lachrymal protein (lysozyme) interaction was evaluated by quartz-crystal microbalance with dissipation (QCM-D). Transmittance and oxygen permeability were studied. A mathematical model was used to estimate the in vivo efficacy of the coated lenses. Results: The coating allowed a controlled release of DCF, while maintaining the required properties for daily contact lens application. Both uncoated and coated hydrogels successfully passed the HET-CAM test. QCM-D data revealed the stability of the layers and some antifouling activity of the coating against lysozyme. The effective diffusion of DCF through the samples was calculated: lower diffusivity was found for the coated hydrogels (1.9 ± 0.7e−13 m2/s) compared to the uncoated (8.6 ± 1.1e−13 m2/s). The mathematical modelling appoint to a significant difference between the samples: by admitting the half maximal inhibitory concentration (IC50) of DCF, an estimated 200% increase in the predicted in vivo efficiency was obtained due to the presence of the coating. Discussion and conclusions: The coated hydrogel presents adequate characteristics to be used in therapeutic contact lenses, concerning the evaluated properties. DCF released was significantly enhanced by the presence of the coating, showing favourable kinetics due to the interactions between the polyelectrolytes and the drug. The applied mathematical model revealed a sustainable release of DCF within the therapeutic window for two weeks.

Hydration of small leaking corneal perforations with cefuroxime.

To describe a new technique for sealing small corneal perforations after penetrating trauma. Corneal perforations in six eyes were sealed using a stromal cefuroxime hydration technique. This technique is identical to the current method used to seal leaking incisions upon completion of cataract surgery except for the use of cefuroxime instead of balanced salt solution. Additionally, cefuroxime was intentionally injected into the anterior chamber. A therapeutic contact lens was used after the hydration. Comparison was made in eight eyes with small traumatic corneal perforation that was sealed using therapeutic contact lenses without hydration. This novel technique was applied in six cases, with leakage stopping immediately following hydration in each of these eyes. In cases presenting with a shallow or flat anterior chamber, this maneuver produced immediate reformation of the chamber. Of note, the corneal scars after hydration were minimal with little effect on visual acuity. When compared to eyes with small corneal perforations which were sealed with therapeutic contact lenses without hydration, all cases that were hydrated with cefuroxime were sealed immediately, as opposed to cases treated without hydration. Furthermore, the eyes that underwent hydration with cefuroxime had a worse average visual acuity on admission, a better average visual acuity 1month post-trauma, and a shorter average length of hospitalization. This new technique offers five major advantages: (1) Immediate sealing of the corneal perforation is achieved. (2) Definitive treatment can be achieved at the slit lamp. (3) Since neither stitches nor glue is applied, healing is achieved with minimal scarring and discomfort. (4) Little equipment is required. (5) Injection of cefuroxime into the anterior chamber provides prophylaxis against infection.

Recurrent corneal erosion: a comprehensive review.

PurposeTo comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management.OverviewRCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered.SummaryNewly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.

Making self-help virtual reality exposure therapy accessible: hardware and design considerations

Virtual Reality Exposure therapy has proven to be as effective as cognitive behavioral therapy with in vivo exposure [1]. Since it is an efficacious and cost effective alternative to in vivo exposure therapy, it can be offered to the clients via software packages containing educational material and self- report questionnaires considering the present state of Virtual Reality technology. This paper aims to identify design considerations and constraints, knowledge of which is highly useful in developing the applications that are accessible user-friendly, require minimal or no therapeutic contact and provide self-help solution to the inaccessibility of anxiety treatment which leads to a massive number of patients being left untreated.

Oxidative stress correction in the treatment of severe keratoconjunctivitis sicca in patients with Sjorgen's syndrome

