Glaucoma Surgical Technique Modifications for Patients Wearing Scleral Lenses

Nguyen, Anhtuan

Glaucoma Surgical Technique Modifications for Patients Wearing Scleral Lenses

Friday, April 25, 2014

KIOSKS (Boston Convention and Exhibition Center)

Anhtuan H. Nguyen, BS, University of Texas School of Medicine at San Antonio, San Antonio, TX, USA

Gloria B. Chiu, OD, Keck Medical Center of USC, Los Angeles, CA, USA

Brian A. Francis, MD, Doheny Eye Institute, Los Angeles, CA, USA

Olivia L. Lee, MD, University of Southern California, Los Angeles, CA, USA

Vikas Chopra, MD, University of Southern California, Los Angeles, CA, USA

Narrative Responses:

Purpose
Glaucoma drainage implants (GDI) frequently alter the scleral contour, which can make scleral lens fittings more challenging. The purpose of the study is to describe surgical management of patients with the concurrent need for GDI and Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens.

Methods
A retrospective case series of 6 patients requiring both PROSE lens wear for ocular surface disease (OSD) and/or irregular corneas and GDI for intraocular pressure (IOP) control. The first group (A) consisted of 2 patients where PROSE lens wear was precluded by the modified scleral surface following anterior chamber (AC) tube shunt placement. The second group (B) consisted of 2 patients where previously placed GDI led to challenging lens fitting. The third group (C) consisted of 2 PROSE lens-wearing patients who needed glaucoma surgery and were able to continue lens wear after GDI placement in the pars plana.

Results
GroupA: One case with an AC tube shunt could not be fitted with PROSE lens. The other case had 2 AC tube shunts that resulted in lens edge lift causing air bubble formation. GroupB: One case with an AC tube shunt with scleral patch graft 1mm from limbus and another with a pars plana tube shunt with scleral patch graft 2mm from limbus required lens diameter and toricity modifications to achieve proper lens fitting. GroupC: In 2 cases, placement of tube shunt in the pars plana with scleral patch graft 3.5mm from limbus resulted in no interference with lens fitting.

Conclusion
In patients with the concurrent need for GDI for IOP control and PROSE lens for OSD and/or irregular corneas, pars plana GDI with posteriorly-placed scleral patch graft should be considered. Anterior chamber tube placement and/or anteriorly-placed scleral patch graft can hinder proper lens fit for these PROSE lens dependent patients.