Table 1. AOCLE 2007 Case Report Workshop Update

Published / accepted for publication

Author(s) (School) / Title / Subject / Status
Miller, Giannoni, Perrigin (Houston) / A Case of Fungal Keratitis; A clinical and in vivo
confocal microscopy assessment / Accepted for publication:
Contact lens and Anterior Eye
Simard, Bitton (Montreal) / The use of high modulus silicone hydrogel (SiHy) lens in the management of
epithelial defects / Published:
Contact Lens and Anterior Eye, 4/2008
Scheid, Kaplan (SUNY) / A Novel Keratoconic Piggyback Fitting Utilizing a SiH Lens & a Synergeyes KC Hybrid / Published:
3/2008
Submitted
Author(s) (School) / Title / Subject / Status
Jurkus (ICO) / Case reports for IACLE Teaching Modules / Submitted
Moehnke, Terry, Wagner (NOVA) / Descemet's membrane detachment attributed to the mechanical forces of
airbag deployment / Submitted to Contact Lens and Anterior Eye
Henry, Bennett (UMSL) / Post-penetrating keratoplasty management with specialty design gas permeable lenses / Submitted to Optometry
Sorbara, Jones, Williams-Lyn (Waterloo) / Case Report: Contact Lens Induced Papillary Conjunctivitis with Silicone Hydrogel Lenses / Submitted to Contact Lens and Anterior Eye

In process or revision

Author(s) (School) / Title / Subject / Status
Conde-Seijo, Cabello (IAUPR) / The Use of Front Surface Toric Gas Permeable Lens to Correct Residual Astigmatism of a Keratoconus Patient / In revision
Kovacich, Pence, Robinson (IU) / Intacs Migration and Overlap: A Case Report / In process
Lotoczky, Morgan, Dinardo (MCO) / Gas Permeable Contact Lens Fitting After Penetrating Keratoplasty in a Patient with Fuchs’ Dystrophy / In process
Janoff, Wagner, Reynolds (NOVA) / Corneal complications of the human t-cell lymphotrophic virus-1 (HTLV-1) in the differential diagnosis of keratoconus / In revision
Silbert (PCO) / Pronounced Hyperopic Shift with Irregular Astigmatism in a
Patient with Radial Keratotomy / In process
Kinoshita, Smythe, Lampa (PUCO) / Clinical Findings and Contact Lens Management of Corneal Scarring Secondary to Pterygium Surgery / In process
Tran (SCCO) / Intracorneal Ring Segment Implants (INTACS): A Case of Corneal Channel Neovascularization Post Toric Hydrogel Contact Lens Wear / In process
Gordon, Clore (UAB) / Keratoconus in a pediatric patient / In process

Selected abstracts of case reports written as part of the workshop.

A case of fungal keratitis: A clinical and in vivo confocal microscopy assessment.

Miller,W.L.Giannoni,A.G.Perrigin,J.
University of Houston, College of Optometry

Abstract:

A presumed case of fungal keratitis is presented. Confocal images highlight the advantage of using such technology to follow therapeutic progress, particularly when standard laboratory testing is inconclusive. This case also demonstrates the importance of continued patient education regarding overall compliance and lens care.

The use of high modulus silicone hydrogel (SiHy) lens in the management of epithelial defects.

Simard,P.Bitton,E.
Ecole d'optometrie, Universite de Montreal, Montreal, Quebec, Canada.

Abstract:

Corneal dystrophies are relatively rare bilateral anomalies. Meesman dystrophy is typically asymptomatic with little effect on visual performance. This case highlights the use of a high modulus silicone hydrogel (SiHy) lens in the management of an atypical presentation of Meesman's dystrophy with associated visual impairment due to epithelial defects. The selection of a SiHy material provided increased oxygenation to re-establish corneal integrity. However, selecting the appropriate modulus was an additional factor to consider in this case since it had a direct effect on the visual outcome. The higher modulus SiHy lenses provided a better visual success for this patient than one with a lower modulus. Modulus consideration may prove to be an additional factor in the lens choice of SiHy in the management of epithelial defects.

