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Purpose: Ocular hypotony after trabeculectomy may be treated medically, surgically and with a tamponade. Three cases are reported in which a scleral lens was applied to treat ocular hypotony after mitomycin C (MMC) augmented trabeculectomy., Methods: In this retrospective case series the records of three eyes of three patients who developed ocular hypotony after they had undergone trabeculectomy augmented with MMC were evaluated. The patients were between 11 and 69 years of age and the intraocular pressure (IOP) after surgery ranged between 3 and 6 mmHg. All three patients showed a negative Seidel test; one had suspected hypotonic maculopathy and one had a collapsed anterior chamber. After unsuccessful treatment with large bandage lenses all three patients were subsequently fitted with a scleral lens. The scleral lens was fitted to fully cover and compress the bleb. Scleral lenses were worn continuously with a check-up after one night of wear and subsequent check-ups when needed. One patient continued to wear the scleral lens for a further 6.5 months on a daily wear basis., Results: In all three eyes the IOP was higher after wearing the scleral lens. Two patients stopped wearing the scleral lens after the IOP was stable. One patient developed a cataract; the cataract surgery was combined with a bleb revision and scleral lens wear was therefore discontinued., Discussion: The scleral lens might be a useful tool in the treatment of ocular hypotony after trabeculectomy augmented MMC surgery. The effect of the scleral lens on the ocular pressure is unpredictable. Caution is advised in vulnerable corneas due to risk factors such as hypoxia and infection. Further research is warranted to establish the safety of the procedure, the patient selection and the overall success in a larger patient group., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Significance: New bitangential mini-scleral lens designs provide a highly precise fit, follow the scleral shape, are comfortable to wear, and can correct residual astigmatism. This new scleral lens design complements the arsenal of medical contact lenses available to eye care practitioners., Purpose: The aim of this study was to evaluate the subjective and objective performance of a new mini-scleral lens design with a bitangential periphery., Methods: In this observational study, data were collected for up to 15 months (median, 84 days; interquartile range, 76 days) from the left eyes of 133 patients fitted with this newly designed lens. Data were recorded during regular visits at Visser Contact Lens Practice's scleral lens clinics: diagnosis, clinical indication for scleral lenses, previous contact lens type, subjective performance, horizontal visible iris diameter, corrected distance visual acuity, and scleral lens fitting characteristics., Results: The most common indication was keratoconus (45%), followed by irregular astigmatism (22%), keratoplasty (16.5%), ocular surface disease (13.5%), and other forms of irregular astigmatism (3%). The majority of patients (79%) scored comfort as either a 4 or 5 (out of 5), and 82% wore their lenses 12 hours or longer a day. Most lenses (81%) had a diameter of 16 mm (median, 16 mm; range, 15.5 to 17 mm) and were composed of Boston XO2 (46%), Menicon Z (44%), Boston XO (9%), or Boston Equalens II (1%). The median corrected distance visual acuity was 0.022 logarithm of the minimal angle of resolution (interquartile range, 0.155). The fitting characteristics revealed optimal values for centration and movement in 91% and 83%, respectively. Finally, the median stabilization axis was 50 degrees., Conclusions: New mini-scleral lenses with bitangential peripheral geometry yield satisfactory clinical results and good subjective performance and are therefore an effective option for managing patients who have irregular astigmatism or other corneal pathology.

