Management of Advanced Keratoconus using a semi-scleral contact lens: A non-surgical option

Abstract

Keratoconus is a bilateral, progressive disease characterised by steepening and thinning of the cornea. In the early stages, spectacles improve visual acuity (VA) but as the disease progresses, rigid contact lenses (CL) are required to neutralise the irregular cornea. In advanced cases, when CLs do not provide a satisfactory fit or VA or are intolerable, keratoplasty is indicated. In Kenya, corneal donor tissue may not be readily available or affordable.

Case: This report describes the fitting of semi-scleral CLs in a patient with advanced keratoconus. A 23-year-old female, referred for CL fitting, presented with advanced keratoconus with minimal improvement in VA on refraction. Tomography revealed a maximum anterior corneal curvature of 90.86 D in the right eye (RE) and 76.52 D in the left eye (LE). Both eyes were fitted with semi-scleral CLs using a diagnostic fitting set. After fitting, using several trial lenses to achieve the optimal central and peripheral fit, VA improved from 1.3 logMAR to 0.3 logMAR and 1.0 logMAR to 0.2 logMAR in the RE and LE respectively. The patient reported to be comfortable wearing the CLs for approxiamtely 12 hours a day.

Conclusion: Noting the limited access to keratoplasty, this case report shows that semi-scleral CLs provide a satisfactory, non-surgical alternative to improve VA in patients with advanced keratoconus.