RESUMEN
OBJECTIVE: The purpose of this study is to determine the peripheral oxygen transmissibility (pDk/t) and respective central oxygen transmissibility (cDk/t) in soft contact lenses (SCLs) which might preclude SCL-driven corneal neovascularization (NV) in healthy myopic SCL users. METHODS: Twenty subjectively successful SCL-wearing patients who presented with asymptomatic but active peripheral corneal NV (not ghost vessels) were recruited as study patients. Twenty-one patients who did not have NV were similarly recruited as controls. Demographic data were collected. Corneal NV was documented and photographed. Current habitual SCLs were collected and thicknesses measured to allow for the calculation of both pDk/t and cDk/t and estimation of local tear oxygen tensions. RESULTS: No statistical differences between study and control groups in patient age, refraction, or the numbers of years, days per week, or hours per day patients reported SCL wear were identified. Statistically significant differences were found between the two groups for both pDk/t (P=0.006) and cDk/t (P=0.004): mean (±SD) pDk/t was 38.0±23.5 and 19.2±17.7 Fatt units for control and study corneas, respectively. Mean cDk/t were 80.0±54.4 and 36.8±33.1 Fatt units for control and study corneas, respectively. Peripheral tear oxygen tension that "protected" corneas from vascular filling was over 84 mm Hg. CONCLUSION: Maintaining a pDk/t above 30 to 40 Fatt units with daily wear SCLs should protect most normal corneas from NV as a complication of SCL wear.
Asunto(s)
Lentes de Contacto Hidrofílicos/efectos adversos , Córnea/irrigación sanguínea , Neovascularización de la Córnea/etiología , Miopía/terapia , Oxígeno/metabolismo , Lágrimas/metabolismo , Córnea/metabolismo , Neovascularización de la Córnea/diagnóstico , Neovascularización de la Córnea/metabolismo , Paquimetría Corneal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miopía/metabolismo , Diseño de Prótesis , Ajuste de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Failure to comply with the manufacturers' recommended replacement frequency (MRRF) is expected to result in ocular complications. The goal of this study is to evaluate the empirical relationship between compliance with MRRF and the presence of ocular complications. METHODS: All soft contact lens-wearing patients who presented at either of 2 clinics were evaluated prospectively for contact lens-related complications and for compliance with MRRF. RESULTS: Compliance with MRRF varies significantly across replacement modality (P < 0.01) and lens solution type (P = 0.04). Among noncompliant patients, average days of overwear beyond MRRF significantly varies across age group (P = 0.02), lens material type (P = 0.01), and lens solution type (P = 0.02). Regression analysis controlling for demographic factors and lens and solution type found a marginally significant (P = 0.07) positive effect of days of overwear on average complications per eye. CONCLUSIONS: We find noncompliance broadly present across demographic groups and patient types and marginally positively related to complications.
Asunto(s)
Lentes de Contacto Hidrofílicos/efectos adversos , Oftalmopatías/etiología , Cooperación del Paciente , Adolescente , Adulto , Anciano , Citas y Horarios , Femenino , Humanos , Masculino , Persona de Mediana Edad , Errores de Refracción/rehabilitación , Factores Sexuales , Adulto JovenRESUMEN
PURPOSE: This study is a cross-sectional analysis of the types and prevalence of contact lens (CL)-related complications among CL wearing patients seen in a university clinic setting. METHODS: Data on CL material and design, care system, and ocular complications were recorded and statistically analyzed for CL wearers. RESULTS: Of the 572 patients (846 eyes) recruited during the study, approximately 50% of the eyes had at least one CL-related complication. Rigid gas permeable (GP) CLs had a statistically lower (P<0.01) average number of complications (0.54 +/- 0.68) than soft contact lenses (SCLs) (0.85 +/- 0.82). Papillae and giant papillary conjunctivitis were the most prevalent complications in both GP and SCL wearers. Silicone SCLs (0.79 +/- 0.76) had a slightly lower, although not statistically different (P=0.23), rate of complication than nonsilicone SCLs (0.90 +/- 0.87). Although not statistically significant (P=0.29), extended wear CL use had a higher complication rate (0.93 +/- 0.84) compared with daily wear (0.73 +/- 0.79). Use of "other" solution, including generic and private label solutions, had the highest rate of complications for both SCLs (1.11 +/- 1.27) and GPs (0.96 +/- 0.93) compared with name brand solutions. CONCLUSIONS: The prevalence of CL-related complications, regardless of lens design, material, and wear modality, highlights the importance of early detection with appropriate professional management and treatment.