Purpose: To evaluate the performance of medical contact lenses (CLs) for a wide range of clinical indications., Design: Prospective cross-sectional study., Methods: A total of 281 eyes were evaluated in 281 consecutive patients (≥18 years of age; CL use ≥3 months) who visited the contact lens service in a tertiary academic clinic for a scheduled follow-up visit. The main outcome measured were clinical indications for CL wear; CL type; change in corrected distance visual acuity (CDVA) with CL use; CL wearing duration; CL wearing time; subjective performance measured using a visual analog scale (VAS) questionnaire (score range: 0-100); and effectiveness of the lens-selection algorithm., Results: Wearing CLs significantly improved CDVA compared to wearing spectacles (median change: -0.15 logMAR, range: 1.00 to -2.10; P<.001). Daily-wear CLs were worn by 77% of patients for a median of 15h/day (range: 5-18h/day), median 7 days/week (range: 1-7 days/week). High subjective scores were measured, with similar results obtained between the scleral lens and soft lens groups. The medical CL fitting was found to be generally effective (the overall satisfaction rating was ≥70 for 81% of patients)., Conclusions: Fitting CLs based on the lens-selection algorithm yielded positive clinical results, including improved visual acuity, satisfactory wearing time, and high overall subjective performance. Moreover, subjective performance was similar between users of scleral lenses and users of soft lenses. These results underscore the importance of prescribing scleral lenses and the need for tertiary eye clinics to offer patients a variety of CL types., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objectives: To investigate the influence of full scleral lenses on corneal curvature and pachymetry in keratoconus patients., Methods: In this intervention study, 20 eyes of 14 patients were measured by Scheimpflug imaging (Pentacam HR, Oculus) at two time points: directly and ≥1 week after scleral lens removal. Steep, flat and maximal keratometry (K(steep), K(flat) and K(max)) and optical pachymetry were analyzed. A generalized estimating equation analysis was performed to correct for paired eyes., Results: Directly after scleral lens removal, all three curvature parameters were significantly flatter compared to ≥1 week after scleral lens removal. Average K(steep) was 0.7 diopter (D) lower (P<0.001), average K(flat) was 0.5D lower (P=0.037) and average K(max) was 1.1D lower (P<0.001). Directly after scleral lens removal, average optical pachymetry was ±2.5% higher (P<0.001) compared to ≥1 week after scleral lens removal., Conclusions: Although scleral lenses do not mechanically touch the cornea, curvature and pachymetry seem to be influenced by scleral lens wear in keratoconus patients. The duration of these changes remain unclear., (Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Subjective and objective evaluation of scleral lens tolerance and fitting before and after corneal cross-linking (CXL) for progressive keratoconus., Methods: In this prospective cohort, evaluations were made of 18 unilateral eyes in patients who underwent CXL and had been wearing scleral lenses before the procedure. All the patients gave informed consent; they were able to cooperate with the study, were eligible for CXL, had been wearing well-fitting scleral lenses for at least 3 months, and had no other active ocular disease. Data were collected before and 1 year after CXL. Outcome measures were changes in clinical and subjective scleral lens performance. The following components were studied: scleral lens corrected distance visual acuity, scleral lens specifications, scleral lens fit, wearing time, and subjective measures on visual analogue scale questionnaires (1 to 100 mm)., Results: There was no significant change in scleral lens corrected distance visual acuity (p = 0.632). Sixty-one percent of eyes needed a scleral lens fit and/or power change. Wearing time (median, 16 hours per day) and subjective tolerance were found to be stable., Conclusions: Scleral lens tolerance after CXL appeared to be stable.

Purpose: To evaluate the clinical results of a new scleral lens design with a bitangential (nonrotationally symmetrical) periphery., Methods: All the necessary data were obtained during the 1-year study period. The bitangential scleral lenses were fitted and monitored according to a standardized fitting methodology. They were cut by precise submicron lathing from high-oxygen-permeable materials (including 10 scleral lenses from Menicon Z material). Subjective performance, visual acuity, and scleral lens-fitting characteristics were recorded after a median of 9.4 weeks (range, 3 weeks to 1 year)., Results: Diagnoses in the 213 eyes (in 144 patients) were keratoconus (n = 121 eyes; 56.8%), ocular surface diseases (n = 31 eyes; 14.6%), penetrating keratoplasty (n = 29 eyes; 13.6%), and other forms of irregular astigmatism (n = 28 eyes; 13.1%). Many patients (164 lenses; 77.0%) gave high ratings for comfort. The most common diameter was 20.0 mm (162 lenses; 76.1%) (range, 18.5 to 21.5 mm). Median decimal best-corrected visual acuity with the bitangential scleral lenses was 0.8 (equivalent to Snellen 20/25) (range, 0 to 1.5). Most bitangential scleral lenses showed good fitting characteristics: optimal values were seen for lens movement (208 lenses; 97.7%) and lens position (208 lenses; 97.7%). Median central corneal clearance was 0.2 mm; clearances differed in the four peripheral directions. The median stabilization axis was 140 degrees (range, 0 to 180 degrees) in the right eyes and 60 degrees (range, 0 to 180 degrees) in the left eyes., Conclusions: The bitangential scleral lens-fitting and performance characteristics were clear and effective for the health professional and the patient. The high-oxygen-permeable material Menicon Z may, in theory, be of benefit to corneas with a high oxygen demand.

