Indications and outcomes of scleral contact lens for severe

1. Indications and outcomes of scleral contact lens for severe ocular surface disease in the acute inpatient setting Maylon Hsu, M.D.; Michael Nolan; Pooja Jamnadas, M.D., Amy Lin, M.D. Loyola University Chicago Stritch School of Medicine, Department of Ophthalmology 1960/D941 Introduction Table 1. Indications and Outcomes of Scleral Lens Therapy Results Scleral Lenses were used in 14 patients. Some patients required bilateral lenses, and one patient with severe periocular burns required repeated rounds of sclera lens therapy, resulting in a total of 30 cases. The age range was 2 weeks to 81 years old. All patients had some degree of exposure ranging from intermittent lag and poor lid closure to over 1 cm of lagophthalmos. 6 patients had cicatricial change; 5 due to flame burns and 1 due to pemphigus vulgaris. 4 patients had lagophthalmos secondary to sedation/ altered mental status. One patient had complete exposure of the globe due to agenesis of the eyelids at birth. The duration of sclera lens use ranged from 1 day to 40 days (Mean = 10.3 days, Median = 7 days). 5 patients expired while being treated with scleral lenses. In 8 out of the 30 cases, the sclera lens was discontinued when a tarsorraphy was placed. In all cases the corneal defects improved or remained stable. Scleral lenses are rigid, gas permeable contact lenses that are usually custom fitted to an individual’s eye and used to manage a variety of ocular surface conditions. Recently they have been applied to the inpatient setting, using a preservative-free lubricating gel in the fluid reservoir. The (PROSE) Posthetic replacement of the ocular surface ecosystem device, formerly known as the Boston Ocular Surface Prosthesis (BOSP) and Jupiter Lens are custom-designed in the inpatient setting, but the thicker gel allows for the fit of the lens to be more forgiving against the shape of the ocular surface. This study reports the clinical courses and outcomes of a series of patients who were treated with the BOSP and Jupiter scleral lenses as inpatients. Methods Data was collected by retrospective chart review of all patients who had insertion of the PROSE device or Jupiter scleral lens as inpatients since 2008. The indication for sclera lens placement and duration of use was recorded. The health of the cornea, development of any complications, and severity of other clinical findings such as lagophthalmos, trichiasis, symblephara, and scarring was recorded. Conclusion The use of sclera lenses in the inpatient setting is a safe and effective means of protecting the cornea from damage due to exposure. The lenses provide a more stable precorneal tear film and decrease the frequency of eyedrop administration by nursing staff. http://www.bostonsight.org References Figures 1-4: Various conditions requiring a scleral lens: 1) lagophthalmos secondary to sedation 2) severe facial and eye lid burns with cicatricial lag 3) lagophthalmos with epithelial defect and corneal scarrin 4) severe facial and eyelid malformation in 2 week old 2 1 3 4 1. Rosenthal P, Cotter J. The Boston Scleral Lens in the management of severe ocular surface disease. OphthalmolClin N Am. 2003;16:89-93. 2. Romero-Rangel T, Stavrou P, Cotter J et al. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol. 2000;130:25-32. 3. Rosenthal P, Cotter J, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. Am J Ophthalmol. 2000;130:33-41. 4. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye and Contact Lens. 2005;31(3):130-134. 5. Jacobs DS. Update on scleral lenses. CurrOpinOphthalmol. 2008;19:298-301. 6. http://www.bostonsight.org Acknowledgement: Grant Support: The Richard A. Perritt Charitable Foundation.