CONCLUSIONS: Technology plays a crucial role in customizing scleral lenses and improving lens alignment, especially in challenging scleral shapes. In addition, remote fitting technology allows optometrists to extend their expertise globally, empowering patients to access to customized lenses without travel expenses.
OBJECTIVE: The objective of this study was to document the difficulties encountered in fitting a scleral lens in a patient with keratoconus and pronounced scleral toricity. In addition, the study aimed to present the successful remote fitting achieved by using advanced technology.
METHODS: An Irish male patient diagnosed with keratoconus exhibited high scleral toricity. Generally, keratoconus eyes often exhibit significant scleral asymmetry associated with cone decentration and disease severity. Improperly aligned scleral lenses can lead to regional changes in scleral shape, lens decentration, discomfort, and visual disturbances. Indeed, previous scleral lens fits were unsuccessful because of these issues. Corneoscleral profilometry was acquired in Ireland and then used in Italy to design customized lenses, which were then delivered to the patient\'s optometrist in Ireland. The first lenses designed and delivered demonstrated excellent overall performance without requiring adjustments.
CONCLUSIONS: This report highlights the importance of corneoscleral profilometry to increase efficiency and reduce lens reorders and chair time, and the remote fitting in overcoming barriers to accessing specialized lens fitting.

Among the components of lower limb prostheses, a perfectly adapted prosthetic socket is crucial to a successful rehabilitation process. Thus, developing a more comfortable socket could improve the quality of life for transfemoral (TF) amputees. The objective of this case report was to compare 2 TF sockets by evaluating the relationship between socket stiffness and user comfort and their influence on functionality to improve the quality of life of TF amputees. The participant received 2 different sockets: (A) flexible Flixt® socket; (B) conventional socket. He used each socket for 90 days, and after that was submitted to an evaluation at the Gait Laboratory (kinematic and dynamic analyses), completed the Prosthesis Evaluation Questionnaire, and performed Timed Up and Go test, 6-Minute March Test (6MWT), 10-Meter Walk Test, and Amputee Mobility Predictor test. After results were analyzed, the socket that obtained the best degree of satisfaction was assigned to the amputee participant. Combined measures showed that socket B does not considerably change the kinematic parameters neither dynamics parameters namely at stance phase. At Prosthesis Evaluation Questionnaire results, socket A had a better rating than socket B. The results of the Timed Up and Go test, 6MWT, 10-Meter Walk Test, and Amputee Mobility Predictor test obtained identical values, except for the 6MWT. This case report shows evidence of participant satisfaction improvement when using the flexible socket. The study also demonstrates that both sockets are quite effective.

Women living with limb loss (amputees) have unique needs that increase during pregnancy. Comfort, pain, and activity are exponentially compromised. Changes in mass and altered center of gravity increase the likelihood of falls and compromise safety for the mother and unborn baby. Subjective and physical functional performance measures data was collected through 2 separate pregnancies on a 36-year-old woman with a right transfemoral amputation. Physiological changes during pregnancy effected comfort, pain, and functional performance. Clinical practice guidelines for prosthetic management should be established to include protocols such as adjustment schedules, specialized socket design, and necessary component changes throughout the course of pregnancy.

OBJECTIVE: To assess outcomes of the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment in patients with advanced Terrien marginal degeneration (TMD).
METHODS: This is a retrospective case series of patients with advanced TMD who were assessed and fit with customized PROSE lenses. Data were collected on PROSE fitting details including visual acuity (VA) before and after PROSE, slit-lamp findings, and corneal tomography scans.
RESULTS: Six eyes in four patients were included. All patients attempted at least one other contact lens (CL) modality before PROSE. Some patients had corneal comorbidities such as pseudopterygium and pseudobleb that contributed to intolerance to previous lenses and warranted extra considerations in the fitting process. With PROSE, VA improved in all six eyes. Patients with structural corneal comorbidities achieved improved vision, comfort, and lens tolerance with PROSE. Two eyes had noncorneal ocular comorbidities that limited PROSE efficacy. Another eye discontinued PROSE wear because of limbal stem-cell disease progression necessitating a limbal stem-cell transplant.
CONCLUSIONS: PROSE treatment can be an effective option to improve vision and comfort for patients with advanced TMD who are intolerant to first-line therapeutic CL modalities, even in the presence of other corneal comorbidities.

UNASSIGNED: : Fitting a femoral prosthesis in a transfemoral amputee with a very short amputation stump is challenging. This case report aimed to introduce an effective and simple method that can preserve the residual limb length by the implantation of antibiotic-loaded bone cement for the treatment of a patient with femoral periprosthetic infection.
UNASSIGNED: : A 30-year-old man who had osteosarcoma at the age of 13 years underwent transfemoral amputation 17 years after the initial surgery because of periprosthetic infection. Antibiotic-loaded bone cement was inserted into the infected bone marrow to control the residual infection and to preserve the stump length. The infection resolved, and the patient regained functional gait using a femoral prosthesis.
UNASSIGNED: : This case report demonstrates the usefulness of antibiotic-loaded cement in preserving the length of residual limbs and for femoral prosthesis fitting after periprosthetic infection. Maintaining the residual bone length is crucial in amputees for the functional fitting of femoral prostheses. The use of antibiotic-loaded bone cement has potential as a simple and useful surgical option in amputees after periprosthetic infection.

