ESCRS - POCOR236 - Scleral Contact Lenses As Vision-Saving Strategy After Penetrating Keratoplasty In An Aphakic Eye

Scleral Contact Lenses As Vision-Saving Strategy After Penetrating Keratoplasty In An Aphakic Eye

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR236 | Type: Free paper | DOI: 10.82333/m26q-9863

Authors: Mrs Eva Ramón* 1 , Ms Mireia Campos 2 , Mrs Clara Bonel 3 , Dr José Luis Güell 3

1General Ophthalmology Department,IMO Grupo Miranza,Barcelona,Spain, 2Optometrist Contact Lenses Department,IMO Grupo Miranza,Barcelona,Spain, 3Cornea and Refractive Surgery Department,IMO Grupo Miranza,Barcelona,Spain

Purpose

To report the visual rehabilitation of a highly complex aphakic eye after penetrating keratoplasty (PK) for fungal keratitis and endophthalmitis, highlighting the role of scleral contact lenses as a conservative alternative to further surgical intervention in cases of severe irregular astigmatism and aniridia.

Setting

Tertiary referral anterior segment and contact lens unit, Department of Ophthalmology, Spain.

Methods

A 49-year-old highly myopic soft contact lens wearer was referred with severe fungal keratitis in the right eye (RE). Presenting visual acuity was hand movement in the RE and 0.8 in the left eye (LE). Slit-lamp examination revealed a failed penetrating keratoplasty, 360º anterior synechiae, dense hypopyon, and aphakia. Fundus visualization was not possible; B-scan ultrasonography demonstrated findings consistent with fungal endophthalmitis. After stabilization, best corrected visual acuity improved to 0.6 with a soft aphakic contact lens and intraocular pressure remained controlled.

Results

Best corrected visual acuity (BCVA) improved from 0.2 postoperatively to 0.6 with aphakic spectacle correction. Despite complete suture removal, significant irregular astigmatism limited further improvement due to persistent corneal surface irregularity. Sequential optical rehabilitation strategies were implemented, including large-diameter soft lenses and iris-tinted lenses.

A potential acuity test was performed prior to rigid gas-permeable lens fitting to assess visual potential. After fitting a rigid gas-permeable lens, corneal surface regularization allowed the patient to achieve a BCVA of 0.9, with marked improvement in visual quality and stability. 

Conclusions

Surgical alternatives such as arcuate keratotomy or secondary intraocular lens implantation were therefore deferred. In complex post-keratoplasty eyes with aphakia, irregular astigmatism, glaucoma drainage devices, and partial limbal dysfunction, scleral or rigid contact lenses can provide substantial visual recovery and postpone or avoid additional surgical procedures.

Careful assessment of visual potential and stepwise conservative management are essential before considering corneal refractive surgery or secondary implants. Contact lenses should be regarded as a primary therapeutic tool in grafted eyes with high optical irregularity.