To evaluate the antioxidative effect of artificial tears in the treatment of keratoconjunctivitis sicca (KCS). The study included 43 patients (60 eyes) with severe KCS: 38 women (50 eyes) and 5 men (10 eyes) aged from 27 to 76 years (in average 52 years). Patients were randomly divided into 2 groups; all patients used therapeutic silicone hydrogel soft contact lens (SCL) and instillations of 0.05% Cyclosporin A (CyA) 2 times a day. Patients of the first group (22 people, 30 eyes) used 0.15% hyaluronic acid. In the second group, patients (21 people, 30 eyes) used a tear substitute with similar surface-active component, but with antioxidant properties. The results of the treatment were evaluated using basic and additional research methods at 1, 3, 6 and 12 months. Corneal epithelialization was achieved after 1 month of conservative treatment in all patients who wore SCLs and were treated with instillations of 0.05% CyA and artificial tears. Then the lenses were removed and the patients were switched to instillations of CyA and artificial tears. Comparative analysis of the results showed that higher functional indicators were achieved in the second group, where patients used Artelac Rebalance drops with antioxidant properties. Improvement of clinical and functional parameters in the treatment of severe forms of KCS was achieved by direct action on both links of pathogenesis with minimal amounts of the drugs and the frequency of their use. Subsequent supportive therapy contributed to stabilization of the results and further increase of the functional parameters.

The Clinical Result of Extended Wear of Therapeutic Contact Lenses and 5% NaCl for Traumatic Recurrent Corneal Erosion

The Clinical Result of Extended Wear of Therapeutic Contact Lenses and 5% NaCl for Traumatic Recurrent Corneal Erosion

A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy–based bibliotherapy intervention among adults living with chronic pain

ABSTRACT Background Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46–0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain.

NURSE’S ROLE IN GERIATRIC PATIENTS REHABILITATION WITH MUSCULOSKELETAL SYSTEM DISEASES

Introduction: There is the increasing number of elderly patients with motion disabilities who require help and infatuations from nursing stuff. According to the Central Statistic Department (GUS), 25,4% people in Poland is over 60. In 2050 this number will increase to 40%(39,9%). This is very important topic because when the number of old people will increase the geriatric care will be more important. Especially because this is partially covered by nursing team. They should be satisfied and content of the job they do, and they should fulfill the aim they had when they started this profession. The aim: Analysis of nurse's work with patients, nursing procedures evaluation, how this procedure is scored by the nurse, what is the nurse's role in the rehabilitation process. Material and methods: There were nursing process with geriatric patients analyzed in this article. There were nursing procedures investigated with the opinion of the person who performed this procedure. Role of the nurse in rehabilitation process was and the satisfaction from typical work load was analyzed. Results: Analyzed results showed that there is a deficit in the nurse's knowledge and the lack of the complex care in elderly patient with disabilities. There is lack of the preparation and education program to perform holistic patient care. This includes monitoring, examination and elderly needs. Conclusions: The nurse is the first link that helps the patient to understand his disease. The nurse develops therapeutic contact that helps the patient to feel safe and positively react for the introduced treatment.

Lactoferrin-loaded contact lenses counteract cytotoxicity caused in vitro by keratoconic tears.

Lactoferrin (LF), an iron-binding protein with antioxidant activity, is significantly reduced in the lacrimal film of patients affected by keratoconus (KC) compared to healthy subjects, and this is supposed to be the cause for tear iron increase and consequent iron deposition and oxygen free radical accumulation in the cornea. We decided to study if LF-loaded contact lenses (LF-CLs) could exert antioxidant activity on epithelial cells incubated in tears collected from two patients affected by keratoconus (KC1 and KC2). Moreover through this model we indirectly estimated iron concentration in the tears of healthy and KC subjects. Reflex tears were collected during the first 2 min of light or onion-induced lacrimation and stored at -20 °C. After incubation in tears for 18 h, mortality of epithelial cells was investigated by trypan blue exclusion test. Successively, LF-CLs were deposed on cells incubated in KC1 tears. For the indirect determination of iron content, cells were incubated with LF 1.2 mg/mL and different FeSO4 concentrations, and for the estimation of iron from the patient's tears, cells were incubated with free serum medium and healthy tears (1:1) and different FeSO4 concentrations. Epithelial cells incubated with reflex tears of KC patients showed increased mortality (27.7 ± 3.9%, p = 0.0003, for KC1 and 17.6 ± 0.95%, p = 0.014, for KC2) compared to epithelial cells maintained in control healthy tears (8.6 ± 1.2%). This difference in mortality was correlated with tear iron concentration, which was estimated at 4.58 μg/mL for the healthy subjects, at 56.28 μg/mL for KC1, and at 8.7 μg/mL for KC2 patient. Application of LF-CLs counteracted KC tear cytotoxicity restoring viability obtained in the presence of control tears. Therapeutic contact lenses obtained by LF loading can reduce oxidative stress induced by patients' tears and might represent an efficient device to arrest the progression of keratoconus.

