Mini-scleral contact lenses for high postoperative astigmatism 30 years after penetrating keratoplasty: a case report

Purpose: To investigate visual improvement and tolerability of mini-scleral contact lenses (mini-SCLs) in a patient with high bilateral postoperative astigmatism about 30 years after penetrating keratoplasty (PK) for keratoconus. Methods: The Authors present the case of a 65 years old woman who underwent PK for keratoconus. PK was performed in 1988 in the left eye (LE) and in 1992 in the right eye (RE). Patient referred to us for blurred vision, intolerance to spectacles, and worsening quality of vision. Corneal graft was clear in both eyes. Uncorrected visual acuity (UCVA) was 20/400 and best spectacle corrected visual acuity (BSCVA) was 20/50 (-1sph=-8 cyl ɑ30°) in the RE, UCVA was 20/200 and BSCVA was 20/40 (-2sph=-6 cyl ɑ110°) in the LE. Mini-scleral rigid gas permeable (RGP) lenses (SLC Conica, Medlac, Avellino, Italy) were applied. Diameter of both lenses was 16.8 mm. Mini-SCLs were centered on the cornea, without touching the grafts, and therefore allowed good optical correction with minimum threat to the graft. Results: BCVA was 20/20 with mini-SCLs in both eyes. Patient wore the lenses for an average of 10 hours a day, not less than 6 hours a day. No discontinuous use of lenses was reported during the period of observation (2 months). No side effects or complications were described (e.g. graft rejection of infective keratitis). “Sapienza” University of Rome Policlinico Umberto I Hospital Eye Clinic Head: Prof. Leopoldo Spadea 1. Spadea L, De Rosa V. Current techniques of lamellar keratoplasty for keratoconus. Saudi Med J. 2016;37(2):127–136. 2. Spadea L, Fiasca A, Federici S. Intraoperative videokeratography in penetrating keratoplasty and excimer laser-assisted lamellar keratoplasty for keratoconus. J Refract Surg 2010 Sep;26(9):660-8. 3. Chu Hs et al. Mini-Scleral Lenses for correction of refractive errors after radial keratotomy. Eye Contact Lens 2018 Nov;44 Suppl 2:S164-S168. 4. Rocha GA et al. Visual rehabilitation using mini-scleral contact lenses after penetrating keratoplasty. Arq Bras Oftalmol 2017 Jan-Feb;80(1):17-20. 5. Alipour F, Behrouz MJ, Samet B. Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye 2015 Feb;38(1):54-8. Conclusions: Mini-SCLs demonstrated to be a safe, effective and well tolerated method to improve visual acuity in case of high astigmatism following PK uncorrectable with spectacles. Mini-SCLs may prevent or postpone the necessity of repeated surgery, by preserving clear corneal graft and making the patient really satisfied.