Purpose: To evaluate the subjective performance of modern scleral lenses in patients of the clinics of Visser Contact Lens Practice., Methods: In this cross-sectional survey, all the necessary data were collected at the first follow-up visit during the 5-month study period. In accordance with the preformed fitting technique developed at Visser Contact Lens Practice, four types of scleral lenses were used: spherical, front-surface toric, back-surface toric, and bitoric. Subjective performance was investigated during an interview that included the use of a five-point Likert scale and by means of a questionnaire supplemented by a 100-mm visual analog scale (VAS)., Results: The interview and questionnaire showed high scores for patient satisfaction with the current scleral lens in the 178 patients (284 eyes) (median score, 4; range Likert scale, 1-5; median score, >or=75; range VAS, 1-100). Significant increases in scores were seen with the current scleral lens compared to the former correction: 78.9% for comfort, 78.2% for visual quality, and 87.7% for overall satisfaction (n=284 eyes) (P<0.001). In the 99 eyes that switched from back-surface spherical to back-surface toric designs, the following significant increases were seen: 61.6%, 37.4%, and 65.7%, respectively (P<0.001). CONCLUSIONS.: High patient satisfaction was seen with all the modern scleral lens designs in the management of several forms of corneal abnormality. The interview showed differences in comfort, visual quality, and overall satisfaction in favor of the back-surface toric designs compared to the back-surface spherical designs.

Purpose: To evaluate the indications for modern scleral lenses and their clinical performance in patients who were fitted with scleral lenses at the authors' practices., Methods: In this cross-sectional survey, all the necessary data were obtained at the first follow-up visit during the 5-month study period. There were four types of scleral lenses: spherical, front-surface toric, back-surface toric, and bitoric. The preformed scleral lens fitting technique developed at Visser Contact Lens Practice was used in all patients. The lenses were cut by precise Sub Micron Lathing from a Boston Equalens II blank at Procornea. Visual acuity and slitlamp findings were recorded. A specially designed classification for scleral lens fitting was used to investigate clinical performance., Results: The largest proportion of the 178 patients (284 eyes) were diagnosed with keratoconus (143 [50.4%] eyes) followed by postpenetrating keratoplasty (56 [19.7%] eyes). The remaining diagnoses were irregular astigmatism, keratitis sicca, corneal dystrophy, and multiple diagnoses. The ratio of spherical to back-surface toric designs was 1:1.1. Clinical examination showed sharp increases in visual acuity (median increase, 0.45) and safe physiologic responses of the anterior eye. All the patients could continue to wear scleral lenses, with 79.2% with the same lens parameters., Conclusions: Several types of corneal abnormality were managed successfully with modern scleral lenses. The main indication was optical correction of an irregular corneal surface. Satisfactory clinical performance meant that all the patients could continue to wear their scleral lenses.

