Outcomes Of Fluid-Filled Scleral Lens For The Management Of Limbal Stem Cell Deficiency

To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SLD) wear in patients with limbal stem cell deficiency (LSCD).

Retrospective consecutive case series.

Data collected included the etiology, the previous and concomitant management of LSCD, the clinical staging of the LSCD severity, and corrected distance visual acuity (CDVA) with SLD. Statistical analysis was performed to identify differences and correlations between changes in CDVA and LSCD stage between last follow-up (the time of discontinuation of SLD wear in eyes which SLD was discontinued and the last visit in eyes which SLD continued) and baseline (after the SLD fit). In a subset of patients that had worsened LSCD while using SLD, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed.

8 eyes (29.6%) were fitted with large diameter scleral lens, 12 eyes (44.5%) with prosthetic ocular surface reconstruction ecosystem lens, and 7 eyes (25.9%) with EyePrintPRO. Baseline LSCD stage was mild in 12 eyes (44.4%), moderate in 12 eyes (44.4%) and severe in 3 eyes (11.1%). The mean follow-up was 37.1±20.2 months. At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P=0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P=0.10). SLD wear was discontinued in 5 eyes (18.5%) due to worsening of LSCD. AS-OCT and AS-FA performed in 5 eyes showed limbal compression and delayed fluorescein filling. 

SLD can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SLD fit is necessary in these compromised eyes.