Gas-permeable scleral contact lens therapy in ocular surface disease

PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeab le scleral contact lenses in the management of patients with ocular surface disease. METHODS: The charts of 49 consecutive patients (76 eyes) with ocular surfac e disease whose management included the use of gas-permeable scleral contac t lenses were reviewed. We also developed a questionnaire to assess the imp act 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 yea rs); 31 patients were female and 18 mere male. The most common indication f or fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 e yes). Other indications included ocular cicatricial pemphigoid, exposure ke ratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital def iciency of meibomian glands, superior limbal keratoconjunctivitis, Sjogren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33. 6 months (range, 2 to 144 months). Improvement in best corrected visual acu ity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes, Zn eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the rem aining 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 t ime of the gas-permeable scleral contact lenses was 13.7 hours per day (ran ge, 4 to 18 hours), Many patients had preparatory surgical procedures befor e lens fitting (for example, punctal occlusion or mucous membrane grafting) , and some had visual rehabilitation surgical procedures (for example, kera toplasty 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. (C) 2000 by Elsevier Science i nc. All rights reserved.