Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty

• We evaluated fitting feasibility and visual results of miniscleral lenses in highly irregular post corneal graft patients.
• Two different types of corneal graft – lamellar and full thickness – were compared together.
• Barriers to acceptance of miniscleral lenses were evaluated.
• Patients’ tolerance and potential complications were evaluated in follow up visits.

ObjectiveTo evaluate fitting feasibility, efficacy, and safety of mini scleral contact lenses in correcting post corneal graft vision.MethodsProspective 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.ResultsThe 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.ConclusionMiniscleral contact lenses can be considered helpful in the visual management of post corneal graft patients. Other factors may influence the acceptance of the lenses.