|Patient||Age, y||Sex||Virus (Eye)||Ocular Comorbidities||Scleral Lens||Time to Edema||Treatment||Transplant|
|1||62||M||HK (OS)||Cataract extraction (OU)|
Previous PKP (OS)
|Zenlens: −1.75 −6.00 × 63; OAD = 15.4; BC = 7.42; Sag = 4.400; CT = 0.25 (Bausch & Lomb Specialty Vision Products, Rochester, NY)||5 mo||Cyclosporine|
|Repeat PKP (OS)|
Cataract extraction (OU)
Previous PKP (OU)
|Zenlens: +2.75 −3.50 × 152; BC = 8.6; OAD = 17.00; Sag = 6.0; CT = 0.42 (Bausch & Lomb Specialty Vision Products)||1 wk||Prednisolone|
|DSAEK under PKP (OD)|
Cataract extraction (OD)
Conjunctival resection with glue reconstruction (OD)
|Zenlens: 8.00 −1.00 × 124; BC = 9.0; sag = 4.7; CT = 0.58; OAD = 16.0 mm; BXO2 (Bausch & Lomb Specialty Vision Products)||4 mo||Loteprednol|
|4||51||F||HK (OS)||Blunt trauma||Zenlens: FT; BC = 9.5; sag = 4.5; CT = 0.42; OAD = 16.0; BXO (Bausch & Lomb Specialty Vision Products)||1 wk||Prednisolone|
- 1.Subclinical endothelial dysfunction: The increased fluid load created by the scleral lens via fluid reservoir interface may overwhelm the already susceptible cells.
- 2.Relative hypoxia: There has been evidence to suggest that oxygen permeability through the lens is dependent on many factors, including the intrinsic diffusion coefficient of the material, thickness of the material, as well as the thickness post-lens tear film.4It is possible that history of HK/HZO may have compromised endothelial function in our patients, increasing corneal susceptibility to relative hypoxia.
- 3.Contact lenses independently cause morphological changes in the corneal endothelial cells.5This, compounded with known endothelial dysfunction in HK/HZO, may explain the rapid and significant onset of corneal edema in our patient population.
- 4.Lastly, it is possible that scleral contact lens use could cause the HK/HZO endothelial disease to flare up independently or in conjunction with any of the above-described mechanisms.
Footnotes and Disclosure
- Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity.Ophthalmology. 2008; 115: S3-12
- Herpes simplex epithelial and stromal keratitis: an epidemiologic update.Surv Ophthalmol. 2012; 57: 448-462
- Modern scleral contact lenses: a review.Cont Lens Anterior Eye. 2014; 37: 240-250
- Oxygen diffusion and edema with modern scleral rigid gas permeable contact lenses.Invest Ophthalmol Vis Sci. 2014; 55: 6421-6429
- Physiologic changes of the cornea with contact lens wear.Eye Contact Lens. 2002; 28: 12-27