The annular tinted contact lens syndrome: corneal topographic analysis of ring-shaped irregular astigmatism caused by annular tinted contact lenses.

PURPOSE: Irregular corneal astigmatism has been reported in association with annular tinted hydrogel contact lenses. We report the abnormal videokeratographic findings of five patients wearing annular tinted contact lenses, who presented with bilateral blurred vision and revealed a loss of best corrected visual acuity. METHODS/RESULTS: The corneal topographic analysis revealed a previously unreported distinct ring-shaped pattern of irregular astigmatism. The topographic circular band of irregular astigmatism was further characterized by concentric areas of relative steepening, flattening, and steepening with a diameter of approximately 4 mm. This pattern suggests that forces acting at the junctional zone between the tinted area and the clear pupillary area are inducing structural abnormalities of the corneal surface. At the time of presentation, the mean surface regularity index (SRI) was 2.06 (range: 0.61-5.88). The topography and best-corrected visual acuity returned to normal within days of discontinuing annular tinted lens use, and the mean SRI decreased to 0.44 (range: 0.21-1.16). Digital imaging of lenses obtained from our patients and of identical control lenses was performed. A masked analysis suggested that the study lenses contain greater amounts of pigment compared to the control lenses. CONCLUSIONS: We present ten characteristic signs and symptoms of this condition, which we have named "the annular tinted contact lens syndrome." Corneal topographic analysis is a powerful tool for detecting specific reversible irregularities of the corneal surface associated with the use of annular tinted contact lenses.

Clinical and overnight corneal swell comparison of the 1-Day Acuvue lens versus the Medalist, Surevue, Biomedics, and Acuvue lenses.

PURPOSE: We characterized the clinical performance of the 1-Day Acuvue contact lens by direct comparison with four frequently prescribed daily wear lenses. METHODS: Forty-eight patients participated in four prospective, randomized masked clinical trials using the 1-Day Acuvue in one eye and the Medalist, Surevue, Acuvue (regular), and Biomedics 55 lenses in the other eye. Each trial lasted 2 weeks. Thirteen symptom variables and overall lens preference were evaluated using a patient preference questionnaire and a symptom-ranking questionnaire. Overnight corneal swell studies were also performed. RESULTS: In the non-allergic (58.4%) subgroup, the overall lens preference variable revealed a significant preference for the Medalist (P = .004), Surevue (P < .001), and Biomedics 55 (P < .001) lenses. In contrast, in the allergic (41.6%) subgroup, the overall lens preferences for the Medalist, Surevue, and Biomedics 55 lenses were completely absent. Multivariate regression analysis in the non-allergic subgroup revealed that lens comfort (.58, P < .001), lens handling upon insertion (.41, P < .001), and quality of vision (.35, P < .001) were significant variables contributing to patient responses regarding overall lens preference. However, in the allergic subgroup, only the lens comfort (.92, P < .001) variable is significant and appears to dominate the decision making. The overnight corneal swell evaluation revealed no significant differences between the 1-Day Acuvue and the Medalist lens. Patients wearing regular Acuvue had significantly less corneal swelling upon awakening (P = .005) and at 60 minutes after awakening (P = .003). CONCLUSIONS: The Medalist, Surevue, and Biomedics 55 lenses outperformed the 1-Day Acuvue lens in the non-allergic subgroup. In the allergic subgroup, there was no statistically significant difference between the 1-Day Acuvue lens and all other lenses tested.

Clinical performance of the Optima toric contact lens versus the CSI toric contact lens.

PURPOSE: To compare the clinical performance of the Optima soft toric contact lens versus the CSI soft toric contact lens. METHODS: Twenty-one patients (five affected by allergies) were followed at 2-week intervals for 4 months in a prospective, randomized, double-masked study comparing the Optima soft toric contact lens to the CSI soft toric contact lens. RESULTS: The patients preference evaluation revealed a statistically significant preference for the CIS toric lens in 14 of 16 variables including overall lens preference (P = 0.0001). The two remaining variables, lens awareness (P = 0.07) and foreign body sensation (P = 0.06), showed a trend toward a preference for the CSI toric lens. The less sensitive symptom ranking questionnaire revealed a significance for, or a trend toward, a significant difference in three of 10 variables, all in favor of the CSI toric lens. The mean degrees of axis rotation were 3.5* for the CSI lens and 7.6* for the Optima lens (P = 0.0001). Factor analysis identified a clustering of variables around specific ranked factors. Factors related to 1) allergy status (.93); 2) visual function (.87); 3) ocular surface (.82); and 4) refractive characteristics (.71) were most significant in determining the overall clinical performance of these toric lenses. Allergic patients significantly preferred the CSI toric lens for 15 of 16 variables, whereas non-allergic patients preferred the CSI lens for seven of 16 variables. CONCLUSIONS: The patient preference, symptom ranking, and axis rotation analysis of this study revealed a superior performance by the CSI toric contact lens when compared to the Optima toric contact lens. Allergic patients revealed an even stronger and statistically significant preference for the CSI lens when compared to non-allergic patients.

