Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty

Purpose: To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP). Materials and methods: A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting. Results: Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and -5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 µm to a postfitting value of 1.57 µm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations. Conclusion: The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment.

Fitting of a New Design of Full Scleral Contact Lens in Advanced Keratoconus with Previous Implantation of Intracorneal Ring Segments

This case report reports the visual rehabilitation obtained with the fitting of a new design of full scleral contact lens (ICD 16.5 contact lens, Paragon Vision Sciences, distributed by Lenticon, Madrid, Spain) in a cornea with advanced keratoconus and previous implantation of intracorneal ring segment with a very limited effect. This eye had a refraction of –3.00 × 55° cylinder, providing a visual acuity of 0.5 LogMAR. The topographic pattern was very irregular with the presence of a significant central protrusion and a significant central corneal thinning. Some previous unsuccessful fittings have been performed with corneal and corneal-scleral lenses. A comfortable wearing was achieved with a fully scleral contact lens of 4600 μm of sagittal height, optical power of –11.25 D, and providing an apical clearance of 196 μm. A visual acuity of 0.0 LogMAR combined with a relevant aberrometric improvement was achieved with this contact lens. The patient was completely satisfied with the fitting. The result was maintained during 1 year after the fitting. Full scleral lenses are then able to provide comfortable wear and a significant increase in visual acuity combined with a significant improvement in the visual quality in eyes with advanced keratoconus.

Errors Associated to Keratoconus Grading using Systems based on Corneal Power

Purpose: To analyze and define the possible errors that may be introduced in keratoconus classification when the keratometric corneal power is used in such classification. Materials and methods: Retrospective study including a total of 44 keratoconus eyes. A comprehensive ophthalmologic examination was performed in all cases, which included a corneal analysis with the Pentacam system (Oculus). Classical keratometric corneal power (Pk), Gaussian corneal power (Pc Gauss), True Net Power (TNP) (Gaussian power neglecting the corneal thickness effect), and an adjusted keratometric corneal power (Pkadj) (keratometric power considering a variable keratometric index) were calculated. All cases included in the study were classified according to five different classification systems: Alió-Shabayek, Amsler-Krumeich, Rabinowitz-McDonnell, collaborative longitudinal evaluation of keratoconus (CLEK), and McMahon. Results: When Pk and Pkadj were compared, differences in the type of grading of keratoconus cases was found in 13.6% of eyes when the Alió-Shabayek or the Amsler-Krumeich systems were used. Likewise, grading differences were observed in 22.7% of eyes with the Rabinowitz-McDonnell and McMahon classification systems and in 31.8% of eyes with the CLEK classification system. All reclassified cases using Pkadj were done in a less severe stage, indicating that the use of Pk may lead to the classification of a cornea as keratoconus, being normal. In general, the results obtained using Pkadj, Pc Gauss or the TNP were equivalent. Differences between Pkadj and Pc Gauss were within ± 0.7D. Conclusion: The use of classical keratometric corneal power may lead to incorrect grading of the severity of keratoconus, with a trend to a more severe grading.

Non-alcoholic fatty liver disease associated with hypobetalipoproteinemia: report of three cases and a novel mutation in APOB gene

Background: Non-alcoholic fatty liver disease, the leading cause of chronic liver disease in children, is defined by hepatic fat infiltration >5% of hepatocytes, in the absence of excessive alcohol intake, evidence of viral, autoimmune or drug-induced liver disease. Conditions like rare genetic disorders must be considered in the differential diagnosis. Case Report: Two male brothers, and a non-related girl, all overweight, had liver steatosis. One of the brothers and the girl had elevated transaminases; all three presented with low total cholesterol, low density lipoproteins and very low density lipoproteins cholesterol levels, hypotriglyceridemia and low apolipoprotein B. A liver biopsy performed in the brother with citolysis confirmed steatohepatitis and the molecular study of apolipoprotein B gene showed a novel homozygous mutation (c.9353dup p.Asn3118Lysfs17). Patients with cytolysis lost weight, however liver steatosis persists. Conclusion: Fatty liver disease might be a consequence of hypobetalipoproteinemia. Evidence is scarce due to low number of reported cases.

Give me a shilling [videorecording]: phenomenon of the street children

Pictures of the Watoto wa Lwanga project, the efforts of the Brothers of St. Charles Lwanga not only to rehabilitate Nairobi's street children, but to prevent slum children from ending up in the streets. Features life in the slums, the situation of the street children, the efforts of the social workers to involve the children's parents, the various reception centers, the vocational school, the Boy's Town Ruai Residential School, the community of the Brothers of St. Charles Lwanga as well as interviews with former street children and with various directors and benefactors of the project.

Letter of recommendation for Elisha Parmele and Reuben Parmele, May 17, 1784

This letter, signed by Stephen West, Ezra Stiles, and Josiah Sherman, attests to the reputable character of Elisha Parmele and his brother, Reuben, who was also a minister. The signers explain the health concerns motivating the brothers' travels southward and request that those who encounter them treat them with "kindness and brotherly love."

Letter from John Quincy Adams to his brother, Thomas Boylston Adams, 1786 July 2

This letter was written by John Quincy Adams on July 2, 1786 to his younger brother, Thomas Boylston Adams, who was then staying with their uncle, the Reverend John Shaw, in Haverhill, Massachusetts. In the letter, John gives Thomas advice on life as a student at Harvard, instructing him to choose his friends carefully, to favor those who are virtuous and studious over those who are idle and prone to vice, to maintain an "unblemished moral reputation," and to spend as much as six hours each day studying in order to excel as a scholar.

Letter from Samuel Willard, Harvard College, Cambridge, Massachusetts, to Catherine Willard, Petersham, Massachusetts, June 22, 1803

Willard mentions his brother’s poor health, his plans to go to teach at Phillips Exeter, and describes various objects that he has sent to different family members, including a razor and books. In his post script, he asks to have a shirt mended.

Letters from Benjamin Welles to John Henry Tudor, 1799-1801

Benjamin Welles wrote these six letters to his friend and classmate, John Henry Tudor, between 1799 and 1801. Four of the letters are dated, and the dates of the other two can be deduced from their contents. Welles wrote Tudor four times in September 1799, at the onset of their senior year at Harvard, in an attempt to clear up hurt feelings and false rumors that he believed had caused a chill in their friendship. The cause of the rift is never fully explained, though Welles alludes to "a viper" and "villainous hypocrite" who apparently spread rumors and fueled discord between the two friends. In one letter, Welles asserts that "College is a rascal's Elysium - or the feeling man's hell." In another he writes: "College, Tudor, is a furnace to the phlegmatic, & a Greenland to thee feeling man; it has an atmosphere which breathes contagion to the soul [...] Villains fatten here. College is the embryo of hell." Whatever their discord, the wounds were apparently eventually healed; in a letter written June 26, 1800, Welles writes to ask Tudor about his impending speech at Commencement exercises. In an October 29, 1801 letter, Welles writes to Tudor in Philadelphia (where he appears to have traveled in attempts to recover his failing health) and expresses strong wishes for his friend's recovery and return to Boston. This letter also contains news of their classmate Washington Allston's meeting with painters Henry Fuseli and Benjamin West.