Erdinest Nir, London Naomi, Levinger Nadav, Lavy Itay
Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Israel.
Private Practice, Jerusalem, Israel.
Am J Ophthalmol Case Rep. 2021 Dec 9;25:101242. doi: 10.1016/j.ajoc.2021.101242. eCollection 2022 Mar.
This case report demonstrates the effectiveness of a combined unique soft contact lens design and hypertonic saline at reducing corneal edema symptoms. In addition, this case shows that using tomographic data is invaluable for detecting and monitoring of these presentations.
A 61 year old patient diagnosed with Fuchs endothelial corneal dystrophy (FECD) presented with complaints over the past year of intermittent blurry, foggy vision upon awakening and glare while driving. Slit lamp examination showed no signs of corneal edema. Data acquired from the Scheimpflug tomographer revealed subclinical signs, including increased corneal thickness, displacement of the thinnest point of the cornea, focal posterior depression, elevated densinometry, "camel's back" sign, irregular isopachs, and a plane slope of pachymetry progression in both eyes. The patient was fit with Therapeutic Hyper-CL™ soft contact lenses for eight days extended wear and instilled 5% sodium chloride six times a day. Visual acuity improved in the right and left eye from 0.5(-2) and 0.5(+1) to 0.4(+2) and 0.3(-1), respectively. Corneal thickness at the thinnest point decreased from 650μm to 632μm-632μm and 604μm in the right and left eye respectively and a significant decrease in total densinometry was noted from 34.7 to 33.8 standardized grayscale units (GSU) to 23.1 and 24 GSU, in the right and left eye respectively. The patient reported a decrease in symptoms and his 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) score was 19 after treatment.
Treatment for one week with Therapeutic Hyper-CL™ soft contact lenses combined with 5% sodium chloride decreased corneal edema signs and symptoms. Tomographic data facilitated diagnosis and monitoring of improvement.
本病例报告展示了一种独特的软性接触镜设计与高渗盐水联合使用在减轻角膜水肿症状方面的有效性。此外，本病例表明，使用断层扫描数据对于检测和监测这些表现非常重要。
一名61岁被诊断为富克斯内皮性角膜营养不良（FECD）的患者，在过去一年中出现晨起时间歇性视物模糊、朦胧以及驾车时眩光的症状。裂隙灯检查未发现角膜水肿迹象。从眼前节分析系统获取的数据显示存在亚临床体征，包括角膜厚度增加、角膜最薄点移位、局部后弹力层凹陷、密度计读数升高、“驼峰”征、等厚线不规则以及双眼角膜厚度测量进展的平面斜率。该患者佩戴治疗性Hyper - CL™软性接触镜，连续佩戴8天，并每天滴注6次5%氯化钠溶液。右眼和左眼的视力分别从0.5（-2）和0.5（+1）提高到0.4（+2）和0.3（-1）。右眼和左眼最薄点处的角膜厚度分别从650μm降至632μm - 632μm和604μm，并且密度计总读数分别从34.7至33.8标准化灰度单位（GSU）显著降至23.1和24 GSU。患者报告症状减轻，治疗后其8项接触镜干眼问卷（CLDEQ - 8）评分为19分。
使用治疗性Hyper - CL™软性接触镜联合5%氯化钠治疗一周可减轻角膜水肿的体征和症状。断层扫描数据有助于诊断和监测病情改善情况。
