Seven-year follow-up of unilateral multifocal pseudophakia in a child.

The purpose of the study was to report the long-term outcome of unilateral implantation of a multifocal intraocular lens (IOL) in a pediatric cataract. This study was carried out at Tertiary Academic Ophthalmology Department, AMC, Amsterdam. This is a case report study of a 7-year-old child with a unilateral irradiation cataract, in whom an apodized diffractive multifocal IOL (SN6D3, Alcon) was implanted at the time of cataract surgery. During the follow-up period, visual acuity was preserved at logMAR -0.1; the child did not develop amblyopia. Binocular single vision was established. Few glistenings were seen on the IOL. The non-operated eye developed more myopia during the follow-up period than the multifocally implanted eye. Straylight was increased to log(s) 1.83. Patient and parents satisfaction were high. In selected cases, unilateral implantation of apodized diffractive multifocal IOLs leads to good long-term results in terms of visual acuity and patient satisfaction. No untoward effects were seen, including few glistenings on the IOL. Straylight is increased, but subjectively not disturbing.

[The practice guideline 'The red eye' (first revision) of the Dutch College of General Practitioners; a response from the perspective ofthe ophthalmologist]. / De standaard 'Het rode oog' (eerste herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de oogheelkunde.

The revised guideline 'The red eye' of the Dutch College of General Practitioners contains adequate and scientifically well-supported recommendations for the diagnosis and management of patients with minor ocular trauma and red eyes. Unfortunately the guideline lacks a roadmap for implementation of these recommendations, as well as a definition of indicators for the measurement of implementation. This is important in the light of the limited implementation of the previous guideline 'The red eye' published in 1996.

A successful alternative: repair of a penetrating limbal wound by lamellar keratoplasty.

PURPOSE: To report repair of a penetrating limbal wound by lamellar keratoplasty 1 year post-traumatically. METHOD: Interventional case report. RESULTS: A 5-year-old boy had a self-inflicted injury leading to a limbal penetrating wound. The wound closed spontaneously by prolapsed subconjunctival uveal tissue and no intervention was planned. One year later surgical closure of the defect was necessary, as the amount of prolapsed tissue had increased. After excising the prolapsed tissue the wound was closed with a lamellar corneal graft, resulting in a quiet and stable anterior segment and a best-corrected visual acuity of 20/16. CONCLUSIONS: Lamellar keratoplasty can be a useful technique to repair a limbal penetrating wound. Corneal allografts have adequate tensile strength, low immunogenicity, and are easy to obtain.

[Eye problems due to contact lenses; an advisory report from the Health Council of the Netherlands]. / Oogproblemen door contactlenzen; een advies van de Gezondheidsraad.

In a recent report, the Committee on Health Risks of Contact Lenses from the Health Council of the Netherlands evaluated the health risks of contact lens wear in the Netherlands. Contact lens-related eye disease appears to be common, with an incidence of approximately 80,000 persons per year, who suffer from self-limiting or mild conditions. Such conditions are multifactorial, caused for example by chronic hypoxia, tear-film dysfunction or inadequate fit of the lens. They can range from ocular irritation to giant papillary conjunctivitis, a common cause of permanent lens intolerance. A very serious complication of contact lens wear is infectious keratitis, caused by bacteria or fungi. This is most common in users of permanent-wear soft lenses (20 per 10,000 persons per year) and can lead to a severe loss of vision. Therefore, the Committee has recommended that permanent-wear lenses should not be used. Moreover, lens fitting and follow-up of contact lens wearers should be a prerequisite for optometrists and ophthalmologists. However, the Dutch government has not taken action with respect to this last recommendation.

In vivo human corneal hydration control dynamics: a new model.

PURPOSE: To introduce a new model describing human in vivo corneal deswelling after hypoxic contact lens wear, based on a damped harmonic oscillator, which can describe an overshoot in corneal deswelling, to compare this new model with the currently used exponential model, and also to test whether a diurnal variation in baseline corneal thickness exists that would have to be taken into consideration when calculating corneal deswelling curves. METHODS: In nine healthy young adults, corneal thickness was measured every 30 minutes for 11.5 hours on average using modified optical pachometry (natural test). On another day, corneal deswelling was monitored for 11.1 hours on average after 2 hours of hypoxic contact lens wear (stress test). The damped harmonic oscillator model and the exponential model were used to calculate best-fitting deswelling curves. Natural test data were analyzed for the presence of a trend. Goodness of fit of the curves to the experimental data was analyzed using the F test. RESULTS: In 82% of the deswelling curves the new damped harmonic oscillator model provided a better fit to the data than the exponential model (P < 0.05). An average overshoot in corneal thickness recovery of 5 microm (range, 0-11 microm) was found. In 50% of the natural tests significant trends were found, without any consistent similarities. The overshoot could not be explained by these trends. CONCLUSIONS: The new damped harmonic oscillator model describes corneal deswelling after hypoxic contact lens wear more accurately than the exponential model. No consistent diurnal variation could be demonstrated.

Morphology and function of the corneal endothelium after long-term contact lens wear.

PURPOSE: To examine whether corneal hydration control is impaired in corneas with endothelial morphologic changes (increased variation in cell size and cell angularity) due to long-term low gas-permeable contact lens wear. METHODS: Twenty-one long-term wearers of low gas-permeable contact lenses (mean age, 41 years +/- 8 SD) and 18 age-matched controls (mean age, 42 years +/- 8 SD) were studied. To assess endothelial morphology, endothelial photographs were taken, enlarged 400X, scanned into a computer, and evaluated. Hydration control was assessed by a corneal stress test. Corneal swelling was induced by applying low gas-permeable soft contact lenses for 2 hours during eye closure. After the lenses were removed, the rate of deswelling was determined using optic pachometry. RESULTS: Morphologic analysis of the endothelial photographs showed a significant increase of polymegethism (P < 0.01) and pleomorphism (P < 0.01) in the group wearing contact lenses compared with the control group. The percentage of recovery of corneal thickness per hour (PRPH) from induced swelling proved to be significantly lower (P = 0.03) and the induced swelling proved to be significantly lower (P < 0.01) in the group wearing contact lenses than in the control group. Multiple regression analysis showed that the PRPH decreased as the morphologic alterations increased. However, this trend appeared not to be significant at the 5% level. A significant relationship was found between morphologic parameters and induced swelling, indicating that induced swelling decreased as the morphologic alterations increased. CONCLUSION: The results of this study indicate that increased endothelial polymegethism and pleomorphism may be accompanied by a decreased corneal hydration control in people who wear contact lenses.

Corneal endothelial cell morphology under permanent wear of rigid contact lenses.

The influence of the permanent wear of rigid high Dk-lenses (nominal Dk 71 or 92) with elliptical geometry on the corneal endothelium was assessed. For this purpose the endothelium of 16 patients was compared by specular microscopy before and after the permanent wear. The wearing time of the lenses varied between 7 and 24 months. Computerized morphometric analysis of the photographs revealed that the variability in cell size (polymegathism) and in cell shape (pleomorphism) did not change during the wearing period. It is suggested that this is due to the high gas-permeability and the elliptical geometry of the contact lenses.