Silicone hydrogel mini‐scleral contact lenses in early stage after corneal collagen cross‐linking for keratoconus: a retrospective case series

Abstract

Background:The aim was to the evaluate performance of a novel silicone hydrogel miniscleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL). Methods: We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales. Results: SHmS fitting was performed 2.1 Ϯ 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 Ϯ 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 Ϯ 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 Ϯ 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes. Conclusions: SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.

Change in corneal microstructure with rigid gas permeable contact lens use following collagen cross-linking: an in vivo confocal microscopy study

“…Severinsky et al 29 had evaluated visual, refractive and topographical outcomes after fitting silicone hydrogel mini-scleral CL post-CXL. Overall, 90% of their study group was successfully fitted with lenses and the mean Snellen visual acuity was 6/9.…”

Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities

“…20 As the severity of KC increases, CL fitting becomes more complex, and special designs to match the altered corneal shape may be required. In case of corneal GP lens failure due to disease severity or corneal GP lens intolerance, other options such as piggyback lenses (corneal GP lens fitted over a soft lens), 21 hybrid lenses (lens with a central GP portion and a soft skirt in the periphery), 22-25 scleral lenses, [26][27][28] or miniscleral lenses [29][30][31] are available. Popularity of scleral lenses for the correction of irregular corneas has increased in the recent years with the advent of better materials and designs.…”

“…43 Piggyback lenses, hybrid lenses, scleral lenses, and mini scleral lenses have a role when corneal GP lenses have failed. [21][22][23][24][25][26][27][28][29][30][31]38,47 Piggyback lenses provided better vision, comfort, and corneal health. 21 In corneal GP lens-intolerant KC eyes, piggyback lenses worn for an average period of 6 months showed improvement in the tolerance level of corneal GP lenses.…”

“…The lenses provided vision comparable to corneal GP lenses and better comfort and vision-related QOL. [22][23][24][25] Similarly mini scleral [26][27][28] and scleral lenses 29-31 provide better vision and comfort in moderate to severe KC when other CL designs fail to fit. Although the comfort level with different types of CLs is different, no difference in the vision-related QOL has been reported with different types of CLs.…”

Silicone Hydrogel Miniscleral Contact Lenses after Corneal Collagen Crosslinking for Post-LASIK Keratoectasia

“…One of the major uses of silicone hydrogel mini-scleral lenses (SHmS) is visual rehabilitation shortly after CXL. 6 The goal of such design is to minimize contact lens interference with recovering and remodeling ocular surface, especially the epithelium. The other implication of SHmS is immediately after refractive or ocular surface reconstruction surgery as a therapeutic, bandage lenses.…”