CHEMICAL INJURY (MANGO SAP) FITTED WITH ONEFIT MED SCLERAL LENS

 

CHEMICAL INJURY (MANGO SAP) FITTED WITH ONEFIT MED SCLERAL LENS

KRISHNA KUMAR DHANKHOTIˡ , DR.SUJAL SHRESTHA², AMIT KUNWAR

1.      OPTOMETRIST AND ORTHOKERATOLOGIST AT MATRIKA EYE CENTER

2.      OPTHALMOLOGIST AT MATRIKA EYE CENTER

3.      OPTOMETRIST AT MATRIKA EYE CENTER

Cornea is the transparent part which covers the front portion of the eye. It covers the Pupil, Iris and Anterior Chamber of eye. The Cornea’s main function is to refract or bend the light. The Cornea is responsible for focusing most of the light that enters the eye. The Cornea is composed of proteins and cells. It does not contain blood vessels, unlike most of the tissue in the human body. Blood vessels may cloud the cornea, which may prevent it from refracting light properly and may adversely affect vision. The cornea is comprised of five layers: the epithelium, Bowman’s layer, the stroma, Descemet’s membrane, and the endothelium. The first layer, the epithelium, is a layer of cells covering the cornea. It absorbs nutrients and oxygen from tears and conveys it to the rest of the cornea. It contains free nerve endings. It also prevents foreign matter from entering the eye. The cornea tends to repair itself quickly from minor abrasions. However, deeper abrasions may cause scars to form on the cornea, which causes the cornea to lose its transparency, leading to visual impairment.

CASE STUDY

A 52 years old female presented to the OPD of Matrika Eye Center for regular checkup. She had a history of Chemical injury (mango sap) at the age of 11years. She had an injury with stick on Right Eye Six years ago. She also had a Right eye cataract Surgery done Six years ago at UK. Her vision OD was CFCF, best corrected visual acuity was 4/60 in right eye with -10.00DSPH/-5.00DCYL X 170 degrees and 6/12 in left eye with -1.50DCYL X 180 6/6. Slit lamp examination of OD, revealed central macular scar on visual axis of cornea, PCIOL Insitu with peaked pupil and OS was normal.



Fundus finding of OD showed tigroid fundus with pigmentary changes on peripheral retinal, parapaillary changes around optic disc with CDR of 0.1: 1. And OS showed lattice degeneration on superior peripheral retina with CDR of 0.1:1.









Discussion

In Corneal Scar central thinning and steepening causing irregular astigmatism. This patient was fitted with Onefit MED Scleral lens because patients had a photophobia and patient will fells more comfortable and have a better vision then others.

Onefit MED are intuitive and easy to use scleral lenses that allows practitioners to customize the ideal lens for a wide range of applications, when a larger diameter is needed for a healthy, highly irregular or medically indicated cornea. Designed to put the practitioner in control of the design and fit, adjustments can be made in four (4) separate zones of the lens: Central, Mid-Peripheral, Limbal and Landing Zone (Edge). To easily find the exact location of the Mid-Peripheral and Limbal zones, the diagnostic lenses are etched with solid lines that can be observed at the slit lamp or OCT image. Onefit MED and Onefit MED minimize both lens thickness and fluid reservoir, maximizing oxygen transmission to the cornea and stem cells. The design serves as its own platform from which Multifocal, Oblate, Front Toric, Toric Haptic, Quadrant Specific and Controlled Peripheral Recess (NOTCHING) can be done.

Onefit MED put you in the driver seat, are extremely easy to fit, save you chair time and provide the patient with exceptional visual acuity, comfort and optimal oxygen to the cornea for long-term corneal health.

Onefit MED trial set consisted of 20 lenses having various combination of SAG/ POWER/ OBLATE/LIMBAL/ EDGE/ DIAMETER/ CPR/ MID and different alignment haptic. Diameter ranges from 15.6mm, 16mm AND 16.4.Additionally customization is done as per requirement. Lenses in trial set consist of torric haptic .These can be further modified as per the requirementof practioer .Sag provided in the trial sets are sufficient enough to vault highly protruded cornea such as in pathological conditions like Kerataglobus, corneal Ectasia, PMCD, Corneal Scar etc. All lenses in the trial set were a standard edge lift. Onefit MED lens was taken with the parameters of SAG OF 4900; total diameter of 15.6mm, back vertex power of -5.00DS and standard edge lift in RE with VA 6/18 and for near vision reading glasses was provided as per required of left eyes too.For finalizing the lens online calculation was done from (https://prod.blcalculator.com/blanchard/onefitmed/fittingtool/) and while fitting the lens some more customized had been done for final parameters.

Quadrant Specification done for final lens.





CONCLUSION

Onefit MED lens provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction with no photophobia and less higher order aberration.

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