Scleral lens after intracorneal ring segments in patients with keratoconus

Background: To report the use of scleral lens (ScCL) to improve vision in patients having keratoconus who had intracorneal ring segment (ICRS) surgery. Methods: Two eyes of two keratoconus patients fitted with ScCL (PROSE - prosthetic replacement of the ocular surface ecosystem, USA) after having undergone ICRS surgery are reported as noncomparative interventional case series. The ICRS implanted were INTACs and kerarings. Indications, visual acuity with ScCL, complications and follow-up are reported. Results: Case 1 underwent ScCL trial as he was referred for keratoplasty for being contact lens intolerant after ICRS surgery. Case 2 was intolerant to both corneal rigid gas permeable (RGP) lens and soft contact lens (SCL). 18.5 and 18 mm diameter ScCLs were dispensed to Case 1 and 2 respectively. The ScCLs had adequate corneal clearance with no corneal touch. There was no staining of the cornea or vascularization with the lens use. Case 1 complained of double images during trial with different Front surface eccentricity (FSE). A ScCL that did not cause diplopia was ordered. At four months of lens wear, the patient had diplopia with ScCL, which cleared when second lens with changed FSE was dispensed. Case 2 used SCL for five years before ScCL was fitted. He used the same ScCLs for five years. ScCL use resulted in improved comfort and visual acuity of 20/20. No complications were noted. Conclusions: ScCL may be tried in patients who have ICRS and are intolerant to corneal RGP or SCL and before subjecting such patients to keratoplasty.