Fitting Irregular Corneas Secondary to Penetrating Keratoplasty

Clinical Report: Fitting Irregular Corneas Secondary to Penetrating Keratoplasty

Overview

This case report evaluates the fitting of a protruding, tilted corneal graft using an oblate semiscleral contact lens. The integration of corneal tomography and AS-OCT facilitated lens fitting and monitoring of corneal health.

Background

Fitting irregular corneas after penetrating keratoplasty (PK) poses challenges due to complex topographies resulting from graft tilt or elevation. Traditional contact lens options often fail.

Data Highlights

Parameter	Measurement
Initial Base Curve	7.46 mm
Final Base Curve	7.1 mm
Diameter	15.0 mm
Power	–7.75 D
Nasal Clearance (Initial)	192 µm
Nasal Clearance (14 weeks)	148 µm

Key Findings

The ROSE K2 XL Oblate lens was effective for fitting a tilted graft post-PK.
Initial fitting attempts with GP, soft toric, and hybrid lenses were unsuccessful due to mechanical strain.
Corneal tomography and AS-OCT were crucial for assessing corneal elevation and lens clearance.
Final lens fitting achieved stable visual acuity of 6/9+ (20/30+).
The patient achieved 14 hours of daily wear with excellent comfort and no corneal staining.

Clinical Implications

The use of oblate semiscleral lenses can provide a fitting strategy for patients with irregular corneas following PK.

Conclusion

This case demonstrates the effectiveness of semiscleral lenses in managing complex corneal grafts.