J Korean Ophthalmol Soc.  2016 Aug;57(8):1241-1247. 10.3341/jkos.2016.57.8.1241.

Scleral Lens Application for Preventing Corneal Edema During Vitrectomy

• Jeong HC
• Jung WJ

• KMID: 2349070
• DOI: http://doi.org/10.3341/jkos.2016.57.8.1241

Abstract

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.

Keyword

Corneal edema; Scleral lens; Vitrectomy

MeSH Terms

Corneal Diseases
Corneal Edema*
Follow-Up Studies
Keratitis
Medical Records
Retrospective Studies
Vitrectomy*

Figure

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  Figure 1. Scleral lens application. (A) Spreading viscoelastics on the posterior surface of scleral lens. (B) Scleral lens application on the cornea before vitrectomy.

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  Figure 2. Measuring total corneal thickness and corneal epithelial thickness from RTVue-100. ‘*’ indicates total corneal thickness.

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  Figure 3. Superficial punctate keratitis (SPK) grading. After fluorescein staining, the total sum of the area of SPK was graded as A0 when the area occupied less than one third of the cornea, A2 when the area occupied one third to two thirds of the cornea, and A3 when the area occupied greater than two thirds of the cornea. The density was graded as D0 when there was no punctate staining, D1 when the density was sparse, D2 when the density was moderate, and D3 when the density was high and the lesions overlapped.

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  Figure 4. Fundus images through each material during core vitrectomy. (A) Scleral lens. (B) Non-scleral lens.

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  Figure 5. Mean total corneal thickness before & after vitrectomy. The corneal thickness increased after vitrectomy in all cases. After vitrectomy, the mean total corneal thickness was lower in Scleral lens group compared to Non-scleral lens group. Preop = preoperative; POD = postoperative day. * Statistically significant.

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  Figure 6. Superficial punctate keratitis (SPK) grade before & after vitrectomy. After vitrectomy, mean SPK grade increased. The difference of SPK grade between the two groups was not statistically significant. Preop = preoperative; POD = postoperative day.

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