Case Report 8 – Mini-Scleral & Scleral RGPs

2 MAIN AREAS

  1. Extreme ectasia / Corneal RGP intolerance / End Stage
  2. Corneal Neuropathic Pain
    1. Corneal Hyperalgesia (plus or minus lacosamide depot Tx)
    2. Ocular Surface Disease
    3. Chronic Dry Eye

The argument for large diameter RGP contact lenses – Scleral and Mini-Scleral RGPs

  1. No corneal touch / insult
  2. Vault very proud /messy ectasias / PK – tilted grafts, graft host junction disease and ectasia
  3. Large footprint on sclera
  4. Stable with good centration
  5. Can not fall out (swimming / bungee jumping/surfing)
  6. No dust under lenses
  7. Big tear reservoir
  8. White eyes – in the absence of atopic and inflammatory eye disease
  9. No glare – well it is minimised depending on ectasia location relative to optic zone
  10. No ptosis – better for patients post graft with surgery induced lid damage
  11. Large corneal clearance = longer lens life = more wiggle room for keratoconus and ectasia progression in the absence of corneal cross linking.

Need to think and calculate in terms of Sag over a chord….. Use topography just to paint a picture and help determine severity.

Touch

Ideal

Too much

Landing Zone is a Tangent with alignment fit

Case – Bilateral extreme (early onset) keratoconus

  • 18 yo male advanced keratoconus OS>OD
  • BILATERAL Hydrops + neo + scarring
  • OD: UAVA 6/CF+ & OS: VA 6/CF-
  • CCT OD: 290um / OS: 280um
  • Patanol bd OU.

Contact Lens Parameters 

  • Gelflex mini-scleral RGP in Harmony Plus material
  • OD: 7.00/12.50/15.25/18.50/-7.25 CT 220um Sag 5857um (6/12=)
  • OS: 7.35/12.50/15.25/18.50/-5.25 CT 220um Sag 6178um (6/15=)

Acute Hydrops in advanced keratoconus: