Jornal de Oftalmologia Clínica e Experimental
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Scleral Contact Lens in a Patient with Tectonic Corneal Graft

Harish Kumar Bhardwaj

Aim:  To describe a case report of a patient with tectonic corneal grafts in both eyes who was unable to achieve functional vision with spectacles or soft contact lenses. The patient was with fit with Atlantis scleral lens in the left eye, and was able to have comfort and reasonably good vision.

Case summary: A 67 years old male diabetic patient with keratoconus who underwent tectonic grafts in both eyes for bilateral spontaneous corneal perforations. He visited our cornea clinic complaining of extremely poor vision; he couldn’t drive and was unable to find his way independently.

Examination showed: vision in the right eye counting fingers at 3 meters and left eye vision was 0.1. Slit lamp examination showed bilateral patch grafts inferiorly that were bulging forward. He was pseudophakic in both eyes. Dilated fundus examination with high resolution-retinal OCT scan showed vitero-macular traction and epiretinal membrane in the right eye. He had normal foveal contour in left eye. The patient underwent right eye pars plana vitrectomy with membrane peeling, endolaser and silicone oil. Few weeks later he had penetrating keratoplasty in the same eye. Post operatively his vision with multiple pin-holes in the right eye was fluctuating at 0.05. The patient was referred the contact lens clinic. Atlantis scleral contact lens fitting was done to the left eye. (Boston, XO materials). The patient’s vision with this contact lens reached up to (0.5). This is considered a reasonable good vision that is suitable for driving according to international standards.

Conclusion:  This patient had tectonic grafts and was initially considered legally blind. After his contact lens fitting in the left eye he was able to drive and to lead normal life. This case report shed the light on the importance of scleral contact lenses in management of severe corneal distortions. It also demonstrates that scleral contact lenses can provide reasonable vision even in patients with tectonic corneal grafts.