Transcript Style B 24 by 48 wide - Loyola University Chicago

Indications and outcomes of scleral contact lens for severe
ocular surface disease in the acute inpatient setting
1960/D941
Maylon Hsu, M.D.; Michael Nolan; Pooja Jamnadas, M.D., Amy Lin, M.D.
Loyola University Chicago Stritch School of Medicine, Department of Ophthalmology
Introduction
Results
Table 1. Indications and Outcomes of Scleral Lens Therapy
Scleral lenses are rigid, gas permeable contact
lenses that are usually custom fitted to an
individual’s eye and used to manage a variety of
ocular surface conditions. Recently they have
been applied to the inpatient setting, using a
preservative-free lubricating gel in the fluid
reservoir. The (PROSE) Posthetic replacement of
the ocular surface ecosystem device, formerly
known as the Boston Ocular Surface Prosthesis
(BOSP) and Jupiter Lens are custom-designed in
the inpatient setting, but the thicker gel allows for
the fit of the lens to be more forgiving against the
shape of the ocular surface. This study reports
the clinical courses and outcomes of a series of
patients who were treated with the BOSP and
Jupiter scleral lenses as inpatients.
Methods
Data was collected by retrospective chart review of all
patients who had insertion of the PROSE device or Jupiter
scleral lens as inpatients since 2008. The indication for
sclera lens placement and duration of use was recorded.
The health of the cornea, development of any
complications, and severity of other clinical findings such as
lagophthalmos, trichiasis, symblephara, and scarring was
recorded.
http://www.bostonsight.org
1
Patient ID Age
Time (days) Eye
Reason for Hospital Admission
Cause of Corneal Exposure
Lids / Lashes
Cornea
Outcome / Reason discontinued
1.1
20
2
OS
septic shock
sedation and AMS
5 mm lag
7x2mm epi defect
cornea unchanged, tarsorrapy placed
1.2
20
1
OD
septic shock
sedation and AMS
2 mm lag, poor Bell's
cornea clear
cornea unchanged, Pt expired
1.3
20
1
OS
septic shock
sedation and AMS
2 mm lag, Poor Bell's
cornea clear
cornea unchanged, Pt expired
2.1
61
1
OD
PICA aneurysm rupture
sedation and AMS
LL ectropion
2x3 mm epi defect
cornea unchanged, lateral tarsorrhaphy placed
3.1
52
4
OD
pemphigus vulgaris
lid damage
3 mm lag
6x5 mm epi defect and corneal abrasion
cornea healed, lag improved
4.1
24
15
OS
MVA - head trauma
sedation and AMS
3 mm lag
8x3 mm epi defect
epi defect decreased, tarsorrhaphy placed
5.1
70
13
OD
MG crisis
sedation and AMS
1 mm lag, poor blink reflex
1 mm epi defect and PEE
epi defect healed
5.2
70
13
OS
MG crisis
sedation and AMS
1 mm lag, poor blink reflex
1 mm epi defect and PEE
epi defect healed
6.1
52
2
OD
flame burn 50% TBSA
lid damage, sedation, AMS
singed lashes, lid edema, 3mm lag
epithelial haze
cornea unchanged, Pt expired
6.2
52
2
OS
flame burn 50% TBSA
lid damage, sedation, AMS
singed lashes, lid edema, 3mm lag
epithelial haze
cornea unchanged, Pt expired
7.1
42
3
OS
flame burn 48% TBSA
lid damage, sedation, AMS
burn damage to lids, intermittent lag
PEE
epi defect healed, tarsorrhaphy placed
7.2
42
4
OD
flame burn 48% TBSA
lid damage, sedation, AMS
3 mm lag, poor Bell's
clear cornea
improved lag
7.3
42
21
OD
flame burn 48% TBSA i
lid damage, sedation, AMS
3 mm lag, poor Bell's
clear cornea
cornea unchanged, tarsorrapy placed
7.4
42
21
OS
flame burn 48% TBSA
lid damage, sedation, AMS
tarsorrhaphy cheesewired, 4 mm lag, LL ectropion
clear cornea
cornea unchanged, tarsorrapy placed
7.5
42
24
OD
flame burn 48% TBSA
lid damage, sedation, AMS
7 mm lag, poor Bell's, LL ectropion
2 mm epi defect at margin
cornea unchanged, Pt expired
7.6
42
19
OS
flame burn 48% TBSA
lid damage, sedation, AMS
4 mm lag, poor Bell's, LL ectropion
1 mm ulcer, acinetobacter
cornea unchanged, Pt expired
8.1
21
10
OD
flame burn 20% TBSA
lid damage
UL edema, intermittent lag
6x3 mm epi defect
cornea clear, improved blink reflex
8.2
21
10
OS
flame burn 20% TBSA
lid damage
intermittent lag
