title: Soft contact lens fitting after intrastromal corneal ring segment implantation to treat keratoconus.
abstract: OBJECTIVE
  To assess the feasibility of fitting a lathed soft toric contact lens (STCL) after the implant of intrastromal corneal ring segments (ICRSs) to treat keratoconus.
  
  
  METHODS
  Six months after ICRS implantation, 47 eyes of 47 patients (18-45 years) were fitted with a STCL. In each eye, we determined refractive error, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometry and asphericity measures. The outcome of STCL fitting was defined according to CDVA as successful (≤0.2logMAR) or unsuccessful (>0.2logMAR). Patients in the unsuccessful group were refitted with a piggy-back (PB) system. The above variables and the change in CDVA observed after STCL and PB lens fitting from spectacle CDVA were compared in the two groups.
  
  
  RESULTS
  STCL fitting was successful in 75%, 66.66% and 0% of the ICRS implanted eyes with stages I-III keratoconus, respectively. Spectacle-CDVA was 1.5 lines better and mean corneal power was 3.62D lower in the successful STCL group. In this group, the difference in cylinder axis between spectacles and STCL was 24.25° lower. PB refitting achieved a PB-CDVA ≤0.2logMAR in all cases. A similar difference in the CDVA change achieved by contact lenses versus spectacles was observed in the successful STCL and PB refitted groups.
  
  
  CONCLUSIONS
  STCL fitting is a feasible option in a large proportion of patients implanted with ICRS. When these lenses are unsatisfactory, a PB system is a good alternative.
authors.affiliation: Applied Vision Research Group, Faculty of Optics, Universidad Complutense de Madrid, 28037 Madrid, Spain. Electronic address: jcarballo@ucm.es.
authors.forename: J
authors.initials: J
authors.lastname: Carballo-Alvarez
authors.affiliation: Applied Vision Research Group, Faculty of Optics, Universidad Complutense de Madrid, 28037 Madrid, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Puell
authors.affiliation: Hospital Clinico San Carlos, 28037 Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Cuiña
authors.affiliation: Hospital Clinico San Carlos, 28037 Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Diaz-Valle
authors.affiliation: Applied Vision Research Group, Faculty of Optics, Universidad Complutense de Madrid, 28037 Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Vazquez
authors.affiliation: Hospital Clinico San Carlos, 28037 Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Benitez-Del-Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003263:Contact Lenses, Hydrophilic; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation / Q000379:methods*; D012029:Refraction, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
keywords: Intrastromal rings; Keratoconus; Piggy back; Soft toric contact lens