Asunto(s)
Lentes de Contacto/efectos adversos , Oftalmopatías/epidemiología , Oftalmopatías/etiología , Adolescente , Adulto , Anciano , Conjuntivitis Alérgica/etiología , Conjuntivitis Alérgica/fisiopatología , Soluciones para Lentes de Contacto/efectos adversos , Lentes de Contacto de Uso Prolongado/efectos adversos , Lentes de Contacto Hidrofílicos/efectos adversos , Estudios Transversales , Femenino , Gases , Humanos , Hidrogel de Polietilenoglicol-Dimetacrilato , Masculino , Persona de Mediana Edad , Permeabilidad , Prevalencia , Siliconas , Adulto JovenRESUMEN
PURPOSE: To investigate the relationship between functional phenotype of and the associated human corneal infection. METHODS: This was an experimental pilot study of patients presenting with corneal infections at the Jules Stein Eye Institute with presumed infection during the period from 12/30/97 to 9/1/00. Thirteen patients were admitted to the study based on positive identification of the causative pathogen as and patient consent. Data were collected (including bacterial cultures, lens wear schedule and care, gender and age, completed history questionnaire, clinical photographs). Statistical analysis of possible correlations was performed. Phenotypes of were determined, and clinical factors associated with infection were explored. RESULTS: Both invasive and cytotoxic phenotypes of were isolated in equal proportion. Cytotoxic strains and invasive strains were found to be associated with patients younger than 50 years of age and older than 50 years of age, respectively. CONCLUSIONS: remains a significant pathogen in corneal infection, especially during contact lens wear. The age of the patient may influence the phenotype of causing infection. Since invasive and cytotoxic strains have different effects on corneal cells, treatment of the infection might require different approaches depending on this phenotype of the causative bacteria.
Asunto(s)
Enfermedades de la Córnea/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/clasificación , Adolescente , Adulto , Técnicas de Tipificación Bacteriana , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
PURPOSE: To quantify and describe the complexity of contact lens correction on corneas altered by refractive surgery. DESIGN: A case-control study involving postrefractive surgery patients and controls from one multidisciplinary contact lens practice. METHODS: The contact lens care of one randomly selected eye of 30 postrefractive surgery patients (15 postincisional and 15 postlamellar refractive surgery cases) was retrospectively analyzed and compared with that of 30 age-and-gender matched nonrefractive surgery controls. We quantified the complexity by the number of diagnostic lenses used to establish the initial lens order, the number of ordered lenses required to complete the fit, and the number of office visits during the first 4 months of lens care. Final contact lens optical powers, corrected visual acuities, complications, and lens success/failure were also studied. The nonparametric Mann-Whitney U test was used for statistical analysis. RESULTS: Postrefractive surgery eyes utilized statistically more diagnostic lenses (P =.048), ordered lenses (P =.008), and office visits (P <.0001). There were no statistical differences in the number of office visits, number of diagnostic contact lenses used, and number of ordered contact lenses between the postincisional and postlamellar refractive surgery patients. Although final contact lens optical powers were not significantly different (P =.06) between the two groups, contact lens corrected LogMAR acuities were statistically worse (P =.013) in the postrefractive surgery eyes than in the control group. Contact lens failures occurred in four postrefractive surgery eyes, while no eyes in the control group failed to tolerate contact lenses. CONCLUSIONS: Corneas altered by either incisional or lamellar refractive surgery techniques are more challenging to fit with contact lenses than nonsurgically altered eyes, requiring more lenses and chair time, while resulting in slightly poorer contact lens corrected visions and more failures.