Miniscleral lenses in the treatment of patients with dry eye syndrome (first own experience)

[Options for contact correction after keratoplasty]

Keratoplasty is a radical surgical method for treating various corneal pathologies. Today, there are many types of keratoplasty, each aiming to restore the integrity and transparency of the cornea. However, keratoplasty-induced ametropia often prevents achieving high visual acuity and makes impossible the use of conventional optical correction methods such as glasses or soft and traditional rigid contact lenses. In this regard, the use of scleral contact lenses is the most optimal method for optical correction of postoperative refractive anomalies, ensuring successful visual rehabilitation and preventing the need for additional keratorefractive interventions.

[Intraocular pressure with miniscleral contact lenses]

According to literature data, some experts do not exclude the possibility that scleral lens wear could influence intraocular pressure.

PURPOSE

To evaluate the influence of rigid gas permeable miniscleral contact lenses on intraocular pressure (IOP), keratometry readings and corneal thickness, and to study the correlation between scleral (IOPs) and corneal (IOPc) intraocular pressure using the Icare ic100 tonometer (model TAO11, Icare Finland Oy).

MATERIAL AND METHODS

The study included 99 volunteers without history of ocular diseases. The first group consisted of 66 participants (122 eyes) aged 22.3±2.2 years - IOPc and IOPs were measured by the Icare ic100 tonometer in order to determine the correlation. The second group (33 participants, aged 22.7±1.7 years) - day 1, diurnal IOPc and IOPs fluctuations were measured; on day 2, a miniscleral lens (diameter 14.9 mm) was placed on the study eye and was worn for 6 hours, the paired eye served as control. IOP was measured before, after lens placement, after 2 hours of lens wear, and before and after lens removal. Corneal topography was evaluated before and after lens removal.

RESULTS

In the first group, there was a weak but significant correlation between IOPc and IOPs (Spearman correlation coefficient 0.285, p=0.001). In the second group, IOPc in the study eye before lens placement (14.8±3.8 mm Hg) and IOPc after its removal (13.6±3.9 mm Hg) were not different from those in the control eye. There were also no statistically significant changes in IOPs before, during lens wear, and after lens removal. The central corneal thickness increased by 2.9% (p<0.001) after 6 hours of lens wear.

CONCLUSION

In young individuals without history of ocular diseases, wearing the miniscleral lens for 6 hours does not have significant influence on IOP and does not cause clinically significant corneal edema.

[Modern options for non-surgical correction of keratoconus]

The article reviews data on the so called non-surgical methods of keratoconus (KC) correction. The combined approach to KC treatment entails three main tasks: prevention of progression, optical correction of induced refractive disorders, and structural repair. Measures taken to accomplish the first two tasks should be regarded as symptomatic treatment, while addressing the last task requires pathogenetically oriented solutions. Corneal cross-linking and optical correction of refractive disorders with rigid gas permeable (RGP) scleral contact lenses should be regarded as the first choice for symptomatic non-surgical correction of keratoconus.