Session Title: Cornea
Session Date/Time: Sunday 17/02/2013 | 08:30-11:00
Paper Time: 10:34
Venue: Hall 2
First Author: : E.Ghinelli ITALY
Co Author(s): : C. Roberto K. Kenyon P. Soragni
Purpose:
Although highly successful, penetrating keratoplasty can have visual acuity post operative delays in terms of best spectacle-corrected visual acuity (BSCVA), glare, haloes, loss of contrast, but more importantly irregular astigmatism. Managing post operative astigmatism is not always easy and successful, and it may often require further operating room access and still not always completely restore 20/20 BSCVA. The efficacy of rigid gas-permeable contact lenses "custom-made" (CM-RPG-CL) and their performance in the management of visual acuity post operative delays are studied.
Setting:
Patients were enrolled and their astigmatism after penetrating keratoplasty managed with CM-RPG-CL induced molding.
Methods:
A number of ten patients scheduled for penetrating keratoplasty due to non infective corneal affections, were enrolled in the study. Keratoplasty was performed using 18 interrupted nylon 10/0 single sutures. The graft diameter was 8.25mm while diameter of recipient was 8.00 mm. The most successful and affordable lens design for each patient was evaluated and the BSCVA monitored and managed using different types of CM-RPG-CL as early as 10 days after keratoplasty and for the following 5 months if CM-RPG-CL was tolerated. Corneal statistics of surface regularity index and surface asymmetry index, mean keratometric values, and optical zone diameter were topographically evaluated during contact lens wearing to preserve corneal tissue health. Confocal biomicroscopy, fluorescein dye test, ecobiometry and pachymetry were also taken to address corneal damage.
Results:
The group of patients showed CM-RPG-CL tolerance in all cases, no infections or major redness were observed and uncorrected visual acuity was obtained 10/20 in 90% of cases while best spectacle-corrected visual acuity of 25/20 was reached in 100% cases. Five months after penetrating keratoplasty visual acuity with contact lenses was 20/20 in 100% cases. Contact lens wearing also resulted in significant improvements in corneal regularity and symmetry, as indicated by Klyce corneal statistics, with concomitant improvements in visual acuity between wearing periods. The residual visual acuity on lens removal after the fifth month was 17/20 and this lens molding effect lasted from some hours to several days. No signs of damage or intolerance were noted during the wearing period.
Conclusions:
Rigid gas-permeable contact lenses wearing ten days after penetrating keratoplasty until 5 months postoperatively can dramatically improve visual acuity allowing excellent results in terms of BSCVA, astigmatism management and corneal tissue tolerance. Topographic index showed that the molding effect occurs and does not disappear after five months of CM-RPG-CL wearing.
Financial Disclosure:
None
