Clinical outcomes and complications of fluid-filled scleral lens devices for the management of limbal stem cell deficiency.

AIMS: To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD). DESIGN: Retrospective consecutive case series. METHODS: 27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed. RESULTS: Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling. CONCLUSION: SL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.

Netarsudil-Induced Corneal Flattening in a Child with Secondary Open-Angle Glaucoma.

We report a case of a child with secondary open-angle glaucoma who developed 6.5 diopters (D) of corneal flattening upon the addition of Rhopressa (0.02% netarsudil dimesylate solution) eye drops to a preexisting treatment regimen of timolol and latanoprost. This change in corneal power reversed after netarsudil, a rho-kinase inhibitor, was discontinued and replaced with Vyzulta (0.024% latanoprostene bunod ophthalmic solution). The 4-year-old female patient presented with bilateral secondary open-angle glaucoma from Paired Box 6 (PAX6)-related aniridia, aphakia, and persistent fetal vasculature. She was started on netarsudil to treat elevated intraocular pressure (IOP) in her right eye, which was not adequately controlled by latanoprost and timolol. Over 4 months, she developed 6.5D of corneal flattening in her right eye. Netarsudil was stopped and the corneal flattening reversed. There is evidence to support the ability of rho kinase inhibitors to increase the healing of the corneal endothelium in addition to their intended IOP-lowering effects. Rho kinase inhibitors may increase cell proliferation and adhesion within the corneal endothelium, hence decreasing apoptosis and promoting cell preservation. If there was an excess of cell proliferation; however, this might induce stromal cells to abnormally secrete enzymes or proteins, such as TGFß-induced proteins. This could result in corneal fibrosis, thereby flattening the cornea. Further investigation is required to explore this phenomenon and elucidate its mechanism of action. Corneal flattening may be considered as a potential side effect of the use of netarsudil, particularly in young pediatric patients.