Impact Of Symblepharon Management On Scleral Lens Fitting In Eyes With Chronic Cicatrizing Conjunctivitis And Keratopathy

Published 2024 - 42nd Congress of the ESCRS

Reference: FP28.05 | Type: Free paper | DOI: 10.82333/kmxa-0186

Authors: Simmy Chaudhary* ¹ , Swapna S Shanbhag ¹ , Anahita Kate ² , Sayan Basu ¹

¹Cornea,LV Prasad Eye Institute,Hyderabad,India, ²Cornea,LV Prasad Eye Institute,Vijayawada,India

Purpose

To describe the importance of symblepharon release with ocular surface reconstruction (OSR) for optimal fitting of scleral contact lenses (SCL) in eyes with chronic cicatrizing conjunctivitis (CCC) and keratopathy.

Setting

Patients with ocular surface disease with symblepharon, who were seen in cornea clinic between January 2018 and January 2022, underwent symblepharon release with ocular surface reconstruction and referred to contact lens clinic for scleral lens fitting were included in the study. Two types of scleral lenses, the BostonSight Scleral (Boston Sight, Needham, MA) lenses and prosthetic replacement of ocular surface ecosystem (Boston Sight, Needham, MA) devices.

Methods

This retrospective study included 32 eyes of CCC and visually significant keratopathy with symblepharon which underwent symblepharon release with OSR and were fitted with SCL. The primary outcome measure was the improvement in best corrected visual acuity (BCVA) with SCL wear. Patients were followed up at 1, 3 and every 6 months after dispensing SCLs. Those who were dispensed SCLs were advised to use preservative-free saline to fill the vault (space between the posterior surface of the lens and the anterior surface of the cornea) and to replace it with fresh saline every 4 to 6 hours. Patients who were fitted with prosthetic soft CLs or rigid gas-permeable CLs were excluded.

Results

Common causes of CCC were Stevens-Johnson syndrome(66%) and ocular burns(16%). The most common location of symblepharon was superior(59%) with limbal involvement in most eyes(94%). Symblepharon release was combined with either mucous membrane grafting(MMG,63%), amniotic membrane grafting(AMG,31%) or conjunctival autografting(CAG,6%) for OSR. The median interval between symblepharon release and SCL trial was 15 weeks[interquartile range(IQR):6-24]. The median BCVA improved from logMAR 1.5(IQR:1.2-1.8) to logMAR 1.2(IQR:0.6-1.4) with SCL after the symblepharon release(p<0.001). The median diameter of the SCL used was 15 mm(IQR:15-16). Symblepharon recurrence was noted in 70% of eyes that underwent AMG; no recurrence was seen with MMG or CAG.

Conclusions

In eyes with CCC with advanced corneal scarring and symblepharon, visual rehabilitation is possible with SCL after surgically managing the symblepharon without having to resort to a penetrating corneal procedure.