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Scleral Contact Lens in a Patient with Tectonic Corneal Graft

Harish Kumar Bhardwaj

Aim: To describe a case report of a patient with tectonic corneal grafts in both eyes who was unable to achieve functional vision with spectacles or soft contact lenses. The patient was with fit with Atlantis scleral lens in the left eye, and was able to have comfort and reasonably good vision. Background: This is a case study conducted in King Abdullah Medical City Bahrain, 67 years old Bahraini male visited the cornea clinic with the complaint of poor vision both eyes in the year 2019; he was not able to find his way independently. History and clinical examination shows tectonic graft in inferior cornea in both eyes, with pseudophakiain both eyes and vitreo-macular traction with Epiretinal Membrane (ERM) in right eye. After going through the retinal surgery (Pars Plana Vitrectomy) and corneal transplant (Penetrating Keratoplasty) surgery in right eye. The patient was referredto the contact lens clinic. Methods: Atlantis scleral contact lens fitting was done to the left eye. (Boston, XO materials).The Atlantis scleral lenses by Xcel are manufactured exclusively in Boston XO materials and are available in 3 diameters, 15.0mm (mini scleral), 16.0mm, 16.5mm (scleral, if Horizontal Visible Iris Diameter is less than 10.5mm).They have 3 parameters which can be adjusted: Central zone (by changing base curve), limbal zone (1-2 steep, standard, 1-2 flat) and scleral zone (1-2 steep, standard, 1-3 flat). Results: The patient’s vision with this contact lens reached up to (0.5). This is considered a reasonably good vision that is suitable for driving according to international standards. Conclusion: This patient had tectonic grafts and was initially considered legally blind. After his contact lens fitting in the left eye he was able to drive and to lead normal life. This case report shed the light on the importance of scleral contact lenses in management of severe corneal distortions. It also demonstrates that scleral contact lenses can provide reasonable vision even in patients with tectonic corneal grafts.