J Korean Ophthalmol Soc.  2018 Oct;59(10):968-973. 10.3341/jkos.2018.59.10.968.

The Therapeutic Effect of Sclerocorneal Lens in Coexisting Corneal Ectasia and Stevens-Johnson Syndrome

• Baek JU
• Park CH
• Na KS
• Kim HS

• KMID: 2422586
• DOI: http://doi.org/10.3341/jkos.2018.59.10.968

Abstract

PURPOSE
We report short-term treatment effects of a mini-scleral lens in patients with Stevens-Johnson syndrome and corneal ectasia.
CASE SUMMARY
A 54-year-old female who had been diagnosed with Stevens-Johnson syndrome and keratoconus presented with persistent right eye pain and decreased visual acuity. Therapeutic lenses, topical antibiotic eye drops, and topical steroid eye drops were used; however the symptoms were not controlled, then the patient was treated with a mini-scleral contact lens in the right eye. At the time of the first visit to our hospital 17 years ago, and the best-corrected visual acuity (BCVA) of the right eye was logMAR 0.22. However, Stevens-Johnson syndrome and corneal ectasia were severe and cataract surgery was considered because of worsening cataracts, but the patients refused this surgery. At the time, the BCVA of the right eye was then reduced to logMAR 1.10. On ophthalmic examination, there was conjunctival fibrosis and corneal neovascularization of the right eye. The symptoms were not managed with a using a therapeutic lens, and then the patient was prescribed a mini-scleral contact lens. After wearing the mini-scleral contact lens, the corneal and conjunctival neovascularization was reduced. After 6 months, the BCVA of the right eye improved to logMAR 0.60.
CONCLUSIONS
In patients with Stevens-Johnson syndrome and corneal ecstasia, mini-scleral contact lens can be considered as a useful treatment option for visual improvement and symptom control.

Keyword

Contact lenses; Miniscleral contact lens; Pathologic dilatation; Stevens-Johnson syndrome

MeSH Terms

Cataract
Contact Lenses
Corneal Neovascularization
Dilatation, Pathologic*
Eye Pain
Female
Fibrosis
Humans
Keratoconus
Middle Aged
Ophthalmic Solutions
Stevens-Johnson Syndrome*
Visual Acuity
Ophthalmic Solutions

Figure

• 

  Figure 1 Slit-lamp ophthalmoscopic findings in the patient. (A) Before wearing the miniscleral lens, conjunctiva of the right eye was moderate injected and there is a tarsus scarring. (B) It is a photograph of 10 hours after miniscleral lens wear. Conjunctival injection and corneal neovascularization of the right eye decreased significantly.

• 

  Figure 2 Topography of the right eye demonstrating nasal cone, asymmetric bow-tie pattern and central thinning. (A) Anterior elevation map (top left), posterior elevation map (top right), keratometric map (bottom left), and pachymetry map (bottom right). (B) Tangential map. OD = oculus dexter.

• 

  Figure 3 After wearing the mini-scleral contact lens, the corneal and conjunctival neovascularization was reduced. (A, B) Tear film between the cornea and the miniscleral lens is well positioned by slit-lamp biomicroscope. (C-F) Photos for cardinal directions; 6 hours after miniscleral lens wear. (C) Temporal side. (D) Nasal side. (E) Superior side. (F) Inferior side. There was no evidence of conjunctival bleaching associated with conjunctival compression by the lens.

• 

  Figure 4 Tear film (arrows) between the cornea and the miniscleral lens is well positioned along the cornea with clear apical corneal clearance. (A) Temporal side. (B) Nasal side. (C) Center.

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