|Year : 1982 | Volume
| Issue : 4 | Page : 201-203
Soft lenses as therapeutic device
Vijay Kumar Dada, Swadesh Chandra Acharjee
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi, India
Vijay Kumar Dada
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi- 110029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dada VK, Acharjee SC. Soft lenses as therapeutic device. Indian J Ophthalmol 1982;30:201-3
Soft lenses have been used for a constant slow release of topical medications by several clinicians in Western Countries. In this study an attempt was made to evaluate the therapeutic soft Contact Lens as a drug delivery system on Indian patients.
| Materials and methods|| |
79 cases of (i) Acute angle closure glaucoma, (ii) Desiccating and collagen diseases (iii) Indolent ulcers (iv) Recurrent herpetic keratitis were included in this study. 70% sauflon hydrophillic lathe cut Contact lenses manufactured in our centre presoaked in pilocarpine, I.D.U. fungizone and gentamycin, steroids and normal saline were used. Lenses were sterilised by autoclaving. They were discarded on completion of the therapy.
| Observation and discussion|| |
1. Acute Angle Glosure Glaucoma: 18 cases of acute glaucoma were fitted with pilocarpine soaked hydrophillic soft contact lens. Lenses were presoaked in 1 % pure pilocarpine with borate buffer without any preservative for 24 hours. Initial and final intraocular pressure (after 2 hours) were measured with Goldmans applanation tonometer. Pupillary size was also noted during the therapy. 3 normal eyes were kept as control additional pilocarpine drops and other systemic drugs were not used.
It was observed out of 18 cases, 12 cases reported within 2 to 4 hrs. of acute attack. 3 cases reported within 8 hrs. remaining 3 reported one week after the acute attack. Miosis was complete within half an hour which persisted upto 72 hours. except in cases who reported late. Intraocular pressure came down to normal (67.65%) in 15 eyes who reported within 8 hours of the attack. 3 cases who came after a week I.O.P. was lowered to some extent 13.8% but it still remained higher than normal. In normal eyes a fall of 4 to 5 mm of Hg (29%) was noted (See table)
In our study average fall of I.O.P. in acute cases was 67.65% and in normal cases was 29% caseswho reported late (6-8 days) for treatment fall of pressure was in significant (13.8%). This can be attributed to the sphincter pupillae as well as in the angle region due to the persistent high pressure.
II. Desiccating and Collagen Diseases
23 cases of kerato conjunctivitis sicca in adult rheumatoid arthitis and 11 other cases of desiccating diseases e.g. in sjogren's syndrome, ocular pemphigoids, Stevens Johnsons Syndrome and exerophthalmia were fitted with soft lenses.
Local antibiotics and 1 : 10 decadron drops were added when indicated. Normal saline drops were used to prevent the lenses from drying and becoming tight. Soft contact lenses have relieved pain by protecting the exposed nerve endings, denuded corneal epithelium and stroma and also considerably improved Vision by eliminating the irregular corneal astigmatism. In few cases pain relief was gradual which showed marked improvement when the associated iritis was treated In some cases we found insertion of soft lens initially increased discomfort. But after several hours wear comfort was obtained and with continuous wear, the reduction of photophobia was marked. Timely application of a large size soft lens also prevented symblepheron formation. Cases of xerophthalmia showed poor response.
III. Indolent Ulcers
Soft lens therapy has been used to facilitate healing and reduce pain by creating a frame work for reepitheliasation and protecting the cornea from lid irritation.
In this study 23 cases were fitted with soft lenses in combination with fungizone or gentamycin. 20 showed immediate relief of pain which continued for the duration of treatment. 3 cases showed no improvement. In successful cases little or no residual scarring occurred and when present it was in the form of nebular opacities. Elimination of infection and removal of necrotic tissue with soft lens therapy aids in the healing process and minimises pain. By 7-12 hrs. complete healing took place. Out of 12 cases where lenses were used without fungizone or gentamycin ulcer healed only in 2 cases. The remaining 10 did not show any sign of healing. Therapeutic effect was apparent within a few days and complete healing occurred within two to three weeks.
IV. Recurrent Herpetic Keratilis
We have treated 4 cases by combination of idodouridine (I.D.U.) and soft lens. Therapy failled in one as it was complicated by secondary conjunctivitis, other three cases obtained relief from recurrent pain. The lesion epithelialised in 7-10 days, congestion and photophobia also disappeared. They used soft lens comfortably for one month and cornea cleared with minimal nebular opacities. In one case 1 : 10 Dexamethasone drops were used in another group of 4 cases with soft lens alone did not show healing during 10 days of observation.
In cases of indolent ulcer pain relief was quick and cases healed within 7-12 days. Pilocarpine soaked lenses produced favourable results in emergency treatment of acute angle closure glaucoma but were poorly tolerated in subacute or chronic cases. Desiccating conditions like keratoconjunctivitis sicca responded very well but cases of xerophthalmia showed poor response. In case of recurent herpetic keratitis pain relief was obtained and within 7-10 days epithelialization was complete. Soft lens is of great help in the protection of cornea and conjunctiva from lid trauma, xerosis and symblepheron.
Sustained release drug delivery system is always better than the pulsed dose method to maintain an adequate and prolonged tissue concentration of a particular drug. Hydrophillic Soft Contact lenses are definitely better and advantageous than another slow release method named 'Ocusert' which is placed in the lower fornix, because the former gives good protection to the cornea in addition to the continuous drug delivery. By protecting the cornea it relives pain and enhances when the cornea is damaged due to the diseased process. Over and above it minimises the total drug requirement with an added advantage that Vision can be maintained or improved. With the lens in situ response to the therapy can also be monitored.
| Summary|| |
Soft Contact lenses were used as a therapeutic measure in 79 eyes with various ocular diseases as a continuous drug delivery system and to alleviate pain, protect the cornea during re-epithalialization.
[Table - 1]