Preserving a Failing Penetrating Keratoplasty Graft with Customized Scleral Lens
Overview
A customized high Dk scleral lens was successfully used to rehabilitate a patient with a failing penetrating keratoplasty graft, improving visual acuity and reducing corneal edema. The lens design optimized oxygen delivery and ocular surface protection, resulting in enhanced graft stability and patient comfort.
Background
Penetrating keratoplasty (PK) graft failure due to endothelial decompensation leads to corneal edema, stromal haze, and visual decline. Scleral lenses provide optical rehabilitation and protect the ocular surface in compromised corneas. Maximizing oxygen permeability through lens material and design is critical to support graft viability and reduce edema. Customized lens parameters can address irregular corneal shapes and improve lens fit and comfort.
Data Highlights
| Parameter | Pre-Lens | Post-Lens (4 weeks) |
|---|---|---|
| Best-Corrected Visual Acuity (BCVA) | Hand motion | 20/150 |
| Corneal Thickness | Increased (central edema) | Reduced (less edema) |
| Symptoms | Glare, fluctuating vision, photophobia | Decreased glare and improved vision stability |
Key Findings
- Patient with failing PK graft exhibited endothelial cell failure and corneal edema with poor vision (BCVA hand motion).
- Existing scleral lens was inadequate due to unstable fluid reservoir and poor optical performance.
- Use of a high Dk material (Optimum Infinite) improved oxygen delivery to the compromised cornea.
- Customized lens design (14.9 mm oblate, toric peripheral curves, edge lift zones) optimized fit and reduced localized compression.
- After 4 weeks of wear, BCVA improved to 20/150 with reduced corneal thickness and symptoms.
- Enhanced oxygen permeability and lens surface wettability contributed to graft preservation and visual rehabilitation.
Clinical Implications
In cases of PK graft failure with endothelial decompensation, selecting a high oxygen-permeable scleral lens material is essential to reduce corneal edema and support graft health. Customized lens designs tailored to irregular corneal topography can improve fit, comfort, and visual outcomes. Regular monitoring and lens refinements may optimize therapeutic benefits and prolong graft viability.
Conclusion
This case highlights that combining a high Dk scleral lens material with a customized design can effectively rehabilitate vision and preserve a failing PK graft by enhancing oxygen delivery and ocular surface protection.
References
- Eaves ME, 2024 -- Preserving a Failing Penetrating Keratoplasty Graft
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