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Fuchs' Superficial Marginal Keratitis: A Rare Clinical Case
Poster Presentations the myopic amblyope’s vision plateaus or is immune to visual improvement. Many theories have been put forth to explain why this occurs, including axial elongation, a family history of high myopia, ocular pathology, a disturbance in the process of emmetropization, and retinal hemorrhage during birth leading to a poorly organized macula. Methods: Three pediatric patients (6, 9, and 11 years old) with anisometropic myopic amblyopia were studied with an OCT looking for macular irregularity between the high myopic eye (.7 D) and the nonmyopic or low myopic eye (,1 D). The best-corrected visual acuity achieved by each of the patients was at least 20/400 at distance and 20/200 at near in the myopic eye and 20/20 at distance and near in the nonmyopic eye. The refractive error ranges from 7.00 to 11.00 DS of myopia and 2.00 to 4.00 DC of astigmatism with 7.00 to 9.50 D of anisometropia. Strabismus was absent in all the patients. Results: The patients have been patching the nonamblyopic eye for 2 hours per day with at least 30 minutes of near work for more than 2 months with no improvement in the visual acuity. The dilated fundus examination on all patients revealed no ocular pathology. The OCT shows obvious structural differences between the myopic and nonmyopic eye of each patient. Conclusion: When clinical and pathological conditions causing anisomyopia are absent, further investigation is warranted to determine if structural irregularities are present, preventing successful amblyopia treatment. This case study contains evidence that strongly suggests anisometropic myopic amblyopes have structural irregularities of the foveal pit as shown with OCT. Further study with a greater number of subjects should be undertaken.
287 Results: There was no difference in reflectivity of basal laminar cells, nerve plexus layer, or superficial stroma between contralateral eyes, indicating that sodium fluorescein instillation does not impact HRT confocal images. In addition, 2 hours of lens wear did not have a substantial effect on these corneal structures. Patients presented with varying numbers of Langerhans cells (range: 0 to 42 cells/scan area). There was no difference in the average number of Langerhans cells detected between the non–contact lens wearers (5.0 cells/ scan area) and the traditional hydrogel lens wearers (5.0 cells/scan area) at baseline. A slightly higher average number of Langerhans cells were observed in silicone hydrogel lens wearers (7.2 cells/scan area) at baseline. Acute lens wear did not have a significant impact on the corneal structure or the number of Langerhans cells in any group. Conclusions: Sodium fluorescein instillation does not impact HRT confocal data. While there were slight differences noted between the habitual silicone and traditional hydrogel lens wearers, further study is required to differentiate between lens effects and other environmental effects. Use of confocal microscopy to evaluate changes in corneal structures as a result of contact lens wear and solutions use is a growing area of research. Therefore, an increased understanding of the technique will be critical for appropriate data interpretation. Further studies are required to understand what hyper-reflective cells represent, the cause(s) of Langerhans cell migration into the cornea, and the utility of confocal microscopy to assess changes in corneal structure over time. (Investigation received grant support: Alcon Research Ltd.)
Poster 4
Contact Lens Poster 3 Impact of Contact Lens Wear and Sodium Fluorescein Instillation on HRT Confocal Microscopy Christine Sindt, O.D., Janet Tsui, M.D., and Trudy Grout, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 Purpose: This series of acute observations aimed to ascertain the histologic effect of contact lens wear and sodium fluorescein instillation using HRT confocal microscopy. Methods: This was a series of contralateral eye, controlled, investigator-masked observations. Ten non–contact lens wearers, 13 hydrogel lens wearers, and 23 silicone hydrogel lens wearers were assessed. Sodium fluorescein was randomly instilled in 1 eye of each subject. All patients underwent HRT confocal microscopy (Heidelberg, Germany) before lens insertion and after 2 hours of lens wear. The anterior stroma, nerve plexus, basal epithelium, and superficial epithelium were analyzed for changes and the presence of hyper-reflective cells. Indicators of immune response were noted.
Fuchs’ Superficial Marginal Keratitis: A Rare Clinical Case Jacqueline Haro, O.D., Eric Drey, B.A., Louise Sclafani, O.D., and Michael Saidel, M.D., Illinois College of Optometry/Illinois Eye Institute, 3241 South Michigan Avenue, Chicago, Illinois 60616 Background: Fuchs’ superficial marginal keratitis is a rare condition found in middle-age adults that is characterized by a chronic course of recurrent ocular irritation with spontaneous remission. It presents initially with marginal infiltrates and progresses into marginal superficial stromal thinning. Pseudopterygium, which does not extend into the central cornea, may also develop over the areas of recurrent keratitis and stromal thinning. Case Summary: This case discusses the treatment of a 41year-old woman with bilateral recurrent corneal infiltration, thinning, and pseudopterygium formation consistent with Fuchs’ superficial marginal keratitis. Prednisolone acetate, cyclosporin A, and an intralimbal rigid gas-permeable contact lens were used in the treatment and management of this condition. This protocol was effective not only in the regression of the condition but also in the improvement of the patient’s quality of vision.
