The effect of landing zone toricity on scleral lens fitting characteristics and optics.

PURPOSE: The fit and optical performance of a scleral lens is affected by the alignment of the landing zone with the underlying ocular surface. The aim of this research was to quantify the effect of landing zone toricity upon scleral lens fitting characteristics (rotation and decentration) and optics (lens flexure) during short-term wear. METHODS: Scleral lenses with nominal landing zone toricities of 0, 100, 150 and 200 µm were worn in a randomised order by 10 young healthy participants (mean [SD] 24 [7] years) for 30 min, with other lens parameters held constant. Scleral toricity was quantified using a corneo-scleral profilometer, and lens flexure, rotation, and decentration were quantified using over-topography during lens wear. Repeated measures analyses were conducted as a function of landing zone toricity and residual scleral toricity (the difference between scleral and lens toricity) for eyes with 'low' magnitude scleral toricity (mean: 96 µm) and 'high' magnitude scleral toricity (mean: 319 µm). RESULTS: Toric landing zones significantly reduced lens flexure (by 0.37 [0.21] D, p < 0.05) and lens rotation (by 20 [24]°, p < 0.05) compared with a spherical landing zone. Horizontal and vertical lens decentration did not vary significantly with landing zone toricity. These trends for flexure, rotation, and decentration were also observed for eyes with 'low' and 'high' magnitude scleral toricity as a function of residual scleral toricity. CONCLUSION: Landing zones with 100-200 µm toricity significantly reduced lens flexure (by ~62%) and rotation (by ~77%) but not horizontal or vertical lens decentration, compared with a spherical landing zone, when controlling for other confounding variables. The incorporation of a toric landing zone, even for eyes with lower magnitude scleral toricity (~100 µm), may be beneficial, particularly for front surface optical designs.

Choledochal cyst as an incidental finding during acute cholecystitis: A case report.

Key Clinical Message: This case demonstrates an atypical presentation of choledochal cysts (CDCs) and elaborates on the diagnostic challenges encountered when presented with CDCs in adulthood, as it principally presents in children. Abstract: A choledochal cyst is a rare congenital anomaly characterized by cystic dilations in the extrahepatic and intrahepatic biliary trees. These cysts are classified according to their location and characteristics. This case study aims to demonstrate how nonspecific clinical features can pose a diagnostic dilemma when presented in adults. Additionally, the case report provides an overview of diagnostic methods and treatment options. In this case, we discuss a 50-year-old female who presented with a 2- to 3-day history of severe colicky pain in the right upper quadrant of her abdomen without any other symptoms or abnormal laboratory tests. In addition to ultrasonography evidence of CBD dilation and cholelithiasis, MRCP results confirmed the diagnosis. She underwent surgical intervention involving cyst excision, a Roux-en-Y hepatojejunostomy, and a cholecystectomy. The postoperative period was without significant complications. The case presented here illustrates the potential outcomes for individuals who present with choledochal cysts during adulthood. Often, these cases present with vague symptoms or as the underlying cause of a more severe condition. This case contributes to the existing knowledge of choledochal cysts by providing insight into the clinical presentation, diagnostic methods, and treatment options.