Scleral Lens Application for Preventing Corneal Edema During Vitrectomy

Purpose: To analyze the effect of scleral lens application for preventing corneal edema during vitrectomy on postoperative corneal status using anterior segment OCT (RTVue 100, Optovue, Fremont, CA, USA). Methods: The medical records of 42 eyes (42 patients) who underwent total vitrectomy with no appreciable corneal disease between November 2014 and June 2015 were retrospectively reviewed. Evaluations were performed at 1 day, 1 week, and 1 month after total vitrectomy. Corneal status was noted at every follow-up visit using anterior segment OCT. An analysis was performed to define the changes in corneal status in association with scleral lens application during the surgery. Results: 18 of 42 eyes were treated with a scleral lens during total vitrectomy. The corneal thickness increased after vitrectomy in all cases. The mean corneal thickness increment was 23.9 ± 9.7 μm in the scleral lens group and 43.0 ± 19.5 μm in the non-scleral lens group at 1 day after vitrectomy (p < 0.001). At 1 week after vitrectomy, the mean corneal thickness increment was 8.1 ± 7.2 μm in the scleral lens group and 32.3 ± 19.2 μm in the non-scleral lens group (p < 0.001). The difference in superficial punctate keratitis grade between the two groups was not statistically significant. Conclusion: Scleral lens application during vitrectomy seems to prevent postoperative corneal edema. More cases and a longer period of study is needed to draw definitive conclusions. J Korean Ophthalmol Soc 2016;57(8):1241-1247

[1]  Y. Takamura,et al.  Changes in Matrix Metalloproteinases in Diabetes Patients' Tears After Vitrectomy and the Relationship With Corneal Epithelial Disorder. , 2015, Investigative ophthalmology & visual science.

[2]  M. J. Behrouz,et al.  Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. , 2015, Contact lens & anterior eye : the journal of the British Contact Lens Association.

[3]  A. Balestrazzi,et al.  Impact of Intraoperative Topical Hydroxypropyl Methylcellulose 2% Versus Sodium Hyaluronate 1.2% on Corneal Reepithelialization After Intentional Epithelial Debridement During Vitrectomy , 2014, Cornea.

[4]  J. González-Méijome,et al.  Modern scleral contact lenses: A review. , 2014, Contact lens & anterior eye : the journal of the British Contact Lens Association.

[5]  M. Feghhi,et al.  Pars Plana Vitrectomy and Silicone Oil Injection in Phakic and Pseudophakic Eyes; Corneal Endothelial Changes , 2014, Journal of ophthalmic & vision research.

[6]  A. Liem,et al.  CORNEAL ENDOTHELIAL CELL DENSITY AFTER VITRECTOMY WITH SILICONE OIL FOR COMPLEX RETINAL DETACHMENTS , 2014, Retina.

[7]  L. Yeung,et al.  PERSISTENT CORNEAL EPITHELIAL DEFECT AFTER PARS PLANA VITRECTOMY , 2013, Retina.

[8]  K. Nishida,et al.  Commercially available rigid gas-permeable contact lens for protecting the cornea from drying during vitrectomy with a wide viewing system , 2012, Clinical ophthalmology.

[9]  Akira Watanabe,et al.  Changes in corneal thickness following vitreous surgery , 2012, Clinical ophthalmology.

[10]  Kristine Dalton,et al.  Fitting an MSD (mini scleral design) rigid contact lens in advanced keratoconus with INTACS. , 2011, Contact lens & anterior eye : the journal of the British Contact Lens Association.

[11]  Sanjay V. Patel,et al.  Jupiter Scleral Lenses in the Management of Chronic Graft Versus Host Disease , 2008, Eye & contact lens.

[12]  D. Jacobs,et al.  Boston Scleral Lens Prosthetic Device for Treatment of Severe Dry Eye in Chronic Graft-Versus-Host Disease , 2007, Cornea.

[13]  P. Rosenthal,et al.  Fluid-Ventilated, Gas-Permeable Scleral Contact Lens Is an Effective Option for Managing Severe Ocular Surface Disease and Many Corneal Disorders That Would Otherwise Require Penetrating Keratoplasty , 2005, Eye & contact lens.

[14]  R. Buckley,et al.  Scleral Contact Lenses: The Expanding Role , 2005, Cornea.

[15]  J. C. Pastor Jimeno,et al.  [Corneal epithelial complications after vitrectomy: a retrospective study]. , 2004, Archivos de la Sociedad Espanola de Oftalmologia.

[16]  E. Franch,et al.  Complicaciones corneales epiteliales de las vitrectomías: estudio retrospectivo , 2004 .

[17]  T. Nishida,et al.  A novel grading method for superficial punctate keratopathy magnitude and its correlation with corneal epithelial permeability. , 2003, Archives of ophthalmology.

[18]  David Zadok,et al.  Scleral Contact Lenses May Help Where Other Modalities Fail , 2003, Cornea.

[19]  P. Rosenthal,et al.  The Boston Scleral Lens in the management of severe ocular surface disease. , 2003, Ophthalmology clinics of North America.

[20]  T. Oshika,et al.  Factors contributing to corneal complications after vitrectomy in diabetic patients. , 2001, Japanese journal of ophthalmology.

[21]  P Rosenthal,et al.  Gas-permeable scleral contact lens therapy in ocular surface disease. , 2000, American journal of ophthalmology.

[22]  J. Baum,et al.  Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. , 2000, American journal of ophthalmology.

[23]  M. Refojo,et al.  Reevaluation of corneal complications after closed vitrectomy. , 1988, Archives of ophthalmology.

[24]  T. Friberg,et al.  The effect of vitreous and retinal surgery on corneal endothelial cell density. , 1984, Ophthalmology.

[25]  F. Tolentino,et al.  Factors related to corneal epithelial complications after closed vitrectomy in diabetics. , 1979, Archives of ophthalmology.

[26]  F. Tolentino,et al.  Corneal complications after closed vitrectomy through the pars plana. , 1978, Archives of ophthalmology.

[27]  Ellen Shorter,et al.  Scleral Lenses in the Management of Ocular Surface Disease , 2018 .

[28]  Y. Tano,et al.  Corneal endothelial cell damage associated with intraocular gas tamponade during pars plana vitrectomy. , 1986, Japanese journal of ophthalmology.

[29]  D. Newsome,et al.  Limited superficial debridement to improve corneal clarity during closed vitrectomy. , 1980, American journal of ophthalmology.