Purpose: The purpose of this study was to investigate whether back surface toric scleral lenses stabilized (i.e., returned to their original position after rotation) and how long the return times were. Return time was studied in relation with actual wearing time and comfort; moreover, the performance of the spherical scleral lens was compared with the toric scleral lens design., Methods: Toric scleral lenses were rotated clockwise and counterclockwise over 60 degrees. Return times and the actual wearing time were recorded. Results were transformed into nasal and temporal return times for symmetry reasons. The present and former types of correction were compared for comfort (ranging from 0: very poor to 10: excellent) and regular wearing time. All the subjects attended regular follow-up visits., Results: Forty-three subjects (43 lenses) entered the study. All the lenses returned to the original position within a median of 4 seconds after nasal rotation and 6 seconds after temporal rotation. A significant correlation was found between mean return times and actual wearing time (r = 0.63). Significant increases in median comfort (from 6-8) and median wearing time (from 15-16 hours) were demonstrated when the toric scleral lens designs were compared with the former type of correction (both p < 0.001). Median comfort and median wearing time also increased significantly after changing from spherical scleral lenses to the toric design (from 7-8 and from 14-16 hours, both p < 0.001, n = 27 eyes)., Conclusions: Toric scleral lenses returned rapidly to their original position after rotation. The flattest meridian of the toric scleral lenses stabilized symmetrically. Patient interviews demonstrated differences in comfort and wearing time in favor of the toric design.

Cowdria ruminantium is a rickettsial parasite which causes heartwater, a economically important disease of domestic and wild ruminants in tropical and subtropical Africa and parts of the Caribbean. Because existing diagnostic methods are unreliable, we investigated the small-subunit ribosomal RNA (srRNA) gene from heartwater-infected material to characterise the organisms present and to develop specific oligonucleotide probes for polymerase chain reaction (PCR) based diagnosis. DNA was obtained from ticks and ruminants from heartwater-free and heartwater-endemic areas from Cowdria in tissue culture. PCR was carried out using primers designed to amplify only rickettsial srRNA genes, the target region being the highly variable V1 loop. Amplicons were cloned and sequenced; 51% were C. ruminantium sequences corresponding to four genotypes, two of which were identical to previously reported C. ruminantium sequences while the other two were new. The four different Cowdria genotypes can be correlated with different phenotypes. Tissue-culture samples yielded only Cowdria genotype sequences, but an extraordinary heterogeneity of 16S sequences was obtained from field samples. In addition to Cowdria genotypes we found sequences from previously unknown Ehrlichia spp., sequences showing homology to other Rickettsiales and a variety of Pseudomonadaceae. One Ehrlichia sequence was phylogenetically closely related to Ehrlichia platys (Group II Ehrlichia) and one to Ehrlichia canis (Group III Ehrlichia). This latter sequence was from an isolate (Germishuys) made from a naturally infected sheep which, from brain smear examination and pathology, appeared to be suffering from heartwater; nevertheless no Cowdria genotype sequences were found in this isolate. In addition no Cowdria sequences were obtained from uninfected ticks. Complete 16S rRNA gene sequences were determined for two C. ruminantium genotypes and for two previously uncharacterised heartwater-associated Ehrlichia spp. Sequenced difference within the V1 loop were sufficient for the derivation of four Cowdria genotype-specific oligonucleotide probes. Four further probes were designed; one for the detection of any Cowdria genotype, one for the detection of any Group II Ehrlichia sp., one for any Group III Ehrlichia sp. and one for all Pseudomonadaceae. All the probes were specific except that for the Cowdria (Ball 3) genotype. The high prevalence (96%) in field samples of pseudomonad-like 16S sequences was the result of environmental contamination. The probes were used to screen DNA from goats in an area free of both Amblyomma ticks and clinical heartwater. A substantial proportion (42%) gave positive reactions for the apparently apathogenic Cowdria (Omatjenne), indicating that this genotype is relatively common.

Although the silicone rubber contact lens (SRCL) is not used frequently, there area number of clinical indications for its use which include paediatric and adult aphakia, decompensated cornea, dry eye, irregular cornea, eyelid defects, corneal ulcer and corneal perforation. The properties of silicone rubber are reviewed and the fitting technique of the SRCL is described.

