PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.

PURPOSE:To understand the clinical pattern of keratoconus in patients visiting a tertiary eye-care center. This may improve the knowledge of the disease and treatment options. METHODS:The records from a tertiary eye-care hospital-based center were reviewed retrospectively to collect the required data. Medical records from 187 patients who had visited the contact lens clinic in the course of a three-month period were reviewed. The data available on demographics, year of diagnosis of keratoconus, topographic measurements, slit-lamp biomicroscopic findings, previously used or currently advised refractive correction, visual acuity and contact lens parameters were reviewed and recorded. RESULTS: Of the 187 patients, 365 eyes were included in the study. Six eyes that had previous corneal grafting and 3 eyes that were fellow normal eyes of unilateral keratoconus were excluded. The patients' mean age was 21.3±6.96 years. There were 172 (47.12%) eyes previously diagnosed as keratoconus and 193 (52.87%) eyes that had been newly diagnosed as keratoconus. In the newly diagnosed group, 188 eyes were fitted with different types of contact lenses and 5 eyes were advised surgery. In the previously diagnosed group, 138 eyes and 6 eyes continued wearing conventional and multicurve custom rigid gas permeable (RGP) contact lenses, respectively. Of the remaining 28 eyes, 3 eyes were fitted with RGP lenses, 16 were refitted with piggyback, 2 with multicurve custom RGP and 7 were advised for scleral lenses or surgery. CONCLUSION: This study brings out the clinical profile of keratoconus patients in a tertiary eye-care center in south India. The findings in this study stresses out the importance of defining the treatment options in keratoconus with the appropriate contact lenses. RESUMEN OBJETIVO:Conocer el patrón clínico del queratocono entre aquellos pacientes que acuden a a una clínica especializada de la visión. Esto puede permitir ampliar la información disponible sobre el estado de la enfermedad, así como las distintas opciones de tratamiento. MÉTODOS: Se analizaron de manera retrospectiva los historiales médicos de un centro médico especializado en oftalmología y adscrito a un hospital, extrayéndose de ahí los datos de interés. Se revisaron con detalle los historiales médicos de 187 pacientes que habían acudido a la clínica (especializada en lentes de contacto) durante un periodo de 3 meses consecutivos. En particular, se recogieron datos demográficos, el año en el que se había diagnosticado el queratocono, datos de topografía corneal, características biomicroscópicas observadas con la lámpara de hendidura, corrección refractiva empleada (en el momento de la visita o anteriormente), agudeza visual, y parámetros de la lente de contacto (si utilizaban una). RESULTADOS: Se incluyeron en el estudio 365 ojos de los 187 pacientes mencionados. Se excluyeron 6 ojos, por haberse realizado un transplante de córnea, así como otros 3 ojos que eran normales (es decir, había 3 pacientes tenían queratocono sólo en uno de sus ojos). L...

Severe neuronal loss in the hippocampus, that is, hippocampal sclerosis (HS), can be seen in 3 main clinical contexts: dementia (particularly frontotemporal lobar degeneration [FTLD]), temporal lobe epilepsy (TLE), and hippocampal ischemic injury (H–I). It has been suggested that shared pathogenetic mechanisms may underlie selective vulnerability of the hippocampal subfields such as the CA1 in these conditions. We determined the extent of neuronal loss in cases of HS-FTLD (n = 14), HS-TLE (n = 35), and H–I (n = 20). Immunohistochemistry for zinc transporter 3 was used to help define the CA3/CA2 border in the routinely processed human autopsy tissue samples. The subiculum was involved in 57% of HS-FTLD, 10% of H–I, and 0% of HS-TLE cases (p < 0.0001). The CA regions other than CA1 were involved in 57% of HS-TLE, 30% of H–I, and 0% of HS-FTLD cases (p= 0.0003). The distal third of CA1 was involved in 79% of HS-FTLD, 35% of H–I, and 37% of HS-TLE cases (p = 0.02). The distal third of CA1 was the only area involved in 29% of HS-FTLD, 3% of HS-TLE, and 0% of H–I cases (p = 0.019). The proximal-middle CA1 was the only area affected in 50% of H–I, 29% of HS-TLE, and 0% of HS-FTLD cases (p = 0.004). These findings support heterogeneity in the pathogenesis of HS.

Modification of not only the vault but also the haptic and total diameter of the device is required to achieve an optimal fit. Though challenging, successful fitting of the scleral lens in ectatic corneas is attainable, with the aid of anterior imaging and spline technologies.

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