Incidence of Rigid Gas-Permeable Contact Lens Wear After Keratoplasty for Keratoconus
To review retrospectively the charts of all 190 patients who underwent penetrating keratoplasty for keratoconus in one hospital during a 5-year period (1995-2000), with special attention paid to contact lens fitting.
The frequency of postoperative contact lens use, the time to fit lenses after grafting, tolerance and visual acuity, and postoperative risks for the graft were studied.
The authors successfully fitted large-diameter (12 mm) tricurve rigid gas-permeable contact lenses for 90 (47%) of 190 penetrating keratoplasty patients with good tolerance. There were nine dropouts, and 91 eyes were corrected in another way. Fitting contact lenses after grafting usually started after 8.5 months (range, 1-60 months). The average tolerance was 9.2 hours a day (range, 2-12 hours), and best-corrected visual acuity was 20/25 (range, 20/16-20/200). The average follow-up was at least half a year. The average age of the patient at the first lens fitting was 36.2 years (range, 14-75 years). There was no increased risk in graft rejection.
Twelve-millimeter rigid gas-permeable contact lens wear was successful in 47% of patients who underwent penetrating keratoplasty for keratoconus. It does not interfere with the use of chronic postoperative topical medication, nor does it increase the risk of corneal graft rejection. It is necessary to recommend likely use of contact lenses to patients who have undergone grafting surgery.
Available from: Boris Severinsky
- "The average initial graft to fit interval in our study was more than 12 years. This value is relatively high when compared to the data presented by other researchers   and may be explained by good spectacle corrected visual acuity, which is often a rule after a successful PK. In an Australian corneal graft registry study in 44% of 4834 total penetrating grafts for keratoconus, spectacles were used as primary visual correction, while 39% did not use any type of visual correction at all . "
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ABSTRACT: To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years.
A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed.
All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2±2.2 years. The mean age of corneal graft was 17.6±11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2±10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0±7.5 diopter (D) and the refractive astigmatism was 8.0±4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78±0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence.
Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.
Contact lens & anterior eye: the journal of the British Contact Lens Association 11/2013; DOI:10.1016/j.clae.2013.11.001 · 1.37 Impact Factor
Available from: ncbi.nlm.nih.gov
- "If astigmatism is under 1D, soft contact lenses would be successful to correct refractive status. In a recent study, Geerards et al. successfully fitted large-diameter (12 mm) tricurve rigid gas-permeable contact lenses for 90 (47%) of 190 penetrating keratoplasty patients with good tolerance . Intralimbal rigid gas-permeable contact lenses are found effective in increasing visual acuity after penetrating keratoplasty, keratoconus and pellucid marginal degeneration as well . "
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ABSTRACT: Keratoconus is the most common corneal distrophy. It's a noninflammatory progressive thinning process that leads to conical ectasia of the cornea, causing high myopia and astigmatism. Many treatment choices include spectacle correction and contact lens wear, collagen cross linking, intracorneal ring segments implantation and finally keratoplasty. Contact lenses are commonly used to reduce astigmatism and increase vision. There are various types of lenses are available. We reviewed soft contact lenses, rigid gas permeable contact lenses, piggyback contact lenses, hybrid contact lenses and scleral-semiscleral contact lenses in keratoconus management. The surgical option is keratoplasty, but even after sutur removal, high astigmatism may stil exists. Therefore, contact lens is an adequate treatment option to correct astigmatism after keratoplasty.
Journal of Ophthalmology 01/2012; 2012(2):832070. DOI:10.1155/2012/832070 · 1.43 Impact Factor
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Posterior lamellar keratoplasty (PLK) offers many substantial benefits compared to penetrating keratoplasty (PK) including:
closed eye surgery elimination of both regular and irregular postoperative astigmatism leading to full visual rehabilitation
with spectacles within 3–6 months, elimination of postoperative corneal anaesthesia, and a reduced risk of postoperative globe
Disadvantages of PLK compared to PK include: corneal stromal scarring is untreatable by PLK, complex anterior segment reconstruction
is more difficult with PLK, PLK often fails in patients with aphakia and/or an incomplete lens iris diaphragm, early donor
dislocation in PLK remains a problem.
PLK techniques, and the indications for it, are still evolving.
PLK is rapidly replacing PK as the procedure of choice for patients with otherwise uncomplicated endothelial cell loss such
as pseudophakic bullous keratopathy and Fuchs' endothelial dystrophy.
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