Clinical outcomes and complications of fluid-filled scleral lens devices for the management of limbal stem cell deficiency

• Published in: Contact lens & anterior eye 2023-02, Vol.46 (1), p.101528-101528, Article 101528
• Main Authors: Bonnet, Clémence, Lee, Andrew, Shibayama, Vivian P., Tseng, Chi-Hong, Deng, Sophie X.
• Format: Article
• Language: English
• Subjects: Anterior segment fluorescein angiography; Anterior segment optical coherence tomography; Cornea; Corneal Diseases - diagnosis; Corneal Diseases - etiology; Corneal Diseases - therapy; EyePrintPRO; Fluorescein; Humans; In vivo confocal microscopy; Limbal Stem Cell Deficiency; Limbal Stem Cells; Limbus Corneae; PROSE lens; Retrospective Studies; Scleral lens
• ISSN: 1367-0484; 1476-5411
• DOI: 10.1016/j.clae.2021.101528

•Scleral lenses are a good option in the management of limbal stem cell deficiency.•Limbal stem cell deficiency progression can occur possibly due to limbal hypoxia secondary to limbal compression by the lens.•Close monitoring after scleral lenses fit is necessary in these compromised eyes. To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD). Retrospective consecutive case series. 27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed. Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). 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). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling. SL 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 SL fit is necessary in these compromised eyes.