288 Conclusion: Current surgical treatments, which include lamellar keratoplasty and combined superficial keratectomy with conjunctival autograft, may lead to complications such as corneal perforation or recurrence of marginal keratitis in the graft. The use of rigid gas-permeable contact lenses is a viable option to improve vision and prolong the necessity of surgical intervention in Fuchs’ superficial marginal keratitis.
Poster 5 Safety Evaluation of Systane UltraÒ in Contact Lens Wearers David Kading, O.D., Specialty Eyecare Group, 11830 NE 128th Street, Kirkland, Washington 98034 Objective: The aim of this study was to evaluate the safety of Systane UltraÒ containing polyethylene glycol 400 and propylene glycol demulcents with hydroxypropyl-guar as a gelling agent (Test Solution) in contact lens wearers. A comparison to a currently marketed contact lens rewetting drop was included as a control. Participants: This was an investigator- and patientmasked, single-site, randomized, prospective study of 2 weeks duration involving 47 successful contact lens wearers with good ocular and general health. Methods: At the screening visit, eligible subjects’ baseline visual acuities and biomicroscopy findings were recorded. Subjects were randomly assigned to receive either the test solution or the control with masked labeling in prenumbered kits. Subjects were instructed to instill their assigned test article in both eyes 15 minutes before lens insertion, at least one drop during lens wear and another drop immediately after lens removal. After 14 days, biomicroscopy, including sum corneal staining and visual acuity results, were recorded. Results: There were no adverse events documented for either the test or control solution. Biomicroscopic evaluations were within normal limits for both test and control solutions and visual acuity was not affected by treatment. Conclusions: These results indicate that Systane Ultra is compatible for use with contact lenses. (Investigators received grant support funded by Alcon Laboratories.)
Optometry, Vol 80, No 6, June 2009 and environmental isolates of Fusarium based on the International Organization for Standardization (ISO) and the U.S. Food and Drug Administration (FDA) Stand-Alone Procedure for disinfecting products. Method: Marketed solutions were challenged with clinical and environmental strains of Fusarium based on the ISO and FDA Stand-Alone Procedure for disinfecting products. Solutions were sampled for surviving microorganisms at the recommended disinfection time, 24 hours and 7 and 14 days. Serial dilutions and pour plates were prepared using validated recovery media. Appropriate incubation times and temperatures were observed. The numbers of viable microorganisms were enumerated and log reductions calculated. The following antimicrobial systems were evaluated: 1) PolyquadÒ (polyquaternium-1)/AldoxÒ (myristamidopropyl dimethylamine), 2) PHMB (polyhexamethylene biguanide), and 3) hydrogen peroxide (3% hydrogen peroxide w/neutralizing system). Results: Solutions containing Polyquad/Aldox and 3% hydrogen peroxide showed similar log reduction activity at the disinfection time (2.0 logs or greater). Solutions containing PHMB showed lower log reduction activity than Polyquad/Aldox and hydrogen peroxide systems at the disinfection time (1.0 log or less). At extended storage times of 7 and 14 days, the Polyquad/Aldox and PHMB systems were effective against regrowth for all microorganisms. Only solutions containing 3% hydrogen peroxide showed regrowth of one or more microorganisms when stored for extended periods. Conclusion: Contact lens care solutions containing the dual antimicrobial system Polyquad/Aldox were effective against clinical and environmental isolates of Fusarium at the disinfection time as well as extended storage times of 7 and 14 days. Hydrogen peroxide systems were effective at the disinfection time, but because of neutralization (at disinfection time) allowed regrowth of one or more microorganisms at 7 and/or 14 days extended storage. Both PHMB and Polyquad/Aldox solutions were effective at extended storage times and showed no regrowth of microorganisms. The results of this study indicate the importance of choosing a solution with a robust antimicrobial system that kills at the disinfection time as well as inhibits regrowth of clinical and environmental isolates of Fusarium. (Investigators are employees of Alcon Laboratories.)
