Articles Tập 67 Số CĐ13-HNKH Bệnh viện 19-8 09/09/2026

OPTICAL CORRECTION OF KERATOCONUS WITH SCLERAL CONTACT LENSES: A CASE REPORT WITH 6-MONTH FOLLOW-UP

Nguyen Ho Viet Lien1,2, Nguyen Le Ngoc Khanh3,4, Nguyen Thi Thu Huong3,4, Nguyen Thi Bich Huong5,6
1 Saigon General Eye Hospital (Cach Mang Thang Tam), Ho Chi Minh City
2 Bệnh viện Đa khoa Mắt Sài Gòn Cách Mạng Tháng Tám, TP HCM
3 Vinmec-Alina Eye Center, Vinmec Times City International General Hospital
4 Trung tâm Mắt Vinmec - Alina, Bv Đa khoa Quốc tế Vinmec Times City
5 epartment of Ophthalmology – Quang Ninh Provincial General Hospital
6 Khoa Mắt – Bệnh viện đa khoa tỉnh Quảng Ninh
DOI: 10.52163/yhc.v67iCD13.6498
16 Views
0 Downloads
Keywords
Keratoconus; scleral lenses; irregular astigmatism; corneal tomography; ABCD classification
Abstract

Background: Keratoconus is a progressive corneal ectasia causing irregular astigmatism and visual impairment. In moderate-to-severe disease, spectacles are often insufficient. Scleral lenses vault the cornea and create a fluid reservoir that neutralizes corneal irregularity.
Case report: A 29-year-old man presented with blurred vision in both eyes. Spectacle refraction yielded BCVA 0.7 (right) and 0.3 (left) in decimal notation. Tomography demonstrated asymmetric bilateral keratoconus: Kmax 47.1 D (right) and 55.4 D (left); thinnest pachymetry 517 µm (right) and 480 µm (left); ABCD staging A0B0C0D (right) and A2B4+C1D (left); BAD-D 2.25 (right) and 8.01 (left). Full scleral lenses (>16.5 mm, high-Dk material) were fitted. Visual acuity improved to 1.0 (right) and 0.9–1.0 (left) during follow-up, with stable tomographic indices at 6 months.

Conclusions: Scleral lenses can markedly improve and stabilize visual function in asymmetric keratoconus when spectacles fail. Long-term monitoring for progression remains essential, and disease-modifying therapy should be considered when indicated.

References
[1]
1. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Contact Lens and Anterior Eye. 2022;45(3):101559. Google Scholar
[2]
DOI: 10.1016/j.clae.2021.101559 Google Scholar
[3]
Liên kết: https://doi.org/10.1016/j.clae.2021.101559 Google Scholar
[4]
2. Belin MW, Duncan JK. Keratoconus: The ABCD Grading System. Klinische Monatsblätter für Augenheilkunde. 2016;233(6):701-707. Google Scholar
[5]
DOI: 10.1055/s-0042-100626 Google Scholar
[6]
Liên kết: https://doi.org/10.1055/s-0042-100626 Google Scholar
[7]
3. Gomes JAP, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, et al. Global consensus on keratoconus and ectatic diseases. Cornea. 2015;34(4):359-369. Google Scholar
[8]
DOI: 10.1097/ICO.0000000000000408 Google Scholar
[9]
Liên kết: https://doi.org/10.1097/ICO.0000000000000408 Google Scholar
[10]
4. Barnett M, Mannis MJ. Contact lenses in the management of keratoconus. Cornea. 2011;30(12):1510-1516. Google Scholar
[11]
DOI: 10.1097/ICO.0b013e318211401f Google Scholar
[12]
Liên kết: https://doi.org/10.1097/ICO.0b013e318211401f Google Scholar
[13]
5. Schornack MM. Scleral lenses: a literature review. Eye & Contact Lens. 2015;41(1):3-11. Google Scholar
[14]
DOI: 10.1097/ICL.0000000000000083 Google Scholar
[15]
Liên kết: https://doi.org/10.1097/ICL.0000000000000083 Google Scholar
[16]
6. Baudin F, Chemaly A, Arnould L, Barrénéchea E, Lestable L, Bron AM, et al. Quality-of-Life Improvement After Scleral Lens Fitting in Patients With Keratoconus. Eye & Contact Lens. 2021;47(9):520-525. Google Scholar
[17]
DOI: 10.1097/ICL.0000000000000821 Google Scholar
[18]
Liên kết: https://doi.org/10.1097/ICL.0000000000000821 Google Scholar
[19]
7. Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Contact Lens and Anterior Eye. 2020;43(6):543-552. Google Scholar
[20]
DOI: 10.1016/j.clae.2019.12.007 Google Scholar
[21]
Liên kết: https://doi.org/10.1016/j.clae.2019.12.007 Google Scholar
[22]
8. Fogt JS. Midday Fogging of Scleral Contact Lenses: Current Perspectives. Clinical Optometry. 2021;13:209-219. Google Scholar
[23]
DOI: 10.2147/OPTO.S284634 Google Scholar
[24]
Liên kết: https://doi.org/10.2147/OPTO.S284634 Google Scholar
[25]
9. Jaynes JM, Edrington TB, Weissman BA. Predicting scleral GP lens entrapped tear layer oxygen tensions. Contact Lens and Anterior Eye. 2015;38(1):44-47. Google Scholar
[26]
DOI: 10.1016/j.clae.2014.09.008 Google Scholar
[27]
Liên kết: https://doi.org/10.1016/j.clae.2014.09.008 Google Scholar
[28]
10. Fisher D, Collins MJ, Vincent SJ. Fluid Reservoir Thickness and Corneal Edema during Open-eye Scleral Lens Wear. Optometry and Vision Science. 2020;97(9):683-689. Google Scholar
[29]
DOI: 10.1097/OPX.0000000000001558 Google Scholar
[30]
Liên kết: https://doi.org/10.1097/OPX.0000000000001558 Google Scholar
[31]
11. Duncan JK, Belin MW, Borgstrom M. Assessing progression of keratoconus: novel tomographic determinants. Eye and Vision. 2016;3:6. Google Scholar
[32]
DOI: 10.1186/s40662-016-0038-6 Google Scholar
[33]
Liên kết: https://doi.org/10.1186/s40662-016-0038-6 Google Scholar