December 2014 Online Photo Diagnosis

BY LUCIANO BASTOS

Neovascularization and Anterior Stromal Haze Following GP Contact Lens Overwear

This image shows the eye of a 19-year-old young man presenting with neovascularization and spotted anterior stromal haze after overwearing his GP lenses.

History

The patient was fitted with the GP Ultracone (Ultralentes) keratoconus lenses in 2010 at age 15. He was referred for corneal collagen cross-linking (CXL) in 2011 by another doctor from his town, even though there was no evidence of significant keratoconus progression. Following the procedure, his cornea developed significant haze, and the corneal topography showed subtle progression in the six months following the procedure. He was refit with steeper GP lenses that same year. The patient continued wearing these lenses during the last few years, returning only for follow up and occasional lens cleaning and polishing.

The patient wore the lenses while sleeping for several weeks last year due to intensive studying. And, although we instructed him that he needed to be refit with new lenses, he failed to follow our recommendations. His lenses were scratched and had a thin line of mucous deposition.

Corneal Biomicroscopy

During his most recent follow-up exam last year, the patient presented with neovascularization and spotted anterior stromal haze (Figures 1 and 2) due to corneal hypoxia. These findings were observed only for the right eye, which had undergone the CXL. Although the scientific ophthalmologic literature has few references to neovascularization related to CXL, it was strange that we observed these findings only in the right eye. He reported increased lens intolerance OD and lower visual acuity (20/40).

Figure 2. Corneal Neovascularization

Management

We instructed the patient to stop wearing his lens OD for one week and then refitted him with new high-Dk GPs that had a slight steeper curve and a design that would maximize tear exchange. The fluorescein patterns in both eyes were very acceptable with the new lenses (Figure 3).

Figure 3. Fluorescein pattern OD (left) and OS (right) with the new GP Ultracone lenses, 125 Dk. The micro air bubble OS disappears after a few blinks.

Conclusion

During his most recent visit, we observed that the cornea presented with ghost vessels (Figure 4) rather than neovascularization; the patient’s visual acuity was restored to 20/25⁺³ in both eyes. We recommended that the patient wear each new pair of lenses for no longer than 18 months.

Figure 4. Ghost vessels still present in the corneal stroma.

Mr. Bastos is the director and clinical instructor of specialty contact lenses at the Instituto de Olhos Dr. Saul Bastos (IOSB), and is the director and specialty lens consultant of Ultralentes, a small laboratory specializing in GP and scleral lens designs in Porto Alegre, RS, Brazil.