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Caroline Cromelin, Scott R Lambert, Buddy M Russell; PIGGY-BACK CONTACT LENS SYSTEMS AFTER CORNEAL TRAUMA. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6077.
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The use of rigid gas permeable (RGP) contact lenses to correct irregular astigmatism after corneal trauma is a well-documented practice. There is a subset of patients who do not tolerate the use of RGPs either because of issues with fit or patient comfort. "Piggy-back” (PB) systems consist of an RGP lens on top of a soft contact lens. To date, all reported cases of PB contact lens system use have been in adult patients. We report a series of children whose vision could not be adequately corrected with glasses after corneal trauma, who were treated successfully with a PG contact lens system.
We reviewed the medical records of all children ages 4-14 years treated in the contact lens section at the Emory Eye Center between 11/1/03 and 11/1/13 with PB contact lens systems.
Four children with a history of corneal penetrating trauma were treated with a PB lens system, with a mean age of 7 ± 0.8 (range: 6 to 8) years. Each child had a full thickness, central corneal scar. Best corrected spectacle vision was count fingers in two of the children and 20/100 and 20/80 in the remaining two. The PB lens system was introduced a mean of 15.67 ± 6.51 (range: 9 to 22) months after the injury. All patients were initially fitted with RGP lenses. Each child achieved 11 or more hours of contact lens wear time in PB systems. The mean best corrected logMAR visual acuity using the PB system was 0.29 ± 0.03 (Snellen equivalent 20/39). The mean improvement in best corrected logMAR between RGP and PB lens systems was 0.14 ± 0.06. The next step under consideration for two of the children was penetrating keratoplasty, but the PB lens systems improved their visual acuity enough that this was not necessary.
Piggy-Back contact lens systems are not first line treatment for the management of irregular astigmatism in children. However, they can be helpful to improve vision in children with irregular astigmatism following corneal trauma who are intolerant of RGP contact lenses.
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