title: Silicone hydrogel mini-scleral contact lenses in early stage after corneal collagen cross-linking for keratoconus: a retrospective case series.
abstract: BACKGROUND
  The aim was to the evaluate performance of a novel silicone hydrogel mini-scleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL).
  
  
  METHODS
  We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales.
  
  
  RESULTS
  SHmS fitting was performed 2.1 ± 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 ± 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 ± 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 ± 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes.
  
  
  CONCLUSIONS
  SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. severinskiy@yahoo.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Severinsky
authors.forename: Denise
authors.initials: D
authors.lastname: Wajnsztajn
authors.forename: Joseph
authors.initials: J
authors.lastname: Frucht-Pery
mesh_terms: D003094:Collagen / Q000378:metabolism*; D003263:Contact Lenses, Hydrophilic; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D007640:Keratoconus / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012828:Silicones; D014792:Visual Acuity
chemical_list: D003432:Cross-Linking Reagents; D012828:Silicones; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D003094:Collagen
keywords: cornea; cross-linking; keratoconus; mini-scleral lenses; silicone hydrogel lenses