Poster 6 Fungicidal Activity of Contact Lens Care Solutions Challenged With Clinical and Environmental Isolates of Fusarium Cindy L. McAnally, B.S., and Roya N Borazjani, Ph.D., Alcon Laboratories, 6201 South Freeway, Fort Worth, Texas 76134 Background: Because of recent outbreaks of Fusarium keratitis associated with a multipurpose contact lens care solution, the fungicidal efficacy of 4 multipurpose solutions and 2 hydrogen peroxide systems was evaluated against clinical
Poster 7 Fluorescence Measurements in Contact Lenses With a Novel Confocal Microscope Ryan Gustus, Matthew S. Muller, M.S., Dean A. VanNasdale, O.D., and Anne Elsner, Ph.D., Indiana University School of Optometry, 800 E. Atwater St., Bloomington, Indiana 47405 Background: We measured the retention of sodium fluorescein in contact lenses, because topical fluorescein is
287 Results: There was no difference in reflectivity of basal laminar cells, nerve plexus layer, or superficial stroma between contralateral eyes, indicating that sodium fluorescein instillation does not impact HRT confocal images. In addition, 2 hours of lens wear did not have a substantial effect on these corneal structures. Patients presented with varying numbers of Langerhans cells (range: 0 to 42 cells/scan area). There was no difference in the average number of Langerhans cells detected between the non–contact lens wearers (5.0 cells/ scan area) and the traditional hydrogel lens wearers (5.0 cells/scan area) at baseline. A slightly higher average number of Langerhans cells were observed in silicone hydrogel lens wearers (7.2 cells/scan area) at baseline. Acute lens wear did not have a significant impact on the corneal structure or the number of Langerhans cells in any group. Conclusions: Sodium fluorescein instillation does not impact HRT confocal data. While there were slight differences noted between the habitual silicone and traditional hydrogel lens wearers, further study is required to differentiate between lens effects and other environmental effects. Use of confocal microscopy to evaluate changes in corneal structures as a result of contact lens wear and solutions use is a growing area of research. Therefore, an increased understanding of the technique will be critical for appropriate data interpretation. Further studies are required to understand what hyper-reflective cells represent, the cause(s) of Langerhans cell migration into the cornea, and the utility of confocal microscopy to assess changes in corneal structure over time. (Investigation received grant support: Alcon Research Ltd.)
Poster 4
Contact Lens Poster 3 Impact of Contact Lens Wear and Sodium Fluorescein Instillation on HRT Confocal Microscopy Christine Sindt, O.D., Janet Tsui, M.D., and Trudy Grout, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 Purpose: This series of acute observations aimed to ascertain the histologic effect of contact lens wear and sodium fluorescein instillation using HRT confocal microscopy. Methods: This was a series of contralateral eye, controlled, investigator-masked observations. Ten non–contact lens wearers, 13 hydrogel lens wearers, and 23 silicone hydrogel lens wearers were assessed. Sodium fluorescein was randomly instilled in 1 eye of each subject. All patients underwent HRT confocal microscopy (Heidelberg, Germany) before lens insertion and after 2 hours of lens wear. The anterior stroma, nerve plexus, basal epithelium, and superficial epithelium were analyzed for changes and the presence of hyper-reflective cells. Indicators of immune response were noted.
Fuchs’ Superficial Marginal Keratitis: A Rare Clinical Case Jacqueline Haro, O.D., Eric Drey, B.A., Louise Sclafani, O.D., and Michael Saidel, M.D., Illinois College of Optometry/Illinois Eye Institute, 3241 South Michigan Avenue, Chicago, Illinois 60616 Background: Fuchs’ superficial marginal keratitis is a rare condition found in middle-age adults that is characterized by a chronic course of recurrent ocular irritation with spontaneous remission. It presents initially with marginal infiltrates and progresses into marginal superficial stromal thinning. Pseudopterygium, which does not extend into the central cornea, may also develop over the areas of recurrent keratitis and stromal thinning. Case Summary: This case discusses the treatment of a 41year-old woman with bilateral recurrent corneal infiltration, thinning, and pseudopterygium formation consistent with Fuchs’ superficial marginal keratitis. Prednisolone acetate, cyclosporin A, and an intralimbal rigid gas-permeable contact lens were used in the treatment and management of this condition. This protocol was effective not only in the regression of the condition but also in the improvement of the patient’s quality of vision.
288 Conclusion: Current surgical treatments, which include lamellar keratoplasty and combined superficial keratectomy with conjunctival autograft, may lead to complications such as corneal perforation or recurrence of marginal keratitis in the graft. The use of rigid gas-permeable contact lenses is a viable option to improve vision and prolong the necessity of surgical intervention in Fuchs’ superficial marginal keratitis.
