For the most part, post-keratoplasty patients are satisfied.1,2 But the procedure isn’t perfect. Some patients with irregular astigmatism or refractive anisometropia end up dissatisfied with their visual outcomes.

To address these patient’s concerns, a research team looked into the benefits of corneoscleral lenses (CSLs) in keratoconus patients who were unsatisfied with their visual outcomes.3 They found that CSLs could be fitted in non-severe cases after keratoplasty with optimal visual results.

The study included 11 patients with unsatisfactory vision with spectacles, due to irregular astigmatism, who were willing to try CSLs before scleral lenses. Doctors evaluated their refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis and endothelial cell count (ECC). They also evaluated patients’ corneal biomechanical parameters including corneal resistance factor (CRF), corneal hysteresis (CH) and corneal-compensated intraocular pressure (IOPcc).

After fitting the patients with CSLs, the researchers quantified their subjective visual quality and comfort. The team also noted the patients’ CSL usage time and kept track of the subjects for a year.3

The results show only two patients rejected the CSLs, leaving nine satisfied with the lenses (six males and three females).3 Visual acuities for these patients improved significantly over best spectacle-corrected vision. Patients reported prolonged usage times, with an average of almost 10 hours a day. The researchers noted no significant adverse ocular effects or clinically relevant changes in any corneal biomechanical parameters, visual quality, comfort rating or usage time.3

The results suggest that CSLs might be a valuable tool in managing visually unsatisfied post-keratoplasty patients.

1. Böhringer D, Schindler A, Reinhard T. Satisfaction with penetrating keratoplasty. Results of a questionnaire census. Ophthalmologe. 2006;103(8):677-81.

2. Kymes S, Walline J, Zadnik K, et al. Changes in the quality-of-life of people with keratoconus. Am J Ophthalmol. 2008;145(4):611-7.

3. Montalt J, Porcar E, España-Gregori E, Peris-Martínez C. Corneoscleral contact lenses for visual rehabilitation after keratoplasty surgery. May 23, 2020. [Epub ahead of print].