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Sarah Alshami, Elizabeth A. Bradley, Cherie B Nau, Muriel Schornack; Outcomes of Scleral Lens Therapy in Patients with Neurotrophic Keratopathy at a Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1795.
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© ARVO (1962-2015); The Authors (2016-present)
Scleral lenses can provide excellent therapeutic benefits for patients with neurotrophic keratopathy. Although the use of proprietary lenses in the management of this condition has been described, current literature lacks reports of outcomes of the use of less expensive commercially available scleral lenses to treat patients with neurotrophic keratopathy. We describe outcomes of scleral lens therapy (visual acuity and maintenance of corneal epithelial integrity) in patients with neurotrophic keratopathy at our institution.
A retrospective chart review was performed for patients diagnosed with neurotrophic keratopathy from 2006 to 2016. Data collected from the record included age, gender, visual acuity and corneal assessments before and after scleral lens therapy, and duration of use. We analyzed improvements in visual acuity (using a paired t-test). Corneal epithelial integrity, corneal scarring, and corneal neovascularization following scleral lens therapy are presented using descriptive statistics.
We identified 42 patients (47 eyes) who met the inclusion criteria and completed the fitting process. 66.7% of our study population were female, and the mean age was 57.6 [15.7] years (mean [SD]) with a range of 23 to 85. The most common etiologies of neurotrophic keratopathy in our population were surgery (n=10), herpes zoster (n=6), diabetes mellitus (n=4), radiation (n=4), and herpes simplex virus (n=3). Of the 47 eyes, 51% were left eyes and 49% were right eyes. Initial visual acuity was logMAR 0.69 [0.47] for all eyes (n=47). Following scleral lens therapy, visual acuity was logMAR 0.35 [0.37] (p<0.005), a 49% improvement in visual acuity. Corneal epithelial integrity was maintained in 26 patients (29 eyes) and improved in 7 patients (7 eyes). Corneal scarring and neovascularization were also assessed; 29 patients (31 eyes) remained stable, 2 patients (3 eyes) experienced improvement, and 2 patients (2 eyes) had progression. Corneal outcomes could not be adequately assessed with information included in the records of 9 patients (11 eyes). The average duration of wear was 26.8 [25.8] months (range 1-98 months).
Commercially available scleral lenses are effective in maintaining corneal epithelial integrity in patients with neurotrophic keratopathy. Improvements in visual acuity were observed in our patient population.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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