The competitive inhibition ELISA (CI-ELISA) format overcomes problems associated with antigen purity since the specificity of the CI-ELISA depends solely on the monoclonal antibody (mAb) used. Therefore, the CI-ELISA format is well suited for use with recombinant antigens. Molecular clones expressing a conserved 19 kDa protein of Anaplasma marginale and a 34 kDa protein of Babesia equi were derived and characterized. The 19 kDa A. marginale protein, conserved in all recognized Anaplasma species, and present in the infected tick salivary gland, was reactive with all bovine immune sera tested. The 34 kDa B. equi protein contains a protein epitope bound by antibody in equine immune sera from 19 countries. Monoclonal antibodies reactive with these proteins were derived and applied with recombinant copies of the 19 kDa A. marginale and 34 kDa B. equi proteins in a CI-ELISA format.

Immunization with Anaplasma marginale outer membranes induced immunity against clinical disease which correlated with antibody titer to outer membrane proteins, including a 19-kDa protein (N. Tebele, T. C. McGuire, and G. H. Palmer, Infect. Immun. 59:3199-3204, 1991). This 19-kDa protein, designated major surface protein 5 (MSP-5), was encoded by a single-copy 633-bp gene. The molecular mass of MSP-5, defined in immunoblots by binding to monoclonal antibody ANAF16C1, was conserved among all recognized species of Anaplasma: A. marginale, A. centrale, and A. ovis. Recombinant MSP-5, which absorbed the antibody reactivity of bovine immune serum to native MSP-5, was recognized by anti-A. marginale and anti-A. centrale immune sera in a competitive inhibition assay with monoclonal antibody ANAF16C1. The presence of antibody to the epitope defined by monoclonal antibody ANAF16C1 in all postinfection sera tested indicates that this epitope is a potential diagnostic antigen for use in identifying persistently infected cattle.

An Anaplasma centrale genomic library was constructed in pUC13. Two clones pAC5 and pAC137 hybridising to A. centrale and A. marginale DNA were isolated from this library. One of these, pAC5, also hybridised to DNA from A. ovis. The total insert of pAC5 was subcloned into pBR322. This subclone, pAC5-12, could detect 1 ng A. centrale, 0.5 ng A. marginale and 3.9 ng A. ovis DNA. The hybridisation pattern obtained with pAC5-12 on digests of A. centrale, A. marginale and A. ovis DNA suggests that this probe detects EcoR1 and Hind111-polymorphisms. Probe pAC5-12 could detect A. ovis DNA in 36% of blood samples tested compared to the 33% detectability obtained with microscopy.

Anaplasmosis can be diagnosed either by immunological techniques or by direct microscopic examination of blood smears. Both methods are time-consuming and labour intensive. The use of DNA probes in an hybridization assay may simplify the diagnosis of anaplasmosis in cattle and sheep. A genomic DNA library of Anaplasma centrale was constructed in an expression vector and screened to detect clones containing A. centrale DNA. Four probes which hybridized to A. centrale and Anaplasma marginale DNA were isolated. One of these (AC-1) hybridized only to A. centrale DNA, whereas AC-2, AC-3 and AC-4 could detect DNA from both A. centrale and A. marginale. Probes AC-1 and AC-2 could detect 127 ng and 8 ng DNA respectively, while AC-3 and AC-4 detected 64 ng A. centrale DNA.

DNA from the Washington, South-Idaho, Virginia and Florida isolates of Anaplasma marginale was hybridized to probes specific for Anaplasma centrale and A. marginale. The A. centrale probes AC-2 and AC-4 hybridized to identical bands on all of these isolates. The hybridization patterns suggests that the Virginia, Florida and the South African isolates are similar. A number of bands were obtained with the Washington isolate which differed from those obtained with the other isolates. Probe AC-2 could be developed to identify relatedness among Anaplasma isolates. Probe AC-2 detected A. marginale DNA in midgut material from infected Dermacentor andersoni ticks. No hybridization was obtained with DNA from salivary gland tissues from these infected ticks.