Poster Presentations 287

the myopic amblyope’s vision plateaus or is immune to vi-sual improvement. Many theories have been put forth to ex-plain why this occurs, including axial elongation, a familyhistory of high myopia, ocular pathology, a disturbance inthe process of emmetropization, and retinal hemorrhageduring birth leading to a poorly organized macula.Methods: Three pediatric patients (6, 9, and 11 years old)with anisometropic myopic amblyopia were studied withan OCT looking for macular irregularity between the highmyopic eye (.7 D) and the nonmyopic or low myopiceye (,1 D). The best-corrected visual acuity achieved byeach of the patients was at least 20/400 at distance and20/200 at near in the myopic eye and 20/20 at distanceand near in the nonmyopic eye. The refractive error rangesfrom 7.00 to 11.00 DS of myopia and 2.00 to 4.00 DCof astigmatism with 7.00 to 9.50 D of anisometropia.Strabismus was absent in all the patients.Results: The patients have been patching the nonamblyopiceye for 2 hours per day with at least 30 minutes of nearwork for more than 2 months with no improvement in thevisual acuity. The dilated fundus examination on all pa-tients revealed no ocular pathology. The OCT shows obvi-ous structural differences between the myopic andnonmyopic eye of each patient.Conclusion: When clinical and pathological conditionscausing anisomyopia are absent, further investigation iswarranted to determine if structural irregularities are pre-sent, preventing successful amblyopia treatment. Thiscase study contains evidence that strongly suggests aniso-metropic myopic amblyopes have structural irregularitiesof the foveal pit as shown with OCT. Further study witha greater number of subjects should be undertaken.

Contact Lens

Poster 3

Impact of Contact Lens Wear and Sodium FluoresceinInstillation on HRT Confocal Microscopy

Christine Sindt, O.D., Janet Tsui, M.D., and Trudy Grout,University of Iowa, 200 Hawkins Drive, Iowa City, Iowa52242

Purpose: This series of acute observations aimed to ascer-tain the histologic effect of contact lens wear and sodiumfluorescein instillation using HRT confocal microscopy.Methods: This was a series of contralateral eye, controlled,investigator-masked observations. Ten non–contact lenswearers, 13 hydrogel lens wearers, and 23 silicone hydrogellens wearers were assessed. Sodium fluorescein was randomlyinstilled in 1 eye of each subject. All patients underwent HRTconfocal microscopy (Heidelberg, Germany) before lens in-sertion and after 2 hours of lens wear. The anterior stroma,nerve plexus, basal epithelium, and superficial epitheliumwere analyzed for changes and the presence of hyper-reflectivecells. Indicators of immune response were noted.

Results: There was no difference in reflectivity of basal lam-inar cells, nerve plexus layer, or superficial stroma betweencontralateral eyes, indicating that sodium fluorescein instilla-tion does not impact HRT confocal images. In addition, 2hours of lens wear did not have a substantial effect on thesecorneal structures. Patients presented with varying numbersof Langerhans cells (range: 0 to 42 cells/scan area). Therewas no difference in the average number of Langerhans cellsdetected between the non–contact lens wearers (5.0 cells/scan area) and the traditional hydrogel lens wearers (5.0cells/scan area) at baseline. A slightly higher average numberof Langerhans cells were observed in silicone hydrogel lenswearers (7.2 cells/scan area) at baseline. Acute lens wear didnot have a significant impact on the corneal structure or thenumber of Langerhans cells in any group.Conclusions: Sodium fluorescein instillation does not im-pact HRT confocal data. While there were slight differencesnoted between the habitual silicone and traditional hydrogellens wearers, further study is required to differentiate be-tween lens effects and other environmental effects. Use ofconfocal microscopy to evaluate changes in corneal struc-tures as a result of contact lens wear and solutions use isa growing area of research. Therefore, an increased under-standing of the technique will be critical for appropriatedata interpretation. Further studies are required to under-stand what hyper-reflective cells represent, the cause(s) ofLangerhans cell migration into the cornea, and the utilityof confocal microscopy to assess changes in corneal struc-ture over time.

(Investigation received grant support: Alcon Research Ltd.)

Poster 4

Fuchs’ Superficial Marginal Keratitis: A Rare ClinicalCase

Jacqueline Haro, O.D., Eric Drey, B.A., Louise Sclafani,O.D., and Michael Saidel, M.D., Illinois College ofOptometry/Illinois Eye Institute, 3241 South MichiganAvenue, Chicago, Illinois 60616

Background: Fuchs’ superficial marginal keratitis is a rarecondition found in middle-age adults that is characterizedby a chronic course of recurrent ocular irritation with spon-taneous remission. It presents initially with marginal infil-trates and progresses into marginal superficial stromalthinning. Pseudopterygium, which does not extend intothe central cornea, may also develop over the areas of re-current keratitis and stromal thinning.Case Summary: This case discusses the treatment of a 41-year-old woman with bilateral recurrent corneal infiltration,thinning, and pseudopterygium formation consistent withFuchs’ superficial marginal keratitis. Prednisolone acetate,cyclosporin A, and an intralimbal rigid gas-permeable con-tact lens were used in the treatment and management of thiscondition. This protocol was effective not only in the re-gression of the condition but also in the improvement ofthe patient’s quality of vision.

