More on bandage lenses

[DrG]

I started a thread somewhere else on this topic, and today I wanted to add another case.

This gentleman came to me last week with severe graft vs. host disease following bone marrow transplantation for acute myelogenous leukemia. At presentation, he was suffering from severe dry eye, and was wearing tight fitting goggles. He stated that he was using artifical tears nearly every 5 minutes, and when he removed his goggles he could barely keep his eyes open. He had severe keratitis wherever his corneas came into contact with his eyelids, and an ulcer was present in his left cornea. After trying several contact lenses, the O2Optix were the most comfortable. Along with the lenses, he was instructed to instill a topical antibiotic 4 times/day, and rewetting drops PRN.

Today, one week later, his condition was dramatically improved. He wears the lenses approximately 10 to 12 hours/day, and has only mild discomfort at the end of that period. His eyedrop useage has decreased to once/hour, and the goggles are history. The ulcer is healed, and the keratitis is much improved along with his vision. We're just going to maintain this course for the time being.

[DrG]

Continuation of another case

Elsewhere I reported treating a woman who had long-standing filamentary keratitis. During her last visit in December, I decided to try a bandage silicone-hydrogel lens. The results were quite good, with almost total resolution of the keratitis, improved comfort, and improved vision. She still uses artificial tears, and she removes the lenses at night. Because of her high astigmatism, she still needs to wear her eyeglasses over the lenses, but that seems to be a small price to pay for the benefits.

In the meantime, I have been trying to fit her with a large RGP lens, and found an almost ideal fit with a modified "macrolens." Unfortunately, the quality of her tears was such that the surface of the lens was non-wettable. I sent the lenses out to be plasma treated to make them more wettable, and the results were that the lenses wetted very well in her eyes, and she was actually able to see a fairly crisp and stable 20/20. After a prescription modification, I hope to be able to let her take the lenses home next week, as they will have to be plasma treated again, and will keep posting updates on her progress.

[DrG]

Update: The woman with the severe filamentary keratitis tolerated the Macrolenses OK. The vision was in the 20/25 range. However, I observed that her corneas looked better with the Focus N&D lenses. I gave her the option of moving on to a scleral lens fitting or going back to the Focus N&D. Since she has to wear reading glasses anyway, she decided in favor of the Focus N&D/spectacles combo. I OKed the use of the Macrolenses for occasional, short-term use, i.e. max. 4 hour's wear.

The Focus N&D provided a simple, highly effective, and economical solution to a severe corneal surface condition.

[DrG]

The gentleman I spoke of earlier with the severe graft vs. host disease came in today for his 3 month follow-up. The corneas were completely and totally clear. He wears the O2Optix 24/7 plus a drop of Zymar at bedtime.

With that update, I am officially closing this topic. I can't really identify too many people on this site with problems as severe as this, and so bandage lenses may not be your cup of tea.

[Rebecca Petris]

I really appreciate all your information about bandage lenses, DrG, and I'm sure I speak for many. I'm afraid it's one of the treatments I forget about far too easily, and your posts, and Ian's story, have helped keep me more aware of it. I was reminded of it by a new member posting about constant use of artificial tears to prevent ulceration.