High-Dk piggyback contact lenses over Intacs for keratoconus: A case report
ABSTRACT The authors describe a case of a keratoconic patient with Intacs fitted with a high-Dk piggyback contact lens system.
A 41-year-old man presented to the clinic 1 week after Intacs surgery for keratoconus with complaints of poor visual acuity (VA) and monocular polyopia OU. The patient was corrected to 20/30 in both eyes with rigid gas permeable contact lenses but could not tolerate the lenses for more than 8 hours OD and 2 hours OS. The patient was then successfully fit with a high-Dk piggyback contact lens system.
The patient was able to wear the piggyback contact lenses comfortably 12 to 18 hours per day and was corrected to 20/25 OD, 20/30 OS, and 20/20 OU.
Patients with Intacs for keratoconus may require a combination of soft and rigid contact lenses for the best possible VA. Contact lens fitting with a high-Dk piggyback contact lens system can provide optimal comfort, corneal health, and VA for patients with Intacs for keratoconus.
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ABSTRACT: Purpose To assess the feasibility of fitting a lathed soft toric contact lens (STCL) after the implant of intrastromal corneal ring segments (ICRSs) to treat keratoconus. Methods Six months after ICRS implantation, 47 eyes of 47 patients (18–45 years) were fitted with a STCL. In each eye, we determined refractive error, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometry and asphericity measures. The outcome of STCL fitting was defined according to CDVA as successful (≤0.2 logMAR) or unsuccessful (>0.2 logMAR). Patients in the unsuccessful group were refitted with a piggy-back (PB) system. The above variables and the change in CDVA observed after STCL and PB lens fitting from spectacle CDVA were compared in the two groups. Results STCL fitting was successful in 75%, 66.66% and 0% of the ICRS implanted eyes with stages I–III keratoconus, respectively. Spectacle-CDVA was 1.5 lines better and mean corneal power was 3.62D lower in the successful STCL group. In this group, the difference in cylinder axis between spectacles and STCL was 24.25° lower. PB refitting achieved a PB-CDVA ≤0.2 logMAR in all cases. A similar difference in the CDVA change achieved by contact lenses versus spectacles was observed in the successful STCL and PB refitted groups. Conclusion STCL fitting is a feasible option in a large proportion of patients implanted with ICRS. When these lenses are unsatisfactory, a PB system is a good alternative.Contact Lens & Anterior Eye 10/2014; 37(5). DOI:10.1016/j.clae.2014.06.001 · 2.00 Impact Factor
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ABSTRACT: Keratoconus is a non-inflammatory corneal disease associated with a cone-shaped protrusion and progressive corneal thinning. Apart from progression control and stabilizing interventions, correcting the optical error induced by a mostly highly irregular corneal surface is of paramount importance with respect to quality of life and ability to work. This goal can be achieved efficiently by contact lenses with only rare adverse conditions. This article provides a current overview on contact lens fitting in keratoconus and presents own associated results.Der Ophthalmologe 08/2013; 110(9). DOI:10.1007/s00347-013-2819-9 · 0.72 Impact Factor
Article: Refractive surgery for keratoconus[Show abstract] [Hide abstract]
ABSTRACT: Traditionally, keratoconus has been managed with glasses when mild, contact lenses when moderate and keratoplasty when severe. When cornea-based refractive surgery was first developed it appeared to be a useful option for keratoconus until reports of post-operative progressive ectasia emerged and thus keratoconus was considered a contraindication to refractive surgery. However, improvements in older techniques and the development of new techniques mean that there are now several viable options to avoid keratoplasty in contact lens-intolerant patients. This review discusses the risks and benefits of excimer laser refractive procedures, both with and without corneal collagen cross linking, as well as intra-corneal ring segments, phakic intraocular lenses and refractive lens exchange with toric intraocular lens implantation.Clinical and Experimental Optometry 03/2013; 96(2):173-82. DOI:10.1111/cxo.12051 · 1.26 Impact Factor