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Law E, Moledina M, Sexton I, Myerscough J. High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses. Eye Contact Lens 2023; 49:417-421. [PMID: 37595277 DOI: 10.1097/icl.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES After penetrating keratoplasty (PK) for keratoconus, vision can be impaired by high-degree astigmatism, particularly in those patients with recurrent peripheral ectasia. Scleral contact lenses (CLs) have long been used in the management of keratoconus both in treatment-naive corneas and those postcorneal transplants. We report the use of miniscleral CLs and their related visual and clinical outcomes in a series of patients with post-PK peripheral rim ectasia. METHODS In this retrospective case series, 5 patients (7 eyes) presented because of reduced visual acuity with their spectacles/CLs and/or reduced comfort with their existing rigid gas-permeable lenses. All patients in this series underwent PK more than two decades ago for keratoconus (mean 28.7 years±7.2). All patients demonstrated characteristic thinning at the graft-host junction, with anterior chamber deepening. Central corneas had remained clear in all patients inferring high visual potential. Contact lenses used were No 7 Comfort 15 miniscleral and the Onefit MED scleral with 14.5 mm and 15.6 mm diameters, respectively. RESULTS All eyes achieved a best-corrected visual acuity of 6/9 or greater. One case had difficulty with insertion and removal and has since discontinued wearing lens at this time. All others are successfully wearing the lenses regularly. CONCLUSION Despite advances in CL design, surgical management is still required in some patients. Miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes before proceeding with repeat surgical intervention.
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Affiliation(s)
- Elizabeth Law
- Department of Ophthalmology (E.L., M.M., I.S., J.M.), Southend University Hospital, Southend-on-Sea, United Kingdom; and Faculty of Medicine and Dentistry (J.M.), University of Plymouth, Plymouth, United Kingdom
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Wolffsohn JS, Dumbleton K, Huntjens B, Kandel H, Koh S, Kunnen CME, Nagra M, Pult H, Sulley AL, Vianya-Estopa M, Walsh K, Wong S, Stapleton F. CLEAR - Evidence-based contact lens practice. Cont Lens Anterior Eye 2021; 44:368-397. [PMID: 33775383 DOI: 10.1016/j.clae.2021.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.
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Affiliation(s)
| | - Kathy Dumbleton
- School of Optometry, University of California, Berkeley, CA, USA
| | - Byki Huntjens
- Division of Optometry and Visual Sciences at City, University of London, London, UK
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Japan
| | | | - Manbir Nagra
- Vision and Eye Research Institute, ARU, Cambridge, UK
| | - Heiko Pult
- Optometry and Vision Research, Weinheim, Germany
| | | | - Marta Vianya-Estopa
- Department of Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Karen Walsh
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Stephanie Wong
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Jacobs DS, Carrasquillo KG, Cottrell PD, Fernández-Velázquez FJ, Gil-Cazorla R, Jalbert I, Pucker AD, Riccobono K, Robertson DM, Szczotka-Flynn L, Speedwell L, Stapleton F. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye 2021; 44:289-329. [PMID: 33775381 DOI: 10.1016/j.clae.2021.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
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Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye & Ear, Cornea and Refractive Surgery Service, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Loretta Szczotka-Flynn
- Department of Ophthalmology & Visual Science, Case Western Reserve University, Cleveland, OH, USA
| | - Lynne Speedwell
- Great Ormond Street Hospital for Children NHS Trust, Moorfields Eye Hospital, London, UK
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Montalt JC, Porcar E, España-Gregori E, Peris-Martínez C. Corneoscleral contact lenses for visual rehabilitation after keratoplasty surgery. Cont Lens Anterior Eye 2020; 43:589-594. [PMID: 32456950 DOI: 10.1016/j.clae.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the use of corneoscleral lenses (CSL) in keratoconus patients who were unsatisfied with their visual outcomes after keratoplasty surgery. METHODS Eleven consecutive cases with unsatisfactory vision with spectacles, due to irregular astigmatism, preferred to try CSL before SL due to handling or economic issues. An eye examination included refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count (ECC) and evaluation of corneal biomechanical parameters (corneal resistance factor, CRF; corneal hysteresis, CH; corneal-compensated intraocular pressure, IOPcc). The fitting process was performed using a diagnostic fitting set. Subjective visual quality and comfort, and CSL usage time were also recorded. Patients were monitored for 1 year. RESULTS Two patients presented intolerance to CSL. Therefore, nine patients (6 males and 3 females; the mean±SD age, 44.56 ± 17.33 years, range 27-82) were fitted with CSL. The log MAR visual acuity of these eyes improved significantly with CSL in relation to the best spectacle-corrected vision (0.02 ± 0.06 vs 0.22 ± 0.15, respectively; p = 0.007). Patients reported prolonged usage times (an average of 9.78 ± 1.99 h; range, 8-14). No significant adverse ocular effects or clinically relevant changes in ocular parameters (ECC, CH, IOPcc, central corneal thickness and keratometry; all p > 0.05), visual quality, comfort rating or usage time were found during the 1-year follow-up. CONCLUSION Corneoscleral lenses could be fitted in non-severe cases after keratoplasty surgery with optimal visual results as they can be a safe and healthy alternative option.
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Affiliation(s)
- Juan Carlos Montalt
- Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain
| | - Esteban Porcar
- Department of Optics, Optometry and Vision Sciences, Physics College, University of Valencia, Burjassot, Valencia 46100, Spain.
| | - Enrique España-Gregori
- Department of Surgery, Ophthalmology unit, la Fe University and Polytechnic Hospital, Faculty of Medicine and Odontology, University of Valencia, Hospital la Fe, Valencia 46026, Spain
| | - Cristina Peris-Martínez
- FISABIO Oftalmología Médica and Aviñó&Peris Eye Clinic. Faculty of Medicine and Odontology, University of Valencia, Valencia 46026, Spain
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Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye 2015; 38:54-8. [DOI: 10.1016/j.clae.2014.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
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Pérez-Cambrodí RJ, Ruiz-Fortes P. Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10025-1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
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.
How to cite this article
Pérez-Cambrodí RJ, Ruiz-Fortes P, Llorens DPP. Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty. Int J Kerat Ect Cor Dis 2013;2(2):69-72.
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Contact lens visual rehabilitation in keratoconus and corneal keratoplasty. J Ophthalmol 2012; 2012:832070. [PMID: 22292112 PMCID: PMC3265106 DOI: 10.1155/2012/832070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/30/2011] [Accepted: 09/21/2011] [Indexed: 11/22/2022] Open
Abstract
Keratoconus is the most common corneal distrophy. It's a noninflammatory progressive thinning process that leads to conical ectasia of the cornea, causing high myopia and astigmatism. Many treatment choices include spectacle correction and contact lens wear, collagen cross linking, intracorneal ring segments implantation and finally keratoplasty. Contact lenses are commonly used to reduce astigmatism and increase vision. There are various types of lenses are available. We reviewed soft contact lenses, rigid gas permeable contact lenses, piggyback contact lenses, hybrid contact lenses and scleral-semiscleral contact lenses in keratoconus management. The surgical option is keratoplasty, but even after sutur removal, high astigmatism may stil exists. Therefore, contact lens is an adequate treatment option to correct astigmatism after keratoplasty.
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Routine Management. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Prazeres S, Malet F, Colin J. Adaptation des lentilles de contact sur greffe de cornée pour kératocône. J Fr Ophtalmol 2008; 31:849-54. [DOI: 10.1016/s0181-5512(08)74724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rapuano CJ. July Consultation # 2. J Cataract Refract Surg 2007. [DOI: 10.1016/j.jcrs.2007.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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