The shape and profile of the cornea after excimer photoablative refractive surgery: Implications for post-operative contact lens fitting

Contact lens fitting following unsuccessful refractive surgery

A retrospective review of case notes of consecutive patients referred to a contact lens clinic after unsuccessful refractive surgery was carried out to determine the success of contact lens fitting. The main outcome variables in determining success were visual improvement, contact lens tolerance, fitting characteristics and wearing time. Thirteen eyes were fitted with conventional rigid gas permeable (CRGP), 10 with soft and 19 with reverse geometry rigid gas permeable contact lenses (RVG). The mean spectacle visual acuity (VA) was 6/9 (20/30) [range: 6/24 (20/80) to 6/5 (20/15)] and the mean VA after contact lens fitting was 6/6 (20/20) [range: 6/18 (20/60) to 6/5 (20/15)]. Of the 42 eyes, the contact lens VA was better than spectacle acuity in 25 (59.5%) eyes, equal in 14 (33.3%) and worse in three (7.1%). A total of 33 (78.6%) eyes were still wearing their lenses at the last visit. Contact lenses can be a valuable method of managing poor VA after refractive surgery.

Reverse geometry contact lens wear after photorefractive keratectomy, radial keratotomy, or penetrating keratoplasty

PURPOSE

To determine if a super diffusion coefficient of lens/lens thickness (Dk/L) reverse geometry gas permeable (steep peripheral and flatter central curve) contact lenses can be successfully worn after excimer photorefractive keratectomy (PRK), radial keratotomy (RK), or penetrating keratoplasty (PK).

METHODS

Patients with residual ametropia after PRK, RK, or PK were fitted with reverse geometry lenses (Plateau lens in SF-P material; Menicon USA, Inc, Clovis, CA, U.S.A.). Contact lens fit characteristics and comfort were assessed. Lens centration, visual quality, and ocular surface status were graded and visual acuity charted.

RESULTS

Thirteen eyes of 11 patients were fitted; eight eyes with PRK, one eye with RK, and four eyes with PK previously performed. The mean follow up of the patients was six months. The visual acuity prior to lenses ranged from 6/12 to counting fingers, and the acuity with lenses ranged from 6/6 to 6/30. Eight of the 11 patients wore the lenses the whole day without problems; 3 patients discontinued lens wear due to discomfort or unsatisfactory vision.

CONCLUSIONS

The combination of super Dk/L and reverse geometry lenses facilitate lens wear and is associated with good visual acuity.