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Lasik, Pellucid Marginal Degeneration, X-Linking, Ectasia, now 20/25 with GVR Scleral Lens

This patient has a 14 year history of multiple vision and ocular complications dating from 2002 to 2015. Because she wanted to see clearer while taking photos and videos under water this patient had LASIK surgery in her right eye in 2002. After the surgery her vision was good except for halos and starbursts at night. After 5 years this patient noted that the vision in her right eye began to decrease. In 2011, she was diagnosed with Anterior Basement Membrane disease and early cataracts. For several months she tried unsuccessfully to wear soft contact lenses. Also around this time she began noticing double vision. In 2013 this patient visited a well respected ophthalmologist in Houston who told her that she had a corneal deformity known as Pellucid Marginal Degeneration (PMD). In late 2013, this patient had Collagen Cross-Linking (CXL) done on her right cornea and a “pocket” CXL done on her left cornea. (Pocket CXL involves the use of a Femtosecond laser to make a “pocket” in the cornea where the active chemical is placed). For a 6 month period following these procedures, this patient suffered inflammations and corneal erosions in both eyes requiring 17 office visits. Following these visits, this patient had no functional vision in her left eye for several months. Following the CXL procedures, the same surgeon removed “several small bumps” (patient quote) from her left cornea using a small scalpel. After this was done this patient tried once again, unsuccessfully to wear soft lenses. When I first saw this patient in October, 2015, I diagnosed her with post-LASIK corneal ectasia in her right eye. Her left cornea was very distorted due to the “pocket” CXL. In addition, the laser used on her left cornea created a significant haze. This was the reason that this patient noted double vision in her left eye. At her initial visit, this patient’s visual acuity was 20/50 in her right eye (with distortions) and 20/80 in her left eye (also with distortions). Over the last few months we were able to fit this patient with GVR Scleral lenses which are providing her with clear (20/25 vision in each eye) stable vision for the first time in many years. In the lower left photo, note the grey-white haze in the center of the cornea. This was created by the Femtosecond laser. The lower photo to the right is a cross-section of this patient’s cornea (with a scleral lens over it) taken with Ocular Coherence Tomography (OCT). The 2 top curved lines represent the front and back surfaces of the scleral lens. The large, curved grey structure is the patient’s cornea. Look carefully and you will note a short white line to the left of center of the cornea. This is the “pocket” created by the laser. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved saline solution. I expect this patient to see clearly and comfortably with her scleral lenses for many years to come. She will never need to undergo corneal transplant surgery.

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