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Conquering the Compromised Cornea with a Bandage Lens

BY JOHN A. MC CALL, JR, OD
DECEMBER 1999

A 79-year-old female underwent uncomplicated cataract surgery, phacoemulsification and a well-centered posterior intraocular lens (IOL) in 1993. Three weeks postoperatively, she presented with a herpes simplex dendritic corneal ulcer OS that responded well to topical antiviral therapy without scarring.

However, over the next 14 months, she experienced numerous flare-ups, many involving stromal herpetic etiology.

Topical and oral antivirals, steroids, NSAIDs, antibiotics and a variety of soft contact bandage lenses maintained relatively good vision in the 20/30 range. After exhausting all medical means for a remission, I referred her to a corneal specialist.

Complications Abound

During the next two years, the patient was treated often for filamentary keratitis, superficial punctate keratitis (SPK), dendritic ulcers and stromal haze. She developed intense SPK, dropping her VA to 5/200, but aggressive medical management, including systemic antivirals, returned her VA to the 20/50 level.

Over the next two months, she failed to respond positively to medical therapy, and her condition progressed from a large pseudomembrane with increased inflammatory reaction in the anterior chamber to areas of bullous keratopathy, to a solid brown scar covering the central 60 percent of the cornea with only light perception remaining.

She then underwent penetrating keratoplasty OS, with good surgical outcome, but the epithelium sloughed off within 48 hours and took three months to re-epithelialize. The graft never regained good clarity and five months later, she presented with an ulcer at the graft's junction. A second graft was performed with a more successful outcome.

The following year, the patient's epithelial cells began sloughing again. The specialist suspected that the herpes simplex virus was invading the graft again because the cornea would not re-epithelialize. The specialist referred her back to me to follow with bandage soft contact lenses and medical therapy to try and save the second graft.

Over the next three months, I tried unsuccessfully to achieve epithelial growth with three brands of soft contact lenses. A biopsy for ocular pemphigoid gave inconclusive results.

After hearing about Proclear Compatibles soft contact lenses (Biocompatibles Eyecare Inc.), I decided to try them as a bandage on this patient.

A Saving Grace

When I initially applied the lens, the patient had been without complete epithelial coverage for over three months. The epithelium totally recovered within seven days, and the patient did so well over the next two months that I removed the lens. Two days later, the epithelium was still intact. However, after two months, it had completely sloughed off again. I replaced the Proclear Compatibles bandage lenses on the patient's eyes and although uveitis flared up and extensive anti-inflammatory topical medications were necessary to manage the anterior chamber, the epithelium recovered completely within two weeks.

Status Update

During the past year and a half, the patient has developed ischemic, age-related macular degeneration (AMD). Best corrected visual acuity OS is around the 5/200 level. The right eye has remained free of complications and has a VA of 20/25.

For this patient, the Proclear Compatibles soft contact lens stabilized a very compromised cornea when other soft contact lens materials could not. CLS

Dr. McCall Jr. specializes in primary care in his private practice in Crockett, Texas, and is currently serving as an officer at the East Texas Medical Center Hospital.