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Gas-permeable scleral contact lens therapy in ocular surface disease

  • Tatiana Romero-Rangel
    Affiliations
    Hilles Immunology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, and Foster)

    Harvard Medical School, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, Rosenthal, and Foster)
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  • Panagiota Stavrou
    Affiliations
    Hilles Immunology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, and Foster)

    Harvard Medical School, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, Rosenthal, and Foster)
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  • Janis Cotter
    Affiliations
    Boston Foundation for Sight (Ms Cotter and Dr Rosenthal), Boston, Massachusetts, USA
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  • Perry Rosenthal
    Footnotes
    Affiliations
    Harvard Medical School, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, Rosenthal, and Foster)

    Boston Foundation for Sight (Ms Cotter and Dr Rosenthal), Boston, Massachusetts, USA
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  • Stefanos Baltatzis
    Affiliations
    Athens University, Athens, Greece (Dr Baltatzis)
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  • C.Stephen Foster
    Correspondence
    Reprint requests to C. Stephen Foster, MD, FACS, Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114; fax: (617) 573-3181
    Affiliations
    Hilles Immunology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, and Foster)

    Harvard Medical School, Boston, Massachusetts, USA (Drs Romero-Rangel, Stavrou, Rosenthal, and Foster)
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  • Author Footnotes
    1 Dr Rosenthal is a paid consultant for Bausch & Lomb. Bausch & Lomb has no financial interest in the Boston Scleral Lens.

      Abstract

      PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease.
      METHODS: The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living.
      RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjögren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting.
      CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.
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