Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens

PURPOSE: To report treatment of persistent corneal epithelial defects unres ponsive to other therapies by extended wear of a fluid-ventilated gas-perme able scleral contact lens. METHODS: In this retrospective study, 14 eyes of 13 consecutive patients re ferred for the treatment of persistent corneal epithelial defects that fail ed to heal with conventional therapies or developed epithelial defects afte r penetrating keratoplasty for persistent corneal epithelial defects were f itted with. an extended-wear gas-permeable scleral lens. These included sev en eyes of six patients with Stevens-Johnson syndrome and seven eyes of sev en patients who did not have Stevens-Johnson syndrome. Twelve eyes had unde rgone recent penetrating keratoplasty. All 14 eyes were fitted with a gas-p ermeable scleral contact lens designed to avoid the intrusion of air bubble s under its optic. An antibiotic and corticosteroid were added to the lens fluid reservoir or instilled before each lens insertion in 12 of 14 eyes. T he lenses were worn continuously except for brief periods of removal for pu rposes of cleaning, replacement of the lens fluid reservoir, and examinatio n and photography of the cornea, RESULTS: Five of the seven persistent corneal epithelial defects associated with Stevens-Johnson syndrome healed. The persistent corneal epithelial de fects of four of these eyes re-epithelialized within 7 days, and a fifth he aled in 27 days of gas-permeable scleral lens extended wear. A sixth persis tent corneal epithelial defect that failed to heal initially re-epitheliali zed after a subsequent penetrating keratoplasty and gas-permeable scleral l ens extended wear. The seventh eye healed after 3 days of gas-permeable scl eral lens extended wear, but the persistent corneal epithelial defect subse quently recurred. Three of seven non-Stevens-Johnson syndrome persistent co rneal epithelial defects re-epithelialized within 36 hours, 6 days, and 36 days, respectively. Of the six (six of 14) persistent corneal epithelial de fects that failed to heal with a gas-permeable scleral lens extended wear, one subsequently healed after multiple amniotic membrane grafts, Microbial keratitis occurred in four eyes (four of 14) and graft failure in one eye, all of which required repeat penetrating keratoplasty. CONCLUSION: Extended wear of an appropriately designed gas-permeable sclera l contact lens was effective in promoting the healing of persistent corneal epithelial defects in some eyes that failed to heal after other therapeuti c measures. Re-epithelialization appears to be aided by a combination of ox ygenation, moisture, and protection of the fragile epithelium afforded by t he scleral lens. However, microbial keratitis represents a significant risk . (C) 2000 by Elsevier Science Inc. All rights reserved.