Abstract:Objective: To investigate the clinical efficacy of the scleral lens in the treatment of keratoconus. Methods: In this retrospective study, 18 (26 eyes) keratoconus patients fitted with a scleral lens in the Eye Hospital of Nanjing Medical University from October 2020 to March 2021 were included. According to the AmslerKrumeich grading of keratoconus, there were 9 eyes with grade I, 3 eyes with grade II, 4 eyes with grade III and 10 eyes with grade IV. All patients were fitted with rigid gas permeable contact lens (RGPCL) by the standard fitting procedure, and a scleral lens was selected due to RGPCL intolerance and poor RGPCL matching. All patients underwent visual acuity, refractive error, slit lamp microscopy, fundus and Pentacam examinations. Scleral trial-lens fitting was evaluated by slit lamp microscopy, fluorescein staining and anterior segment optical coherence tomography (OCT). The central and peripheral corneal clearances were assessed, as well as the peripheral landing area. Corrected visual acuity and subjective comfort were evaluated after wearing a scleral lens. The Friedman test was used for statistical analysis. Results: The scleral lenses were well positioned by a slit lamp microscope when keratoconus patients first wore them. The initial average central corneal clearance was 212±58 μm measured by OCT. After wearing the scleral lenses for 4 hours, the average central corneal clearance was 164±58 μm, the nasal side was 101±38 μm, the inferior side was 224±135 μm, the temporal side was 103±72 μm, and the superior side was 89±45 μm. No abnormalities were observed in conjunctival vessels at the lens edge. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) after wearing glasses, BCVA after wearing RGPCL and BCVA after wearing scleral lenses were 1.35 (1.00, 2.00), 0.52 (0.22, 0.79), 0.15 (0, 0.30), and 0.10 (0, 0.22) (LogMAR visual acuity), respectively. The visual acuity differences were statistically significant (χ2 = 67.11, P<0.001). Compared to UCVA and BCVA after wearing glasses, BCVA after wearing scleral lenses improved significantly, and the difference was statistically significant (χ2 =59.90, P<0.001; χ2 =31.08, P=0.001). There was no significant difference in BCVA between the scleral lenses and RGPCL (P=1.000). After wearing scleral lenses for 4 h, subjective comfort (comfortable or very comfortable) was reported in 22 eyes (22/26), as well as subjective visual acuity (favorable or very favorable) in 24 eyes (24/26). Conclusions: Due to good positioning and comfort, wearing a scleral lens can effectively improve the corrected visual acuity of keratoconus patients. The scleral lens is an effective treatment for keratoconus patients
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