Incidence of Rigid Gas-Permeable Contact Lens Wear After Keratoplasty for Keratoconus

Cornea and Contact Lens Department, The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Eye & Contact Lens Science & Clinical Practice (Impact Factor: 1.47). 08/2006; 32(4):207-10. DOI: 10.1097/01.icl.0000191953.84449.d6
Source: PubMed


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.

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    • "Re-suturing, astigmatic keratotomy – either manual or femtosecond laser assisted, corneal inlays, toric IOLs, and keratorefractive surgery are surgical options that can be used for improving vision [16,18–24] but further surgical interventions are neither effective/feasible nor acceptable (at least from patients' point of view) in many cases. Corneal RGP contact lenses have been used for correcting these refractive errors [17] [25] which have proved effective in some patients and ineffective in others due to the high level of irregularity of the cornea or astigmatism; therefore, contact lenses with a special back surface design have been proposed [26] [27]. Reverse geometry lenses are the most popular types of these lenses which should be used for flat corneas [28] [29]. "
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    ABSTRACT: Objective: To evaluate fitting feasibility, efficacy, and safety of mini scleral contact lenses in correcting post corneal graft vision. Methods: Prospective interventional case series, 56 visually unsatisfied post corneal graft eyes of 45 patients were fitted with miniscleral lenses (15.8 mm). Keratometric values, UCVA and BSCVA, fit, best corrected vision with the lens, decision to order lens, comfortable daily wearing time (CDWT), contact lens handling issues, and contact lens related complications were documented. Results: The mean age was 34.6 years (SD: 10.9), ranging from 8 to 63 years. Forty-three eyes had history of full thickness corneal graft, 12 eyes had deep anterior lamellar graft (DALK) and 1 eye had the rotational graft. The mean UCVA was 1.05 logMar (SD: 0.54), ranging from 0.30 to 2.52 logMar. The mean BSCVA was 0.73 logMar (SD: 0.50) ranging from 0.09 to 2.00 which improved to 0.17 logMar (SD: 0.19) with the miniscleral lens. All eyes had ideal (40 eyes) or acceptable (16 eyes) fits. Nineteen patients (23 eyes) ordered their lenses of whom 11 (14 eyes) continued using the lens with a mean follow up time of 21.92 months (SD: 6.8). These patients reported a mean CDWT of 9.62 h/day (SD: 4.5). Five eyes of 4 patients discontinued the lens. Four eyes were lost to follow-up. The main reported barriers for ordering the lenses were economic and handling concerns. Conclusion: Miniscleral contact lenses can be considered helpful in the visual management of post corneal graft patients. Other factors may influence the acceptance of the lenses.
    No preview · Article · Oct 2014 · Contact Lens & Anterior Eye
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    • "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 [5] [6] 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 [35]. "
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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.
    Full-text · Article · Nov 2013 · Contact lens & anterior eye: the journal of the British Contact Lens Association
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    • "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 [26]. Intralimbal rigid gas-permeable contact lenses are found effective in increasing visual acuity after penetrating keratoplasty, keratoconus and pellucid marginal degeneration as well [27]. "
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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.
    Full-text · Article · Jan 2012 · Journal of Ophthalmology
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