288 Optometry, Vol 80, No 6, June 2009

Conclusion: Current surgical treatments, which include lam-ellar keratoplasty and combined superficial keratectomy withconjunctival autograft, may lead to complications such as cor-neal perforation or recurrence of marginal keratitis in the graft.The use of rigid gas-permeable contact lenses is a viable optionto improve vision and prolong the necessity of surgical inter-vention in Fuchs’ superficial marginal keratitis.

Poster 5

Safety Evaluation of Systane Ultra� in Contact LensWearers

David Kading, O.D., Specialty Eyecare Group, 11830 NE128th Street, Kirkland, Washington 98034

Objective: The aim of this study was to evaluate the safetyof Systane Ultra� containing polyethylene glycol 400 andpropylene glycol demulcents with hydroxypropyl-guar as agelling agent (Test Solution) in contact lens wearers. Acomparison to a currently marketed contact lens rewettingdrop was included as a control.Participants: This was an investigator- and patient-masked, single-site, randomized, prospective study of 2weeks duration involving 47 successful contact lenswearers with good ocular and general health.Methods: At the screening visit, eligible subjects’ baselinevisual acuities and biomicroscopy findings were recorded.Subjects were randomly assigned to receive either the testsolution or the control with masked labeling in prenum-bered kits. Subjects were instructed to instill their assignedtest article in both eyes 15 minutes before lens insertion, atleast one drop during lens wear and another drop immedi-ately after lens removal. After 14 days, biomicroscopy, in-cluding sum corneal staining and visual acuity results, wererecorded.Results: There were no adverse events documented for ei-ther the test or control solution. Biomicroscopic evaluationswere within normal limits for both test and control solu-tions and visual acuity was not affected by treatment.Conclusions: These results indicate that Systane Ultra iscompatible for use with contact lenses.

(Investigators received grant support funded by AlconLaboratories.)

Poster 6

Fungicidal Activity of Contact Lens Care SolutionsChallenged With Clinical and Environmental Isolates ofFusarium

Cindy L. McAnally, B.S., and Roya N Borazjani, Ph.D.,Alcon Laboratories, 6201 South Freeway, Fort Worth,Texas 76134

Background: Because of recent outbreaks of Fusarium ker-atitis associated with a multipurpose contact lens care solu-tion, the fungicidal efficacy of 4 multipurpose solutions and2 hydrogen peroxide systems was evaluated against clinical

and environmental isolates of Fusarium based on the Inter-national Organization for Standardization (ISO) and theU.S. Food and Drug Administration (FDA) Stand-AloneProcedure for disinfecting products.Method: Marketed solutions were challenged with clinicaland environmental strains of Fusarium based on the ISOand FDA Stand-Alone Procedure for disinfecting products.Solutions were sampled for surviving microorganisms atthe recommended disinfection time, 24 hours and 7 and14 days. Serial dilutions and pour plates were prepared us-ing validated recovery media. Appropriate incubation timesand temperatures were observed. The numbers of viablemicroorganisms were enumerated and log reductions calcu-lated. The following antimicrobial systems were evaluated:1) Polyquad� (polyquaternium-1)/Aldox� (myristamido-propyl dimethylamine), 2) PHMB (polyhexamethylenebiguanide), and 3) hydrogen peroxide (3% hydrogenperoxide w/neutralizing system).Results: Solutions containing Polyquad/Aldox and 3% hy-drogen peroxide showed similar log reduction activity atthe disinfection time (2.0 logs or greater). Solutions con-taining PHMB showed lower log reduction activity thanPolyquad/Aldox and hydrogen peroxide systems at the dis-infection time (1.0 log or less). At extended storage timesof 7 and 14 days, the Polyquad/Aldox and PHMB systemswere effective against regrowth for all microorganisms.Only solutions containing 3% hydrogen peroxide showedregrowth of one or more microorganisms when stored forextended periods.Conclusion: Contact lens care solutions containing the dualantimicrobial system Polyquad/Aldox were effective againstclinical and environmental isolates of Fusarium at the disin-fection time as well as extended storage times of 7 and 14days. Hydrogen peroxide systems were effective at the disin-fection time, but because of neutralization (at disinfectiontime) allowed regrowth of one or more microorganismsat 7 and/or 14 days extended storage. Both PHMB andPolyquad/Aldox solutions were effective at extended storagetimes and showed no regrowth of microorganisms. Theresults of this study indicate the importance of choosing asolution with a robust antimicrobial system that kills at thedisinfection time as well as inhibits regrowth of clinicaland environmental isolates of Fusarium.

(Investigators are employees of Alcon Laboratories.)

Poster 7

Fluorescence Measurements in Contact Lenses With aNovel Confocal Microscope

Ryan Gustus, Matthew S. Muller, M.S., DeanA. VanNasdale, O.D., and Anne Elsner, Ph.D., IndianaUniversity School of Optometry, 800 E. Atwater St.,Bloomington, Indiana 47405

Background: We measured the retention of sodium fluores-cein in contact lenses, because topical fluorescein is