Poster 5 Safety Evaluation of Systane UltraÒ in Contact Lens Wearers David Kading, O.D., Specialty Eyecare Group, 11830 NE 128th Street, Kirkland, Washington 98034 Objective: The aim of this study was to evaluate the safety of Systane UltraÒ containing polyethylene glycol 400 and propylene glycol demulcents with hydroxypropyl-guar as a gelling agent (Test Solution) in contact lens wearers. A comparison to a currently marketed contact lens rewetting drop was included as a control. Participants: This was an investigator- and patientmasked, single-site, randomized, prospective study of 2 weeks duration involving 47 successful contact lens wearers with good ocular and general health. Methods: At the screening visit, eligible subjects’ baseline visual acuities and biomicroscopy findings were recorded. Subjects were randomly assigned to receive either the test solution or the control with masked labeling in prenumbered kits. Subjects were instructed to instill their assigned test article in both eyes 15 minutes before lens insertion, at least one drop during lens wear and another drop immediately after lens removal. After 14 days, biomicroscopy, including sum corneal staining and visual acuity results, were recorded. Results: There were no adverse events documented for either the test or control solution. Biomicroscopic evaluations were within normal limits for both test and control solutions and visual acuity was not affected by treatment. Conclusions: These results indicate that Systane Ultra is compatible for use with contact lenses. (Investigators received grant support funded by Alcon Laboratories.)
Optometry, Vol 80, No 6, June 2009 and environmental isolates of Fusarium based on the International Organization for Standardization (ISO) and the U.S. Food and Drug Administration (FDA) Stand-Alone Procedure for disinfecting products. Method: Marketed solutions were challenged with clinical and environmental strains of Fusarium based on the ISO and FDA Stand-Alone Procedure for disinfecting products. Solutions were sampled for surviving microorganisms at the recommended disinfection time, 24 hours and 7 and 14 days. Serial dilutions and pour plates were prepared using validated recovery media. Appropriate incubation times and temperatures were observed. The numbers of viable microorganisms were enumerated and log reductions calculated. The following antimicrobial systems were evaluated: 1) PolyquadÒ (polyquaternium-1)/AldoxÒ (myristamidopropyl dimethylamine), 2) PHMB (polyhexamethylene biguanide), and 3) hydrogen peroxide (3% hydrogen peroxide w/neutralizing system). Results: Solutions containing Polyquad/Aldox and 3% hydrogen peroxide showed similar log reduction activity at the disinfection time (2.0 logs or greater). Solutions containing PHMB showed lower log reduction activity than Polyquad/Aldox and hydrogen peroxide systems at the disinfection time (1.0 log or less). At extended storage times of 7 and 14 days, the Polyquad/Aldox and PHMB systems were effective against regrowth for all microorganisms. Only solutions containing 3% hydrogen peroxide showed regrowth of one or more microorganisms when stored for extended periods. Conclusion: Contact lens care solutions containing the dual antimicrobial system Polyquad/Aldox were effective against clinical and environmental isolates of Fusarium at the disinfection time as well as extended storage times of 7 and 14 days. Hydrogen peroxide systems were effective at the disinfection time, but because of neutralization (at disinfection time) allowed regrowth of one or more microorganisms at 7 and/or 14 days extended storage. Both PHMB and Polyquad/Aldox solutions were effective at extended storage times and showed no regrowth of microorganisms. The results of this study indicate the importance of choosing a solution with a robust antimicrobial system that kills at the disinfection time as well as inhibits regrowth of clinical and environmental isolates of Fusarium. (Investigators are employees of Alcon Laboratories.)
Poster 6 Fungicidal Activity of Contact Lens Care Solutions Challenged With Clinical and Environmental Isolates of Fusarium Cindy L. McAnally, B.S., and Roya N Borazjani, Ph.D., Alcon Laboratories, 6201 South Freeway, Fort Worth, Texas 76134 Background: Because of recent outbreaks of Fusarium keratitis associated with a multipurpose contact lens care solution, the fungicidal efficacy of 4 multipurpose solutions and 2 hydrogen peroxide systems was evaluated against clinical
Poster 7 Fluorescence Measurements in Contact Lenses With a Novel Confocal Microscope Ryan Gustus, Matthew S. Muller, M.S., Dean A. VanNasdale, O.D., and Anne Elsner, Ph.D., Indiana University School of Optometry, 800 E. Atwater St., Bloomington, Indiana 47405 Background: We measured the retention of sodium fluorescein in contact lenses, because topical fluorescein is