Acute corneal edema decades after penetrating keratoplasty for keratoconus in eyes wearing scleral contact lenses

Murillo, Sofia; Shariff, Ayesha; Lass, Jonathan H.; Szczotka-Flynn, Loretta

doi:10.1016/j.clae.2020.10.008

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…Interestingly, late-onset DM detachment has been described in patients without ectasia following disruptive procedures such as transscleral cyclophotocoagulation and laser iridotomy . In our patient, the mechanical stresses of SCL use may have precipitated trauma via SCL-induced negative pressure and via the insertion and removal of the lens …”

Section: Discussionmentioning

confidence: 99%

Acute Corneal Edema in a Middle-Aged Patient

Tran,

Kaufman,

Ciolino

2024

JAMA Ophthalmol

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Section: Discussionmentioning

confidence: 99%

Acute Corneal Edema in a Middle-Aged Patient

Tran,

Kaufman,

Ciolino

2024

JAMA Ophthalmol

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“…2 and 3), with clearance much greater than optimal levels overlying the graft. There are reports of corneal edema in scleral lens wearers after keratoplasty, 10,27 and such reports may deter clinicians from considering scleral lenses as a potential solution in post-PK eyes. However, the Onefit MED miniscleral lens allows a customizable design where it is possible to adjust the sagittal height in specific zones only as seen in cases 2 and 4.…”

Section: Discussionmentioning

confidence: 99%

High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses

Law,

Moledina,

Sexton

et al. 2023

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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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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“…Similarly, a retrospective chart review (Murillo et al, 2021), investigated three cases of acute corneal edema occurring years after PK in patients wearing scleral contact lenses with previously clear corneal grafts. All three cases had keratoconus before being grafted.…”

Section: Post Penetrating Keratoplastymentioning

confidence: 99%

Key Factor Influencing Corneal Edema with Scleral Lens Wear; Healthy Versus Unhealthy Corneas

karadsheh

2024

Preprint

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Scleral lenses are an important treatment option for irregular corneas, but improper fitting can cause hypoxia and edema. This review elucidates key factors influencing corneal edema with ScL wear in healthy and compromised corneas. ScL parameters like oxygen permeability, thickness, post-lens tear film thickness, limbal clearance, and alignment impact edema. Studies show high oxygen permeability (DK 100+) lenses under 300 μm thickness typically limit edema to under 2% in healthy eyes. Theoretical modeling and many studies advise post lens tear film thickness <200 μm. Compromised corneas are more susceptible to edema from hypoxia and mechanical stress. Shorter wearing times and close monitoring of corneal health are advised for compromised corneas. There are gaps regarding long-term safety, regional edema response, and the optimal lens parameters for compromised corneas. Further large studies controlling confounding factors and standardizing measurements would strengthen our understanding of the relationship between scleral lenses and corneal edema.

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Acute corneal edema decades after penetrating keratoplasty for keratoconus in eyes wearing scleral contact lenses

Cited by 7 publications

References 39 publications

Acute Corneal Edema in a Middle-Aged Patient

Acute Corneal Edema in a Middle-Aged Patient

High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses

Key Factor Influencing Corneal Edema with Scleral Lens Wear; Healthy Versus Unhealthy Corneas

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