Keratoconus Patient with Transplant and ALK now 20/25 with GVR Scleral Lens

The young woman in the center of this photo was diagnosed with keratoconus many years ago. In the 1980’s she underwent corneal transplant surgery in her right eye. Over the years this patient has had difficulties wearing any type of contact lens to restore quality vision especially in her right eye which is the eye with the transplanted cornea. In 2000, this patient was referred to a internationally renown eye institution where 2 surgical incisions (AK surgery) were placed into the transplanted cornea in an effort to decrease the corneal astigmatism. The surgical incisions in the right transplanted cornea never healed and remained open to this day. The vision in this patient’s right eye decreased after this surgery and she continued to experience unstable vision along with frequent eye pain. Last year in an effort to stabilize her corneas she underwent Collagen Cross Linking therapy. When this patient first visited out office 3 months ago, the visual acuity in her right eye was 20/800 and in her left eye 20/250. Over the last 3 months we have been fitting her with GVR Scleral lenses. With these lenses this patient is corrected to 20/25 vision in each eye. She can now see clearly and comfortably with all day lens wear. In the bottom left photo you can see a profile of her right cornea. The faint grey line is where the host cornea and donor cornea meet. Look carefully toward the bottom of this photo. You will note a curved line within the lower portion of the corneal transplant. This is one of the open incisions placed into this cornea. The bottom right photo is a frontal view of the transplanted cornea. Note the curved line at the top of the photo going from 11:00 O’Clock to 2:00 O’Clock and the curved line at the bottom of the photo going from 6:00 O’Clock to 8:00 O’Clock. These curved lines are the AK or “relaxing” incisions which created many problems for this patient. These incisions are open exposing the internal corneal tissues to the environment and the blinking action of the eyelids. The scleral lenses, in addition to providing vision also are acting to protect the compromised cornea and to keep the cornea in a moist environment. I feel that this patient will be able to wear her scleral lenses comfortably and with clear vision for many years.