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Corneal Confocal Analysis after Scleral Lens Wear in Keratoconus Patients: A Pilot Study

Optom Vis Sci. 2022 Oct 25. doi: 10.1097/OPX.0000000000001954. Online ahead of print.

ABSTRACT

SIGNIFICANCE: Scleral lenses rely on the scleroconjunctival region without bearing the cornea, which could improve the symptoms and modify the corneal nerve plexus morphology.

PURPOSE: To evaluate symptoms and changes in corneal nerve plexus morphology and density of Langerhans cells in keratoconus patients with and without intrastromal corneal ring before and after scleral lens wear.

METHODS: Sixteen scleral lens wearers with keratoconus were recruited for this short-term experimental pilot study. Subjects were divided into two groups: keratoconus (KC group) and intrastromal corneal ring (KC-ICRS group). All subjects were examined in two visits: baseline (before scleral lens wear) and after six months of scleral lens wear, after lens removal. The Schirmer I test, Ocular Surface Disease Index (OSDI questionnaire), tear break-up time (TBUT) and in vivo confocal microscopy were evaluated.

RESULTS: The mean age was 42.33 ± 11.27 years. A significant decrease of TBUT was found in the total group (P = .01, Wilcoxon) compared with baseline. OSDI score had decreased after six months of scleral lenses wear in KC-ICRS subgroup (P = .03, Wilcoxon) and in total group (P = .001, Wilcoxon). No statistical changes in nerves density, tortuosity and ramification were found for the total group either subgroup. However, the mean nerves length was higher in all groups, especially in the keratoconus subgroup (P = .03, Wilcoxon) after 6 months of scleral lens wear. Regarding optical density, the total group showed a significant increase after 6 months of wearing, (P = .02, Wilcoxon). Finally, Langerhans cells density was not statistically different in any group.

CONCLUSIONS: These results suggest that scleral lens wearing improve the symptoms and increased the mean length nerves after six months of wear use in keratoconus patients.

PMID:36301598 | DOI:10.1097/OPX.0000000000001954

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