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Post-penetrating keratoplasty management with specialty design gas permeable lenses

Vinita Allee Henry and Edward S. Bennett

University of Missouri St. Louis School of Optometry

Abstract :

Background: To demonstrate the use of specialty GP contact lenses with challenging patients following post-penetrating keratoplasty.

Case Report: Large diameter specialty design gas permeable (GP) lenses were fit to a 68 year old male who had post-penetrating keratoplasty OU with the procedures performed in the early 1980's. He was wearing a spherical GP lens on the right eye and a bitoric lens on the left eye and was not satisfied with his vision. The Rose K2 IC intra-limbal lens was fit to both eyes and, after a few adjustments to improve both vision and fitting relationship, he was enjoying good short-term success with these lenses.

Conclusions: Using the latest in manufacturing technology, new large diameter specialty lens designs, such as the Rose K2 IC, can be successful with post-penetrating keratoplasty patients.

CASE REPORT: CONTACT LENS INDUCED PAPILLARY CONJUNCTIVITIS WITH SILICONE HYDROGEL LENSES

L. Sorbara OD MSc, L. Jones PhD, and D. Williams-Lyn OD, PhD

University of Waterloo School of Optometry
Abstract:

Purpose: To describe the re-fitting of a soft lens wearer into a silicone hydrogel lens due to neovascularization. This change, in turn, caused contact lens induced papillary conjunctivitis (CLPC) and a further re-fitting was necessary.
Methods: The patient was refit into a high Dk surface treated silicone hydrogel with a high modulus value. A second re-fitting was undertaken into a lower Dk silicone hydrogel contact lens with a lower modulus value which had no surface treatment but incorporated an internal wetting agent.
Results: A high Dk/t lens was used to resolve existing neovascularization and chronic hyperaemia. Subsequently, CLPC response occurred, possibly due to poor front surface wetting and a high modulus, which irritated the under surface of the upper eyelid. This resulted in temporary lens discontinuation. A second silicone hydrogel lens was fitted, along with the use of a non-preserved care system, which led to improvement and eventual resolution of the condition.
Conclusion: High Dk silicone hydrogel lenses have shown excellent efficacy in resolving hypoxic complications such as neovascularization and hyperemia, but attention needs to be paid to the surface properties of lenses and their potential effect on the upper tarsal plate. More than one silicone hydrogel lens may be needed to help resolve these issues.

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The Use of Front Surface Toric Gas Permeable Lens to Correct Residual Astigmatism of a Keratoconus Patient

Manuel A. Conde-Seijo O.D., Iris Cabello O.D.

Inter-American University Puerto Rico

The purpose of this article is to report a case of a 23 y/o male complaining of blur vision OD with or without spectacle correction. He was seen in 2004 at our primary eye care clinic. Keratoconus was diagnosed in OD with no apparent corneal changes in OS at the date of the exam. Several Gas Permeable (GP) lenses were diagnostically fitted obtaining good results in OD with an aspheric GP lens. The left eye could not be fitted with a spherical GP lens because of a residual astigmatism that resulted with each fit. We tried fitting a Front Surface Toric GP

lens with good results. At this date the patient is still wearing one aspheric GP lens (Art Optical Keratoconus System) in OD and a Front Surface Toric GP lens OS with acuities of 20/20 OD, OS, and OU.

Intacs Migration and Overlap: A Case Report

Kovacich S, Pence N, Robinson T

Indiana University School of Optometry

Abstract:

Introduction: The application of intrastromal implants (Intacs®) for the treatment of mild myopia has been expanded to include therapeutic use for cornea ectasias such as keratoconus and pellucid marginal degeneration. While the utilization of this procedure to flatten myopic and irregular corneas is generally successful, complications can arise. The fact that the procedure can be reversed with the removal of the implants makes this a less drastic option compared to penetrating keratoplasy. Case: A case report detailing complications of Intacs migration which occurred after the implantation in an irregular cornea is described here. Conclusion: The use of Intacs is becoming more prevalent in the management of some pathological corneal irregularities. Unlike other surgical procedures, some of the complications resulting from the surgery can be alleviated by removing the implants. A review of the literature did not reveal other examples of Intacs migration after implantation. Ultimately, the complications in this case were resolved with the removal of the corneal segments.