Miniscleral contact lenses (CLs) may provide an effective refractive management strategy for individuals with peripheral ectasia who previously underwent penetrating keratoplasty (PK) for keratoconus, according to research published in Eye & Contact Lens. However, surgical management may still be required for some of these patients, according to the report.
Researchers performed a retrospective case series, which included 7 eyes from 5 patients (age range, 49-53 years) who presented to a single center with decreased visual acuity with spectacles or CLs, or because of reduced comfort with their rigid gas-permeable lenses. All participants in this series underwent PK for keratoconus a mean 28.7 years prior to the investigation.
All patients exhibited characteristic thinning at the graft–host junction, with anterior chamber deepening. The central corneas remained clear in all participants, inferring high visual potential.
All eyes achieved a best-corrected visual acuity of 6/9 or better with the miniscleral lenses, the report shows. With the exception of 1 participant who discontinued wear due to insertion and removal difficulties, the remaining participants wore their lenses 4 days or more per week with a minimum wear time of 8 to 10 hours daily.
“Despite the advances in CL design, surgical management is still required in some patients,” the study authors explain. “Because peripheral ectasia can present decades after PK, many patients are of older age with insufficient manual dexterity to handle CLs, may be CL intolerant, or may not be motivated to wear a CL for other reasons. In conclusion, miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes as an alternative to further surgical intervention.”
Study limitations include a retrospective design and small sample size.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Law E, Moledina M, Sexton I, Myerscough J. High astigmatism secondary to peripheral ectasia recurrence in postpenetrating keratoplasty eyes managed with miniscleral contact lenses. Eye Contact Lens. Published online August 18, 2023. doi:10.1097/ICL.0000000000001022