The clinical performance of the Surevue, Focus, and CSI daily wear lenses in allergic and normal contact lens patients.

Sixty-three daily wear contact lens patients (42 non-allergic [66.7%] and 21 allergic [33.3%]) were randomized into three groups (CSI vs. Surevue; Focus vs. CSI; Focus vs. Surevue) and evaluated every two weeks for six months with regard to patient preferences and ranked symptom responses for 14 variables, including overall contact lens preference. Allergic patients (43.9 +/- 94.3 ng/mL) revealed significantly higher (P = .011) tear IgE levels versus non-allergic patients (15.6 +/- 25.8 ng/mL). Non-allergic patients preferred CSI over Surevue for 12 of 14 variables including overall lens preference (P < .001); CSI over Focus for 6 of 14 variables, including overall lens preference (P < .009); and Focus over Surevue for 13 of 14 variables, including overall lens preference (P < .001). In contrast, allergic patients preferred Focus over CSI for 8 of 14 variables; CSI over Surevue for 4 of 14 variables, including overall lens preference (P < .001); Focus over Surevue for 4 of 14 variables, including overall lens preference (P < .001). Surevue and Focus lenses were replaced at 4 and 8 week intervals, respectively. No significant differences in the ranked symptom responses were observed for Surevue at 4 weeks versus 2 weeks, or for Focus at 8 weeks versus 4 weeks. A regression of time versus symptom responses for non-allergic patients wearing the CSI lens revealed decreasing symptoms over time, while the allergic patients showed no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

External iliac arteriovenous fistula following total hip arthroplasty. A case report.

An external iliac arteriovenous fistula developed 3 years after revision of the acetabular component of a total hip arthroplasty in a patient with rheumatoid arthritis. The mechanism of this complication, which also produced disseminated intravascular coagulopathy, was chronic erosion of the iliac artery from a large bolus of bone cement and/or the protrusio shell that were used to reconstruct a severe acetabular protrusio. Care must be taken to avoid intrapelvic intrusion of hardware or cement during acetabular reconstruction to avoid immediate and late injury to the iliac vessels.

Transfusion of previously deposited autologous blood for patients undergoing hip-replacement surgery.

The efficacy of a program of transfusion of previously deposited autologous blood for patients undergoing total hip-replacement surgery was studied by comparing five different parameters for a group of fifty consecutive patients who deposited blood for autologous transfusion and a randomly chosen, closely matched control group of fifty patients who received only homologous blood. Sixty-two per cent of the patients in the group that deposited autologous blood did not receive additional homologous blood while in the hospital. The patients who deposited autologous blood had a mean preoperative hematocrit of 36 per cent, compared with 39 per cent for the control group, but the average postoperative hematocrits of the two groups did not differ (33 per cent). There was no significant difference in the average total loss of blood or need for replacement of blood between the groups. Transfusion-related complications developed in two patients in the control group. We concluded that previous deposit of autologous blood for transfusion is an effective method for reducing the need for transfusion of homologous blood and for avoiding the attendant complications of transfusion of homologous blood. This method of the replacement of blood should be considered for patients who are to undergo a major orthopaedic procedure on the hip.

ASA-dipyridamole prophylaxis in elective total hip replacement.

A prospective, double-blind clinical study was performed to evaluate the combination of dipyridamole 225 mg/day and acetylsalicylic acid 1 gm/day prophylaxis of postoperative venous thromboembolism in elective total hip replacement. Patients were stratified according to age, and randomly assigned to receive drug or placebo. All patients were followed with 125I-labeled fibrinogen scanning for one week postoperatively, or until fully mobile. Venography was performed in 79/132 patients; in 36 patients the venogram was obtained to confirm a positive fibrinogen scan, in 43 patients an elective venogram was obtained on the seventh postoperative day to evaluate the operated thigh (a blind area for scanning). Thrombosis (by scan or venogram) was found in 17/68 (25%) in the control group, and in 23/64 (36%) in the treated group. Overall incidence was 40/132 (30%). Correlation of scan with venography was 90%. There were no clinically significant pulmonary emboli in either group. The combination of acetylsalicylic acid (ASA) and dipyridamole as given in this study is not effective prophylaxis in elective total hip replacement.