Influence of Specialty Contact Lens Wear on Posterior Corneal Tomography in Keratoconus Subjects.

OBJECTIVE: To evaluate the effect of specialty contact lens (CL) wear on posterior corneal tomography in keratoconus subjects. METHODS: Patients with keratoconus who were wearing specialty CL were included in this retrospective cohort study. Tomographic parameters were evaluated with Scheimpflug imaging (Pentacam HR) before lens fitting and immediately after removal of CLs worn habitually for a period of several months. Subjects were divided into groups, according to type of lens (corneal, scleral, and hybrid) and keratoconus severity based on Belin/Ambrosio D (BAD-D) score, for further analysis. RESULTS: Thirty-four eyes of 34 subjects diagnosed with keratoconus were included. Mean duration of habitual CL wear was 7.0±0.3 months. For the entire cohort, a small increase in flat keratometric reading at the anterior corneal surface (K1F; P =0.032) and at the posterior surface (K1B; P =0.041) was found. In the corneal CL group (10 eyes; 29.4%), flattening of the anterior corneal curvature was detected (K max ; P =0.015). An increase in K1B value was seen in the scleral CL group (15 eyes; 44.1%) ( P =0.03). Combined topometric indices showed a small but significant difference in the entire cohort ( P <0.05) and in the subgroups of corneal CL wear and of moderate keratoconus (BAD-D score≥7). CONCLUSION: Various types of specialty CLs exert a differential influence on corneal parameters. A small steepening of keratometry at the posterior surface (K1B) was observed in the scleral lens group. Although corneal lens wear flattens the anterior cornea (K max ), it does not significantly alter the posterior corneal surface.

Combined recession and resection of the same lateral Rectus in the treatment of exotropia.

BACKGROUND: Besides rest position abnormalities, exotropia could also be due to hypertonia of the Lateral Recti (LR) given divergence frequently decreases under general anesthesia (GA). Combined Recession-Resection of the Same Muscle (RRSM) is a promising alternative to the Faden procedure in the surgical treatment of overacting MR in esotropia. We thus examined here the effectiveness of combined RRSM of the LR for the treatment of exotropia that decrease under GA. METHODS: We performed a retrospective, single-center evaluation over a 16-month period of 100 patients operated on for exotropia that decreased under deep GA (91% of 110 consecutive operated cases). We excluded re-operations and pure convergence insufficiencies. We performed a combined RRSM of one or two LR. It included a 10mm-recession and a "fine-tuned" resection of LR based on Quantitative Forced Duction Test scores. MR resection was combined when exotropia exceeded 35PD or for unilateral surgery. We report on patient outcomes 6 months after surgery. RESULTS: Successful results were obtained (-8-+8 PD measured on Alternate Cover Test) among 83% of cases at distance fixation and 91% at near fixation after 6 months. The Newcastle Control Score also improved from 5.8 to 1.7 after 6 months. No surgery-related complications or repeat surgeries were reported. CONCLUSIONS: In our experience a majority of exotropias decrease under GA and our strategy of combined RRSM of the LR is effective for the treatment of such exotropias. Long-term follow-up of the cohort is required to investigate the stability of these outcomes, and confirmation of our results by other works.

Recurrent multiple eye muscle palsy as a first sign of sarcoidosis.

Purpose: To report a case of (neuro)sarcoidosis presenting solely with recurrent cranial nerve palsies in a 57-year-old Caucasian female. Methods: Case report with clinical imaging. Results: A 57-year-old female first presented with a right sixth nerve palsy, which resolved spontaneously after 6 months. Three years later she was diagnosed with a sixth nerve palsy in the fellow eye followed by a complete palsy of the left third cranial nerve four months after. Medical history consisted of migraine and hypercholesterolemia. Further neurological and ophthalmic work-up was unrevealing at first. After repeated magnetic resonance imaging, an enhancing lesion in the left cavernous sinus was seen, which was initially diagnosed as a meningioma. However, imaging of the chest revealed an image of sarcoidosis, and the lesion and ophthalmoplegia of the left eye disappeared with systemic corticosteroid treatment. Discussion: Sarcoidosis is the ultimate imitator and the possibility of neurosarcoidosis must be taken into account when presented with unexplained ophthalmoplegia. Neurosarcoidosis has imaging properties very similar to other diseases such as a meningioma, and misdiagnosis occurs easily. Spontaneous recovery of ophthalmoplegia can rarely occur in neurosarcoidosis.

Long-term evolution of age-related distance esotropia.

PURPOSE: To evaluate the evolution of horizontal deviation and fusional amplitudes both at distance and at near in patients with age-related distance esotropia (ARDET). METHODS: The medical records of consecutive patients diagnosed with ARDET between January 2008 and March 2016 were reviewed retrospectively. Patients with at least 60 months' follow-up were eligible for inclusion. Horizontal deviation, fusional convergence amplitude, and fusional divergence amplitude both at distance and at near were compared. RESULTS: Of 131 cases reviewed, 31 patients were identified for inclusion. Median age at diagnosis was 73 years. Median distance esodeviation was 6Δ esotropia at initial examination (range, 2Δ-12Δ esotropia) and 8Δ eostropia at final examination (range, 2Δ-25Δ esotropia). Median near deviation was orthophoria at initial examination (range, 10Δ exophoria to 8Δ esophoria) and 4Δ esophoria at final examination (range, 4Δ exophoria to 14Δ esophoria). Median fusional divergence amplitude at distance was 4Δ at initial and at final examinations. At near, median fusional divergence amplitude was 8Δ at initial and at final examinations. Median fusional convergence amplitude at distance was 14Δ at initial examination and 12Δ at final examination. At near, median fusional convergence amplitude was 26Δ at initial and at final examinations. Base-out prisms were prescribed in all patients. In 23 patients the prism correction gradually increased. Strabismus surgery was performed in 3 patients. CONCLUSIONS: Our patients with ARDET experienced a slight increase in distance esodeviation (P < 0.001), whereas no significant change in fusional amplitudes was observed over time (P ≥ 0.05).