Pitfalls in aphakic contact lens fitting.

We examined 23 consecutive cases of unilateral aphakia reporting to the contact lens office for endothelial count and morphology, corneal thickness and toricity. The fellow eye served as a control in all the cases. It was found that there is a significant drop in the central endothelial cell density, and change in the size and shape of the cells. These observations indicate a thermodynamically unstable state. The aphakic corneas were thicker than the controls but not to a significant extent. The cell count and pachymetry had no statistical correlation. Toricity of the aphakic corneas make successful fitting of a lens difficult. Since prolonged use of extended wear gas permeable as well as hydrogel lenses have a deleterious effect on the endothelium it is suggested that a careful case selection be made and strict monitoting carried out at follow up. These corneas are liable for decompensation with only mild noxious stimuli. This article is intended to acquaint the ophthalmologist with the pitfalls in aphakic contact lens fitting so that a cautious follow up may be planned.