Visual management of aphakia with concomitant severe corneal irregularity by mini-scleral design contact lenses

Abstract

PurposeTo evaluate visual results, comfort of use, safety, and efficacy of mini scleral contact lenses in optical management in patients with traumatic aphakia and severe concomitant irido-corneal injury.MethodsIn a case series, eight eyes with post traumatic aphakia and severe concomitant irido-corneal injury that were evaluated at the Contact Lens Clinic of Farabi Eye Hospital, Tehran, Iran for contact lens fitting and could not be corrected with conventional corneal RGP contact lenses were fitted with miniscleral contact lenses. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and BCVA (Best corrected visual acuity) with miniscleral lens were recorded. Slit lamp examination, comfortable daily wearing time, and any contact lens-related complication were documented in each follow-up visit.ResultsThe mean UCVA and BSCVA of the cases was >2.7 and 0.41 LogMAR, respectively (BSCVA could not be assessed in one case due to severe corneal irregularity). The mean final BCVA with the miniscleral lens was 0.05 LogMAR (range from 0.4 to −0.04 LogMAR). The mean follow-up period was 14.6 months. The mean comfortable daily wearing time (CDWT) was 11.6 h, ranging from 8 to 16 h. The only contact lens-related complication was mild redness and irritation that was observed in 2 patients during the follow-up visits. All patients were comfortable with handling these lenses.ConclusionMiniscleral contact lenses can be considered a safe and effective option in aphakia patients with concurrent corneal scarring secondary to ocular injury for whom surgical intervention would be complicated.

Update on indications, complications, and outcomes of scleral contact lenses

“…Aphakia, when unilateral, produces significant aniseikonia, thus limiting the use of spectacles for optical correction. SCLs, specifically the mini-scleral design (MSD), are a good option for managing traumatic aphakia with concomitant irregular astigmatism secondary to corneal scarring [ 54 ]. Alipur and Hosseini evaluated the visual outcomes of the MSD in the optical treatment of individuals with traumatic aphakia associated with iridocorneal injury.…”

“…The VA significantly improved in all of the assessed eyes, and the average time spent comfortably wearing the MSD was 11.6 h (range 8–16 h). The only adverse effect observed was mild redness in two cases [ 54 ]. High ametropia (non-aphakic), as stated above, was first corrected with SCLs by August Müller in 1889 [ 55 ].…”

BCLA CLEAR – Medical use of contact lenses

“…In 1967, a large rigid lens, the Apex lens, was designed to provide mechanical stability [630], and is the basis for more recent lens designs. More recently, a mini-scleral lens design has been successfully fitted for severe corneal irregularity and aphakia after trauma [640].…”

“…However, soft lenses can be fitted initially followed by refitting with rigid corneal lenses if adequate vision cannot be achieved with soft lenses [647]. Scleral lenses were a safe and effective option to improve vision with reasonable comfort [640]. In cases of traumatic aphakia with additional complaints of photophobia from traumatic aniridia, rigid corneal lenses made of fluorosilicone acrylate with a dark brown tint have been fitted with success and decreased photophobia [632].…”

Management of Contact Lenses and Visual Development in Pediatric Aphakia

“… 39 In addition, two separate studies conducted in recent years reported that mini-scleral and scleral lenses can also be used as safe and effective options in aphakic children. 40 , 41 …”