MANAGING KERATOGLOBUS WITH A SCLERAL LENS

Alan Kwok

Abstract

BACKGROUND: Keratoglobus is a rare corneal disorder characterized by limbus-to-limbus thinning and ectasia. Hydrops and traumatic corneal perforations are not unusual. Because of their severe ectasia and distorted corneal topography fitting these eyes with corneal GP contact lenses is challenging. Moreover, corneal transplant surgery is considered a last resort because of the high rate of complications. GP scleral lenses offer the best option for vision rehabilitation if the lens has enough sagittal depth for sufficient corneal clearance.

CASE REPORT(S): PM is a 47 year old white female with keratoglobus OU. She had received a lamellar graft and then penetrating keratoplasty OD providing functional vision for decades. However, the vision had deteriorated to 20/70 in that eye from graft edema and her referring doctor suggested a scleral lens be fit on the left eye to provide vision. OS vision upon presentation was finger counting at 6 feet. Biomicroscopy revealed an edematous graft with a hazy peripheral cornea OD. Descemet’s breaks along with a thinned cornea of approximately 20% of full thickness were noted nasally in the cornea OS. Central corneal pachymetry readings were 700 um OD, 400 um OS. We fit her left eye with the Boston Ocular Surface Prosthetic which vaults her cornea, is worn all her waking hours with excellent comfort and corneal tolerance and corrects vision to 20/25-. The base curve of the lens is 7.8 mm despite its high vault and its power is -7.50 D.

CONCLUSIONS: Scleral lenses that can be designed to clear the extreme ectasia of keratoglobus eyes while maintaining a combination of base curve and power consistent with optimal vision correction are a viable method of managing these patients.

Details

Year: 2008

Program Number: 85083

Resource Type: Scientific Program

Author Affiliation: Boston Foundation for Sight

Co-Authors: Perry Rosenthal, Deborah S. Jacobs

Co-Author Affiliation: Boston Foundation for Sight, Boston Foundation for Sight

Room: n/a