Combined Treatments of Severe Irregular Cornea

Most irregular cornea cases are patients who have keratoconus and are post-corneal transplant (phototherapeutic keratectomy [PTK]). As new technologies evolved, some practitioners also use combined treatments in an effort to give the patient the best possible result. In some cases, even with these combined treatments, the technique that will definitely improve patients’ visual acuity (VA) is scleral lens fitting.

History

Figure 1 shows the right eye of a 48-year-old patient who was diagnosed with binocular keratoconus when she was 10 years old. She underwent PTK and then topo-guided photorefractive keratectomy (PRK) when she was 18 and 19 years old, respectively.

Her visual acuity was still poor, and her eyecare practitioner performed corneal ring implantation and corneal cross-linking. Her non-corrected VA was 20/100 OD and 20/80 OS. A scleral lens fitting was attempted while she was in that disease state, but she was unable to wear the scleral lenses due to discomfort and conjunctival hyperemia in both eyes. She was referred to us by her surgeon for a scleral lens fit.

Her past scleral lenses presented with 360º of conjunctival hyperemia with zones of compression and corneal touch (Figure 2).

 Anterior segment tomography maps after surgical interventions can be seen in Figures 3 and 4.

Scleral Lens Fitting

After determining the ideal sagittal (sag) value (Figure 3), during the initial scleral lens evaluation, we observed a compression at 3 and 9 o’clock. We decided to customize the scleral lens haptic in order to achieve a smooth landing (Figures 5 and 6). VA improved to 20/20 in each eye.

Conclusion

Scleral lens fitting is a healthy direction to go in the visual rehabilitation of patients who have irregular cornea conditions.