Two presentations of contact lens-induced papillary conjunctivitis (CLPC) in hydrogel lens wear: local and general.
ABSTRACT The purpose of this study was to confirm that two distinct clinical presentations of contact lens-induced papillary conjunctivitis (CLPC), local and general, occur in hydrogel lens wear.
Retrospective analyses of 124 CLPC events were identified. The classification of CLPC was based on location and extent of papillae. CLPC was classified as local if papillae were present in one to two areas of the tarsal conjunctiva and general if papillae occurred in three or more areas. The CLPC events were compared with an asymptomatic control group in prospective clinical trials conducted from 1993 until 2003 at two clinical sites, Australia and India. Two hundred sixteen subjects from Australia and 914 subjects from India wore either high Dk silicone hydrogel or low Dk hydrogel lenses on a 6-night (6N) or 30-night extended-wear (EW) schedule. The physiological responses of the ocular surface, including tarsal conjunctiva redness and roughness, number of papillae present, lens fit and performance, and subjective patient symptoms, were measured during each visit at each site. These variables listed were compared between local CLPC groups and asymptomatic controls and general CLPC groups and asymptomatic controls.
Two types of CLPC in hydrogel lens wearers have been confirmed. Of the 124 CLPC events, there were 61 local and 63 general events. Local and general CLPC cases reported significantly greater frequency of symptoms compared with the asymptomatic controls, in particular itching, lens awareness, secretion, and blurred vision (p < 0.1).
The classification of CLPC into two types, local and general, in hydrogel lens wear was confirmed based on presentations at both sites. This distribution of papillae between local and general CLPC may indicate separate etiologies involved in the pathogenesis of the condition.
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ABSTRACT: To examine the relative changes in modulus of nine soft contact lens materials when exposed to three lens care solutions. Measurements of elastic modulus were made using an Instron 3343 tensiometer of lenses which had been pre-soaked in ReNu Multi-Purpose (Bausch & Lomb), OPTI-FREE RepleniSH (Alcon), Clear Care (CIBA Vision) hydrogen peroxide, or a saline control solution for one week. The solutions were changed three times during the week-long soaking period. Following this, the lenses were measured for centre thickness and were cut into two samples of identical width. Young's modulus was measured in the force range of 0.015-0.035 N. Measurements in saline ranged form 0.31MPa for etafilcon A to 1.76 MPa for lotrafilcon A. All of the lenses, with the exception of senofilcon A, displayed a significant change in modulus with at least one of the solutions. Both etafilcon A and lotrafilcon B showed a significant change in modulus with all solutions. With lotrafilcon B in hydrogen peroxide solution, modulus reduced from 1.32 to 0.93 MPa (P<0.0001). Galyfilcon A decreased from 0.36 to 0.31 MPa in ReNu Multi-Purpose (P<0.0001) and lotrafilcon A decreased from 1.76 to 1.64 MPa in OPTI-FREE RepleniSH (P=0.04). Comfilcon A increased from 0.78 to 0.85 MPa (P<0.0001) in peroxide. The use of some contact lens-solution combinations results in significant changes in modulus. In the case of the multi-purpose solutions, the changes probably relate to uptake of the formulation components and, in the case of peroxide, to chemical changes to the polymer.Contact lens & anterior eye: the journal of the British Contact Lens Association 10/2010; 33(5):210-4. DOI:10.1016/j.clae.2010.06.002 · 2.00 Impact Factor
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ABSTRACT: To describe the refitting of a soft lens wearer into a silicone hydrogel lens due to neovascularization. This change, in turn, caused contact lens induced papillary conjunctivitis (CLPC) and a further refitting was necessary. The patient was refit into a high Dk surface treated silicone hydrogel with a high modulus value. A second refitting was undertaken into a lower Dk silicone hydrogel contact lens with a lower modulus value which had no surface treatment but incorporated an internal wetting agent. A high Dk/t lens was used to resolve existing neovascularization and chronic hyperaemia. Subsequently, CLPC response occurred, possibly due to a combination of factors, resulting in irritation of the palpebral conjunctiva. This resulted in temporary lens discontinuation. A second silicone hydrogel lens was fit, along with the use of a non-preserved care system, which led to improvement and eventual resolution of the condition. High Dk silicone hydrogel lenses have shown excellent efficacy in resolving hypoxic complications such as neovascularization and hyperaemia. However, attention needs to be paid to their potential effect on the upper tarsal plate. More than one silicone hydrogel lens may be needed to help resolve these issues.Contact lens & anterior eye: the journal of the British Contact Lens Association 02/2009; 32(2):93-6. DOI:10.1016/j.clae.2008.07.005 · 2.00 Impact Factor