BACKGROUND:

A custom scleral lens (SL), Zenlens, utilizes integrated design flexibility and customization options to achieve a precise fit in patients with various corneal conditions; Zenlens ECHO provides additional customization for advanced degenerative, postoperative, or traumatic corneal conditions. Although successful lens fitting can be achieved with standard clinical technology, use of optical coherence tomography (OCT) and scleral profilometry helps streamline the process. Case Summary A 72-year-old male with a history of corneal transplant attended our clinic for SL fitting (OS); he had previously discontinued SL use due to ocular discomfort. He presented with a tilted cornea post-graft; profilometry revealed considerable elevation of a superior graft with significant elevation change in that meridian. Pre-SL fitting visual acuity (VA) and keratometry were 20/400 and 62.1/72.7@058, respectively. The deepest diagnostic lens was used during fitting but still maintained contact with the graft. The first lens ordered utilized Bi-Elevation to vault over the graft (lens parameters: 7.30mm base curve (BC), 17.0mm diameter oblate, plano power, sagittal depth (SD): 6200/6700µm, standard advanced peripheral system). Additional modifications were required to prevent contact with the graft without overvaulting the other quadrants, as the SL still impacted on the superior graft. Optimal SL fit was achieved during the fourth fit using Zenlens ECHO. The BC was flattened to increase midperipheral clearance, and the SD of each quadrant (Q) was adjusted independently. Final lens parameters were 7.77mm BC, 17.0mm diameter oblate, +5.75 power, SD: Q1 6.400 Flat 1, Q2 5.900 Steep 1, Q3 6.800 standard, Q4 6.000 standard. OCT demonstrated acceptable alignment with the superior graft; a very light touch with no staining was observed after 6 hours of wear (considered acceptable provided the graft continues to remain healthy). At the 8-week follow-up, the patient’s VA was 20/20 and he could comfortably wear the lens all day. The patient was advised to return for a routine SL appointment in 6 months.

CONCLUSION:

This case study provides real-world insights into Zenlens outcomes and fitting practices using clinical technology in a patient with a postoperative corneal abnormality, demonstrating the prolonged comfortable wearing time and improved vision that can be achieved by utilizing Zenlens ECHO.