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Fitting Gas-Permeable Contact Lenses After Penetrating Keratoplasty
491
Correspondence
Vol. 100, No.3
space of the rabbit. Invest. Ophthalmol. Vis. Sci. 22:292, 1982. 4. Frambach, D. A., Weiter, J. J., and Adler, A. J.: A photogrammetric method to measure fluid movement across isolated frog retinal pigment epithelium. Biophys. J. 47:547, 1985. 5. Frambach. D. A., and Misfeldt, D.S.: Furosemide sensitive Cl transport in embryonic chicken retinal pigment epithelium. Am. J. Physiol. 244:F679, 1983.
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8Y2 x ll-inch bond paper with 1Y2-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before formal publication. THE JOURNAL does not publish correspondence dealing with Letters. Such communications should be directed to the authors.
increased difficulty or complication rate specific to patients fitted while sutures were still in place, it seems advantageous to fit these patients early for more rapid visual rehabilitation, if contact lenses are indicated. Our patients were fitted successfully as early as 16 weeks postoperatively. Most subjects in the study by Genvert and associates, as well as in our own study, had keratoconus and presumably had pregraft contact lens experience. This experience increases the chances of a successful fit after keratoplasty. We commend the authors on their study, and suggest that if the suturing technique used includes buried knots, keratoplasty patients who require rigid contact lenses can be fitted early in the postoperative course, long before sutures are removed. Although such an approach may require refitting after suture removal, it allows for safe and rapid correction of vision.
MARK J. MANNIS, M.D. KARLA ZAONIK, 0.0.
Davis, California
Reference Fitting Gas-Permeable Contact Lenses After Penetrating Keratoplasty EDITOR:
We read with interest the article, "Fitting gas-permeable contact lenses after penetrating keratoplasty" (Am. J. Ophthalmol. 99:511, May 1985), by G. I. Genvert, E. J. Cohen, J. J. Arentsen, and P. R. Laibson. The authors conclude that gas-permeable hard contact lenses can be fitted successfully in most patients after penetrating keratoplasty with good visual results. It is interesting, however, that contact lenses were not usually fitted until after suture removal, approximately 12 to 18 months postoperatively. In a recent similar retrospective analysis of 29 eyes fitted with rigid contact lenses after keratoplasty, 1 we found that the effect of the presence of sutures on rigid contact lens wear was negligible. More than 40% of these patients had all or some of the sutures present at the time of fitting, and there appeared to be no influence of suture material on fitting success or contact lens tolerance. In view of the absence of any
1. Mannis, M. J., Zadnik, K., and Deutch, D.: Rigid contact lens wear in a corneal transplant patient. CLAD J., in press.
_ _ _ _ _ _ _ Reply EDITOR:
_
We prefer to delay gas-permeable hard contact lens fitting until 12 to 18 months postoperatively for reasons unrelated to the presence of sutures. During this period the refractive error is often variable. When there is significant and stable astigmatism, selected interrupted sutures are removed. A spectacle correction is given whenever possible. Wound healing is slow and incomplete after penetrating keratoplasty, leading to concern about trauma secondary to lens insertion or removal. Rejection episodes are most common during the first year postoperatively. Inflammation induced by contact lenses may be a factor predisposing to allograft rejection. The success reported by Mannis and Zadnik
Correspondence
Vol. 100, No.3
space of the rabbit. Invest. Ophthalmol. Vis. Sci. 22:292, 1982. 4. Frambach, D. A., Weiter, J. J., and Adler, A. J.: A photogrammetric method to measure fluid movement across isolated frog retinal pigment epithelium. Biophys. J. 47:547, 1985. 5. Frambach. D. A., and Misfeldt, D.S.: Furosemide sensitive Cl transport in embryonic chicken retinal pigment epithelium. Am. J. Physiol. 244:F679, 1983.
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 8Y2 x ll-inch bond paper with 1Y2-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before formal publication. THE JOURNAL does not publish correspondence dealing with Letters. Such communications should be directed to the authors.
increased difficulty or complication rate specific to patients fitted while sutures were still in place, it seems advantageous to fit these patients early for more rapid visual rehabilitation, if contact lenses are indicated. Our patients were fitted successfully as early as 16 weeks postoperatively. Most subjects in the study by Genvert and associates, as well as in our own study, had keratoconus and presumably had pregraft contact lens experience. This experience increases the chances of a successful fit after keratoplasty. We commend the authors on their study, and suggest that if the suturing technique used includes buried knots, keratoplasty patients who require rigid contact lenses can be fitted early in the postoperative course, long before sutures are removed. Although such an approach may require refitting after suture removal, it allows for safe and rapid correction of vision.
MARK J. MANNIS, M.D. KARLA ZAONIK, 0.0.
Davis, California
Reference Fitting Gas-Permeable Contact Lenses After Penetrating Keratoplasty EDITOR:
We read with interest the article, "Fitting gas-permeable contact lenses after penetrating keratoplasty" (Am. J. Ophthalmol. 99:511, May 1985), by G. I. Genvert, E. J. Cohen, J. J. Arentsen, and P. R. Laibson. The authors conclude that gas-permeable hard contact lenses can be fitted successfully in most patients after penetrating keratoplasty with good visual results. It is interesting, however, that contact lenses were not usually fitted until after suture removal, approximately 12 to 18 months postoperatively. In a recent similar retrospective analysis of 29 eyes fitted with rigid contact lenses after keratoplasty, 1 we found that the effect of the presence of sutures on rigid contact lens wear was negligible. More than 40% of these patients had all or some of the sutures present at the time of fitting, and there appeared to be no influence of suture material on fitting success or contact lens tolerance. In view of the absence of any
1. Mannis, M. J., Zadnik, K., and Deutch, D.: Rigid contact lens wear in a corneal transplant patient. CLAD J., in press.
_ _ _ _ _ _ _ Reply EDITOR:
_
We prefer to delay gas-permeable hard contact lens fitting until 12 to 18 months postoperatively for reasons unrelated to the presence of sutures. During this period the refractive error is often variable. When there is significant and stable astigmatism, selected interrupted sutures are removed. A spectacle correction is given whenever possible. Wound healing is slow and incomplete after penetrating keratoplasty, leading to concern about trauma secondary to lens insertion or removal. Rejection episodes are most common during the first year postoperatively. Inflammation induced by contact lenses may be a factor predisposing to allograft rejection. The success reported by Mannis and Zadnik