Corneal Limbal Stem Cell Deficiency in Children with Stevens–Johnson Syndrome

To determine the incidence of corneal limbal stem cell deficiency (LSCD) as chronic ocular sequelae in children with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and analyze the factors associated with LSCD development. Retrospective case series. Medical records were reviewed of pediatric patients who had been admitted to Seoul National University Hospital with SJS/TEN and who were diagnosed as having acute ocular involvement. For each record, the following data were collected: demographic information, underlying diseases, causative agents, acute systemic and ocular manifestations, systemic and ocular treatments, chronic ocular complications including LSCD, and visual acuities. Of 19 children with SJS/TEN, LSCD developed in 6 (32%) patients at a mean of 12.3 ± 21.3months after the onset of SJS/TEN (median 3.5months). Severity of acute systemic involvement including elevation of liver enzyme levels and serum C-reactive protein levels was significantly correlated with the development of LSCD (P= .0038) and chronic ocular complications (P= .0044). The presence of corneal epithelial defect necessitating the use of therapeutic contact lenses in the acute phase was also associated significantly with LSCD development. Combined penetrating keratoplasty and limbal allograft were performed in 3 of 6 LSCD patients, and grafts failed in 2 (67%) patients because of infection. At the last follow-up, visual acuities were significantly poorer in patients with LSCD compared with those without LSCD (P= .0055). Corneal LSCD occurred in 32% of pediatric patients with SJS/TEN, leading to poor visual outcome. Severity of acute systemic involvement was significantly associated with the development of LSCD and chronic ocular complications.

Nonsurgical treatment involving a contact lens and hyperosmotic solution for acute bullous keratopathy in a cat

A 4-year-old castrated male Korean domestic shorthair cat was referred with bilateral corneal edema. Focal and generalized acute bullous keratopathy in the oculus dexter and oculus sinister, respectively, were diagnosed by ophthalmologic examinations. Intensive topical treatment was administered to both eyes. A therapeutic soft contact lens was inserted in the oculus sinister as a corneal bandage instead of surgical treatment. The patient achieved complete recovery at 44 days after treatment. A therapeutic soft contact lens and an intensive regimen involving a topical hyperosmotic solution successfully treated acute bullous keratopathy in a feline patient.

Influence of a Therapeutic Soft Contact Lens on Epithelial Healing, Visual Recovery, Haze, and Pain After Photorefractive Keratectomy.

To examine the influence of a therapeutic soft contact lens (TSCL) after alcohol-assisted photorefractive keratectomy (PRK) on visual recovery, epithelial closure, pain perception, and haze formation. Prospective, randomized, single-center, contralateral eye, patient-masked study. Same surgeon treated 15 patients with bilateral PRK using a Vidaurri Fluid Retention Ring (Katena) with 8.7 mm inner diameter to apply ethanol 18% for 30 sec. Each patient received a TSCL (Balafilcon A, PureVision, Bausch & Lomb) in a randomized fashion in one eye only. Without knowing which eye had a contact lens, four patients preferred the eye with TSCL so much that these patients wanted a TSCL inserted in the second eye as well. Uncorrected distance visual acuity improved postoperatively from day 1 to 3 months from 0.61 to 1.18 with TSCL and from 0.21 to 1.04 without TSCL. Uncorrected distance visual acuity was statistically significantly better on days 1 and 2 with TSCL. Epithelial defect was on average smaller with TSCL. Epithelium was closed at day 4 in all eyes except one without TSCL. Pain perception was significantly lower with TSCL on days 1 and 2. Haze levels after 3 months were significantly lower with TSCL (with 0.09/without 0.45, respectively). One eye without TSCL had haze grade 2 (Fantes). A TSCL had statistically significantly and clinically meaningful beneficial effects in the first days in visual recovery and pain perception and after 3 months in haze formation. Epithelial healing was slightly quicker with the use of TSCLs (not statistically, but clinically significantly).