title: Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes.
abstract: OBJECTIVE
  To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years.
  
  
  METHODS
  A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed.
  
  
  RESULTS
  All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2 ± 2.2 years. The mean age of corneal graft was 17.6 ± 11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2 ± 10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0 ± 7.5 diopter (D) and the refractive astigmatism was 8.0 ± 4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78 ± 0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence.
  
  
  CONCLUSIONS
  Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel. Electronic address: severinskiy@yahoo.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Severinsky
authors.affiliation: Microlens Ltd., Tel-Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Behrman
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Frucht-Pery
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D003261:Contact Lenses; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects* / Q000534:rehabilitation*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012030:Refractive Errors / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
keywords: Irregular astigmatism; Keratoconus; Penetrating keratoplasty; Recurrent ectasia; Scleral contact lenses