Título

Adaptation of scleral lenses after radial keratotomy

Objetivo

To report a case of scleral lens fitting in a patient with irregular astigmatism after radial keratectomy.

Relato do Caso

62-year-old man with high myopia.
History of refractive surgery with the surgical technique of keratotomy in parallel lines in the shape of a cross in both eyes. He refers intolerance to rigid gas permeable lenses with corneal support and poor visual acuity with soft lenses.
In the biomicroscopy was observed a keratotomy in parallel lines in the shape of a cross in both eyes (fig 1). There was vascularity in the incisions and diffuse keratitis.
Visual acuity with best correction:
OD 20/200 with -1.25 -2.25x75
OS 20/150 with -2.75 -3.25x165
In the corneal topographies, the typical central lake is observed in both eyes and the corneal irregularity is reflected in the difference of more than 40 diopters observed between the areas of greater and lesser curvature.
Different RGP lens designs were tested of corneal support and a tendency to decentering was observed in all cases. So, it was decided to evaluate a scleral support contact lens fitting (fig 2).
Final Test:
OD: Base Curve 7.50. Power -16.50. Diameter 15.00. Sag 4.150. Limbar zone: single steep. Scleral zone: single flat. 20/40.
OS: Base Curve 7.50. Power -15.50. Diameter 15.00. Sag 4.000. Limbar zone: single steep. Scleral area: single flat. 20/60

Conclusão

The use of scleral support RGP contact lenses improved the visual quality of a patient with post-radial keratotomy corneal irregularity in both eyes. The comfort and tolerance obtained were greater than with corneal support RGP lenses. Corneal physiology remained stable.