scleral lens on keratoconus with dry eyes and piguecula case study

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Case Study Scleral Lens on Keratoconus associated with Dry Eyes and Piguecula Abstract Patient had a history of bilateral keratoconus, he was submitted to post-intrastromal rings implants and then he underwent to a reverse procedure to extract the intracorneal rings as he had a extrusion of one segment; He also was submitted to Collagen Crosslinking with Riboflavin under UV Rays in both eyes. His vision was never improved with both the previously procedures. He visited several practitioners in Brazil and in the US where he lived for a year studying. He was fit in the US with hybrid lenses and it worked for a some months until he developed intolerance to the lens, presenting hyperemia and burning sensation after 7 to 8 hours of continued wear and decreasing time until he just could not wear them anymore . Back in Brazil the patient was not able to wear his hybrid contact lenses and was fit with Rose K2 which he could tolerate up to 5 to 6 hours of continued wear or making interruptions so he could rest his eyes and get the lens back to wear so he could work. He was fit with scleral GP lenses and the results were an optimal fitting relationship, great comfort, increased wearing time and an optmal visual acuity.

Introduction The patient came from Sao Paulo to see us at IOSB in south Brazil, he informed us that he just had given up to find a solution for his problem and was about to submit himself to a corneal transplant until he heard about our work in south Brazil and thought giving a last shot, he told us exactly these words: “You guys are my last hope.” It is a real challenge when a patient say something like that, we told him that we were up to give our best to resolve his problem and that he could count on us. The real difficulties in this case is the long history of failures and the complications that arose from previous treatments and contact lens fittings. This case was conducted by Dr. Marcelo Bittencourt, MD and me in respect to the clinical consultation and lens customization. Beyond that, we had only five week days to resolve the fit as the patient works in a large multinational and his presence was required after that time.

Case Report Patient R.P.A., male, 32 years old, Engineer, bilateral keratoconus, underwent intrastromal ring implants, another procedure to extract the rings and then submitted to corneal crosslinking (CXL). He developed lens intolerance after six months of hybrid lens wear, he described that during the time he was in the US he was able to wear the lens for 12 to 13 hours a day and suddenly had an episode of redness and the wearing time decreased rapidly until he could not tolerate the hybrid lens wear anymore. He also referred burning sensation during lens wear. Back in Brazil he was fit with Rose K2 in both eyes and wearing time was up to 5 to 6 hours daily until the redness appear. The patient became very sensitive and he presents redness occasionally and spontaneously, we attributed this due to lacrimal deficiency as a probable cause.

Contact Lens Examination and Fit Evaluation - Day one In the first examination the patient presented a tear break-up time (T-But) of 5 to 6 seconds and we also observed a bilateral pinguecula. He was previously instructed to interrupt the GP lens wear for four days prior to examination so we could make sure there was no influence of corneal topography. Despite the crosslinking procedure and also to the fact that at his age the cornea is already more stable keratoconic eyes commonly have an altered corneal hysteresis and a weaker biomechanical resistance.

His Ks readings were:

OD OS

46.62 x 49.12 @ 135° 52.12 x 45.87 @ 57°

Rx readings were:

OD OS

-6.25 = -2.75 @ 118° -8.00 = -4.12 @ 48°

UCVA

OD OS

20/80 20/200


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