5x3 mm epi defect
cornea clear, improved blink reflex
9.1
23
40
OS
flame burn
lid damage
burn damage to lids, intermittent lag
corneal abrasion
cornea improved, skin graft to lids
9.2
23
37
OD
flame burn
lid damage
burn damage to lids, intermittent lag
irregular epithelium
cornea improved, skin graft to lids
10.1
81
4
OD
flame burn to head
lid damage
sloughed epithelium, singed lashes
large central epi defect
epi defect decreased, lag resolved
10.2
81
1
OS
lid damage
sloughed epithelium, singed lashes
3x1 mm epi defect
cornea unchanged, Pt expired
11.1
2 weeks
8
OS
flame burn to head
hydrocephalus, possible Fraser
syndrome
lid agenesis
lid agenesis
4x2 mm epi defect
epi defect decreased, Switched to soft BCL
12.1
19
7
OD
MVA with facial degloving
lid damage and AMS
lid edema
epi defect inferior 1/2 of cornea
cornea unchanged, tarsorrapy placed
13.1
37
6
OD
MVA
sedation and AMS
sutured lid laceration, poor Bell's
4x2 mm epi defect
epi defect healed
13.2
37
6
OS
MVA
sedation and AMS
intermittent lag, poor Bell's
6x1 epi defect
epi defect healed
14.1
53
14
OD
flame burn 53% BSA
lid damage
singed lashes
confluent PEE nasally
epi defects resolved, no lag
14.2
53
14
OS
flame burn 53% BSA
lid damage
burn damage to lids, singed lashes
4x2 mm epi defect
epi defects resolved, no lag
14.3
53
3
OD
flame burn 53% BSA
lid damage
8mm lag, skin sloughing
3x2 mm epi defect and central PEE
cornea unchanged, Pt expired
14.4
53
3
OS
flame burn 53% BSA
lid damage
10 mm lag, skin sloughing
2x1 mm epi defect
cornea unchanged, Pt expired
2
3
4
Figures 1-4: Various
conditions requiring a scleral
lens: 1) lagophthalmos
secondary to sedation 2)
severe facial and eye lid
burns with cicatricial lag 3)
lagophthalmos with epithelial
defect and corneal scarrin 4)
severe facial and eyelid
malformation in 2 week old
Scleral Lenses were used in 14 patients. Some
patients required bilateral lenses, and one patient
with severe periocular burns required repeated
rounds of sclera lens therapy, resulting in a total of
30 cases. The age range was 2 weeks to 81 years
old. All patients had some degree of exposure
ranging from intermittent lag and poor lid closure to
over 1 cm of lagophthalmos. 6 patients had
cicatricial change; 5 due to flame burns and 1 due to
pemphigus vulgaris. 4 patients had lagophthalmos
secondary to sedation/ altered mental status. One
patient had complete exposure of the globe due to
agenesis of the eyelids at birth. The duration of
sclera lens use ranged from 1 day to 40 days (Mean
= 10.3 days, Median = 7 days). 5 patients expired
while being treated with scleral lenses. In 8 out of
the 30 cases, the sclera lens was discontinued
when a tarsorraphy was placed. In all cases the
corneal defects improved or remained stable.
Conclusion
The use of sclera lenses in the inpatient
setting is a safe and effective means of
protecting the cornea from damage due
to exposure. The lenses provide a more
stable precorneal tear film and decrease
the frequency of eyedrop administration
by nursing staff.
References
1. Rosenthal P, Cotter J. The Boston Scleral Lens in the management of severe
ocular surface disease. Ophthalmol Clin N Am. 2003;16:89-93.
2. Romero-Rangel T, Stavrou P, Cotter J et al. Gas-permeable scleral contact
lens therapy in ocular surface disease. Am J Ophthalmol. 2000;130:25-32.
3. Rosenthal P, Cotter J, Baum J. Treatment of persistent corneal epithelial
defect with extended wear of a fluid-ventilated gas-permeable scleral contact
lens. Am J Ophthalmol. 2000;130:33-41.
4. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens
is an effective option for managing severe ocular surface disease and many
corneal disorders that would otherwise require penetrating keratoplasty. Eye
and Contact Lens. 2005;31(3):130-134.
5. Jacobs DS. Update on scleral lenses. Curr Opin Ophthalmol. 2008;19:298301.
6. http://www.bostonsight.org
Acknowledgement: Grant Support:
The Richard A. Perritt Charitable Foundation.