Corneoscleral contact lenses for visual rehabilitation after keratoplasty surgery

Purpose: To report the use of corneoscleral lenses (CSL) in keratoconus patients who were unsatisfied with their visual outcomes after keratoplasty surgery. Methods: Eleven consecutive cases with unsatisfactory vision with spectacles, due to irregular astigmatism, preferred to try CSL before SL due to handling or economic issues. An eye examination included refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count (ECC) and evaluation of corneal biomechanical parameters (corneal resistance factor, CRF; corneal hysteresis, CH; corneal-compensated intraocular pressure, IOPcc). The fitting process was performed using a diagnostic fitting set. Subjective visual quality and comfort, and CSL usage time were also recorded. Patients were monitored for 1 year. Results: Two patients presented intolerance to CSL. Therefore, nine patients (6 males and 3 females; the mean SD age, 44.56 +/- 17.33 years, range 27-82) were fitted with CSL. The log MAR visual acuity of these eyes improved significantly with CSL in relation to the best spectacle-corrected vision (0.02 +/- 0.06 vs 0.22 +/- 0.15, respectively; p = 0.007). Patients reported prolonged usage times (an average of 9.78 +/- 1.99 h; range, 8-14). No significant adverse ocular effects or clinically relevant changes in ocular parameters (ECC, CH, IOPcc, central corneal thickness and keratometry; all p > 0.05), visual quality, comfort rating or usage time were found during the 1-year follow-up. Conclusion: Corneoscleral lenses could be fitted in non-severe cases after keratoplasty surgery with optimal visual results as they can be a safe and healthy alternative option.