Case Report: Managing a Postgraft Keratoconus Patient with Scleral Lenses.

SIGNIFICANCE

Because the prognosis of corneal regrafting is worse than a primary graft, it is pertinent to recognize other clinical management options to postpone the need for surgical intervention. Scleral lenses are a viable option in achieving excellent vision and comfort for post-graft patients; however, close monitoring is vital to success.

PURPOSE

The purpose of this study was to report a case in which a post-graft keratoconus patient can be successfully fit and refit with scleral lenses as their corneal tissue changes shape with time. Ultimately, the goal for this patient was to delay the need for regrafting procedures.

CASE REPORT

This case presents a 57-year-old patient who has undergone penetrating keratoplasty in both eyes secondary to keratoconus. His original corneal grafts were 15 years or older. Because of a history of graft rejection in the right eye, he had a regraft in 2004. The left eye has signs of early rejection. The patient has been a scleral lens wearer since 2008. Within the past 24 months, he has required lens adjustments and refits because his fragile corneal tissue has changed shape. Lens changes were indicated when he presented with complaints of fogging associated with redness and irritation. We continued to work closely with the patient's corneal ophthalmologist, who recommended we maximize scleral lens wear in lieu of a corneal regraft. Because of the change from an oblate to prolate cornea, fitting this patient in a scleral lens has been a challenging task.

CONCLUSIONS

Scleral lenses are a viable option in post-graft patients who present with ectatic changes to their corneal tissue. This patient continues to see 20/20 in each eye and comfortably wears his lenses for up to 6 hours. By fitting this patient in a scleral lens, we have been able to avoid the need for a regraft and the possible negative outcomes that can be associated.