Contact lens fitting after corneal collagen cross-linking

Abstract

BACKGROUND:Contact lenses (CLs) remain the mainstay in improving vision in patients having keratoconus. With corneal collagen cross-linking (CXL) performed worldwide, whether the same CLs can be used or needs replacement needed to be assessed and considered.AIMS:The aim of this study was to evaluate the changes in CL fitting following CXL.SETTINGS AND DESIGN:This is a retrospective study conducted at a tertiary center.SUBJECTS AND METHODS:We analyzed the medical records of patients who underwent CXL and used CL. Data collected included demographics, pre- and post-CXL refraction, corneal topography, anterior-segment examination, and CL [rigid gas permeable(RGP)] fitting details and duration between CXL and RGP fitting.STATISTICAL ANALYSIS:Descriptive analysis and paired t-test were used to compare the pre- and post-CXL data on refraction, visual acuity, and CL parameters. The statistical significance was kept at P < 0.05.RESULTS:Thirty-four eyes (keratoconus = 32, pellucid marginal degeneration = 1, and post-LASIK ectasia = 1) of 27 patients who used CL before and after undergoing CXL were analyzed. Mean duration between CXL and RGP lens use was 2.53 months. Mean sphere and cylinder post-CXL was −4.11 ± 4.32 D and −3.54 ± 2.51 D, respectively. A mean change of 0.75 ± 3.72 D sphere and 0.71 ± 3.39 D cylinder was noted post-CXL. The post-CXL best spectacle-corrected visual acuity (CVA) was 0.52 ± 0.36 and with RGP lens it was 0.09 ± 0.18. There was no significant difference in pre- and post-CXL RGP lens CVA (0.07 ± 0.09 and 0.09 ± 0.18, respectively; P = 0.556). Pre-CXL, 3-point-touch fitting was in 24 eyes (70.59%) and central fluorescein pooling was in 10 eyes (29.41%). Post-CXL, 30 eyes (88.24%) had 3-point-touch and central fluorescein pooling was found in four eyes (11.76%). One patient had CL intolerance after CXL. Of the 32 keratoconus eyes, 62.5% (n = 20 eyes) were prescribed new lenses; 37.5% (n = 12 eyes) continued using own lenses.CONCLUSIONS:There was no significant difference in refraction, topography indices, and RGP lens parameters pre- and post-CXL. However, changes in RGP lens fitting characteristics suggest a possible change in shape or apex location of the cornea after CXL. RGP lenses remain the best option to improve visual acuity after CXL in corneal ectasia.

A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China

“…This might be attributed to the high cost of RGP lenses and the relatively low economic status of subjects in Central China, which is different from other regions of China and other countries. Significant challenges in the management of progressive KC are to improve vision and arrest the progression of the disease 54 . The effectiveness of CXL surgery in arresting disease progression has been reported in several studies 55 , 56 .…”

Keratoconus: An updated review

“…This surgical procedure was found to be safe and effective for keratoconus in children and adolescents as evaluated post-operatively for periods ranging from 1 to 3 years [358][359][360][361], with similar initial efficacy as in adults [362], particularly in terms of improvement in visual and topographic outcomes following the first year of treatment [358]. Patients undergoing CXL typically still require contact lens correction following surgery [363]. More recently, several methods of "epi-on" (i.e., transepithelial) CXL have been proposed as keeping the corneal epithelium intact is likely to be less painful and may help avoid epi-off CXL-associated adverse events.…”

Visuelle Rehabilitation mit Sklerallinsen bei einem atypisch flachen Keratoglobus nach cornealem Crosslinking

“…20,22-24 A retrospective study found that, on average, corneal RCLs were worn again 2.53 months after CXL. 25 Following an epi-off procedure, it is recommended to wait at least three months before fitting RCLs; however, scleral lenses can be fitted earlier after CXL. 24 Criteria for initiating lens wear after surgery include complete re-epithelialisation.…”

“…Changes in corneal curvature are anticipated after CXL, and this is considered a desired effect of the procedure. 21,25,26 The flattening of the corneal curvature can impact the fit of RCLs, necessitating frequent refitting. 24 However, scleral lenses, based on literature and the author's experience, are minimally affected by corneal curvature changes due to CXL, 20,24 making them a favourable choice when prompt visual rehabilitation is required after the procedure.…”