In times of unlimited availability of exchange lenses on the internet and in discount stores, the contact lens has increasingly become a lifestyle but also a disposable product. The targeted marketing of the contact lens as a mass product could only be realized because the fitting and application of the contact lenses are presented as very simple. The numbers of contact lens-induced complications, as well as the fact that the German market in particular has not seen any increase in the number of contact lens wearers in recent years (2015 to 2019), however, speak a different language.How to fit your patient correctly after a detailed explanation of the different types of contact lenses and their areas of application, how to instruct him or her on how to use them correctly and what risks the patient must be informed about is the subject of this 2nd part of \"The basics of practical contact lens fitting\". It also explains how to avoid complications that can occur when wearing contact lenses and how to advise and care for patients with contact lens intolerances.

Scleral lenses (SLs) partially mask higher-order aberrations (HOAs) in highly aberrated eyes. Although visual acuity (VA) may show satisfactory quantitative clinical outcomes during SL wear, residual (uncorrected) HOAs can leave subjective visual quality goals unmet.
The purpose of this study was to report a case where a \"20/20 unhappy\" patient with SLs was able to meet visual goals with wavefront-guided SLs.
A 40-year-old male with bilateral keratoconus, whose Snellen VA with SLs was 20/20 right eye (OD) 20/16 left eye (OS), reported halos and glare at night and perceptual smearing. When viewing a point of light, a \"Ferris wheel\" shadowing was observed OD and a U-shaped shadowing OS. Residual higher-order root mean square wavefront error was 0.49 μm OD and 0.39 μm OS; visual image quality measured by visual Strehl ratio was 0.067 OD and 0.092 OS (pupil size, 4.00 mm). Wavefront-guided SLs reduced residual higher-order root mean square to 0.19 μm OD and 0.25 μm OS, VA improved to 20/10 OD and 20/13 OS, and visual Strehl improved to 0.150 OD and 0.121 OS. The patient reported reduced smearing, shadowing, and night vision concerns, meeting his visual expectations and goals.
Wavefront sensing quantifies both lower and HOAs, which can cause visual dissatisfaction in individuals with highly aberrated eyes, despite sometimes reaching typical levels of VA. As wavefront-guided SLs targeting these residual aberrations to improve visual image quality become more available, they should be considered for 20/20 unhappy patients when conventional clinical options are unsatisfactory.

Because the prognosis of corneal regrafting is worse than a primary graft, it is pertinent to recognize other clinical management options to postpone the need for surgical intervention. Scleral lenses are a viable option in achieving excellent vision and comfort for post-graft patients; however, close monitoring is vital to success.
The purpose of this study was to report a case in which a post-graft keratoconus patient can be successfully fit and refit with scleral lenses as their corneal tissue changes shape with time. Ultimately, the goal for this patient was to delay the need for regrafting procedures.
This case presents a 57-year-old patient who has undergone penetrating keratoplasty in both eyes secondary to keratoconus. His original corneal grafts were 15 years or older. Because of a history of graft rejection in the right eye, he had a regraft in 2004. The left eye has signs of early rejection. The patient has been a scleral lens wearer since 2008. Within the past 24 months, he has required lens adjustments and refits because his fragile corneal tissue has changed shape. Lens changes were indicated when he presented with complaints of fogging associated with redness and irritation. We continued to work closely with the patient\'s corneal ophthalmologist, who recommended we maximize scleral lens wear in lieu of a corneal regraft. Because of the change from an oblate to prolate cornea, fitting this patient in a scleral lens has been a challenging task.
Scleral lenses are a viable option in post-graft patients who present with ectatic changes to their corneal tissue. This patient continues to see 20/20 in each eye and comfortably wears his lenses for up to 6 hours. By fitting this patient in a scleral lens, we have been able to avoid the need for a regraft and the possible negative outcomes that can be associated.

Ceramic acetabular liner fracture is a rare complication and requires early revision surgery to avoid abrasive damaging of metal components by ceramic particles. Chromium-cobalt femoral head can be used in revision surgery if only fractured ceramic particles are completely removed because the abrasive effect of ceramic debris is more pronounced on metal head compared to ceramic head. In this article, we report a 50-year-old male patient of delayed acetabular liner fracture in which we used a ceramic head that is more resistant to residue ceramic particles. We assessed the patient by using computed tomography (CT) to locate the ceramic particles. By using CT imaging, we can detect which ceramic particles pose high morbidity risk for debridement.

Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Between 2012 and 2017, forty-five patients with global brachial plexus injuries approached our centre, of which nineteen (42.2%) were treated with bionic reconstruction. While fourteen patients were amputated at the transradial level, the entire upper limb was replaced with a prosthetic arm in a total of five patients. Global upper extremity function before and after bionic arm substitution was assessed using two objective hand function tests, the action research arm test (ARAT), and the Southampton hand assessment procedure (SHAP). Other outcome measures included the DASH questionnaire, VAS to assess deafferentation pain and the SF-36 health survey to evaluate changes in quality of life. Using a hybrid prosthetic arm mean ARAT scores improved from 0.6 ± 1.3 to 11.0 ± 6.7 (p = 0.042) and mean SHAP scores increased from 4.0 ± 3.7 to 13.8 ± 9.2 (p = 0.058). After prosthetic arm replacement mean DASH scores improved from 52.5 ± 9.4 to 31.2 ± 9.8 (p = 0.003). Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively. Bionic reconstruction can restore simple but robust arm and hand function in longstanding brachial plexus patients with lack of treatment alternatives.