Corneal Response to Scleral Contact Lens Wear in Keratoconus.

OBJECTIVE: To verify corneal alterations in patients with keratoconus who wear scleral contact lenses (ScCLs), focusing on corneal endothelial assessment. METHODS: Scleral contact lenses were fitted in 22 patients with keratoconus. During a 90-day follow-up, patients were assessed in three visits: at baseline, after 30 days, and after 90 days. Patients underwent visual acuity measurement, slitlamp biomicroscopy of the anterior segment, specular microscopy of the corneal endothelium, corneal pachymetry, measurement of the clearance between the cornea and the lens, and follow-up of ectasia. RESULTS: Variables related to endothelial morphology and pachymetry values did not change significantly over time. Central clearance measurements decreased in the 90-day period. No progression of corneal ectasia was observed, neither were infectious or inflammatory processes in the same period. CONCLUSION: Daily wear of ScCLs in patients with keratoconus was not associated with adverse effects on the cornea or endothelium over a period of 90 days nor was there evidence of disease progression. Central clearance values diminished over that period, but the significance of this observation remains unclear.

Reabilitação visual com lentes de contato após transplante de córnea / Visual reabilitation with contact lenses after corneal keratoplasty

Resumo A adaptação de lentes de contato após o transplante de córnea tem sido considerada um desafio na reabilitação visual. Atualmente existe a possibilidade de adaptação de lentes de contato de vários tamanhos, diversos desenhos e com diferentes espessuras e materiais, como por exemplo lentes gelatinosas, lentes corneanas rígidas gás-permeáveis, lentes córneo-esclerais, mini esclerais e esclerais. O objetivo deste estudo foi apresentar uma revisão da literatura atual que possa exemplificar a utilização de alguns dos diferentes tipos de lentes de contato que possam ser usadas após o transplante de córnea. Foi realizada uma revisão integrativa da literatura médica na língua inglesa, utilizando como base de dados para a pesquisa, Pubmed e Mendeley. Como critério de inclusão, foi estabelecido a relevância do artigo de acordo com a experiência da equipe. Foram selecionados 26 artigos, com ano de publicação entre 2001 e 2018. Dentre os artigos selecionados, cinco possuem como principal assunto o transplante de córnea, nove artigos sobre lentes de contato em geral, e 12 artigos sobre lentes de contato esclerais ou mini esclerais. Devido a maior transmissibilidade de oxigênio para a córnea, o uso das lentes corneanas rígidas gás-permeáveis mostrou-se mais seguro e com probabilidade de uso por um período maior de tempo.

Abstract Contact lens fitting after corneal transplantation has been considered a challenge in visual rehabilitation. There is currently the possibility of adapting contact lenses of various sizes, various designs and with different thicknesses and materials, such as gelatinous lenses, gas-permeable rigid corneal lenses, corneal-scleral lenses, mini-scleral and scleral lenses. The objective of this study was to present a review of current literature that may exemplify the use of some of the different types of contact lenses that can be used after corneal transplantation. An integrative review of the medical literature in the English language, using as a database for the research, Pubmed and Mendeley. Twenty six articles were selected, with year of publication between 2001 and 2018, as inclusion criterion, the relevance of articles according to the authors' experience was used. Five articles were selected that have as main subject corneal transplantation, nine articles on contact lenses in general, and 12 articles on scleral or mini scleral contact lenses. Due to the greater transmissibility of oxygen to the cornea, the use of rigid gas-permeable corneal lenses was shown to be safer and more likely to be used for a longer period of time.