Leah Ann Johnson
A case of concomitant keratoconus and Fuchs’ endothelial corneal dystrophy fit with hybrid contact lenses. Abstract Text:
Purpose: To report a case of concomitant keratoconus and Fuchs’ endothelial dystrophy.
Methods: Case report
Results: A patient with concurrent corneal diseases is best managed for comfort, vision, and corneal physiology with hybrid contact lenses.
I. Case History a. 40 year old Caucasian male complained that his hybrid contact lenses adhere to his eyes and are hard to remove. He had mild lens awareness in the left eye. b. The patient was diagnosed with keratoconus (KC) 20 years ago and Fuchs’ endothelial dystrophy (FED) 1 year prior. c. The patient did not have any significant medical history and not taking any medications.
II. Pertinent findings a. Clinical exam findings: Visual acuity with SynergEyes ClearKone (dk 100): OD: 20/40+1, OS: 20/30+2 b. Slit lamp exam:
1. Presenting contact lenses: OD lens: Steep2 skirt, good fit overall, vault 150um over cornea, OS lens: Medium skirt, central corneal bearing, peripheral pooling 2. Right eye: Vogt’s striae, anterior scarring, grade 2+ guttae. 3. Left eye: No Vogt’s striae, anterior scarring, grade 2+ guttae
c. Patient’s endothelial cell count was OD: 961mm2, OS: 1002mm2. Pachymetry was OD: 462um, OS:478um. d. Visual acuity with trial scleral gas permeable lenses: 20/40+, 20/30+2
1. Patient did not like comfort and wishes to be re-fit with SynergEyes ClearKone hybrid lenses.
1. OD: Steep2 skirt, 20/40+1, OS: Steep2 skirt, 20/20-2
2. Good contact lens fit with good (150-200um) vault over cone, good movement, OU. III. Differential Diagnosis:
KC with concomitant FED
Irregular astigmatism with guttae
IV. Diagnosis and discussion a. KC is reported to occur with other corneal dystrophies. FED is the most common dystrophy association. b. Patient had advanced KC with corneal scarring present in both eyes. c. In addition to the stromal and epithelial pathological changes induced by KC, this patient’s corneas are also challenged by endothelial disease, which led to his low cell count. d. Acceptable comfort and vision was only achieved with hybrid lenses.
V. Management a. For patients with KC, it is important to use a lens with high oxygen transmissibility. b. The high dK center and silicon hydrogel skirt provide optimal vision, comfort, and physiology.
VI. Conclusion: Clinical Pearls a. Don’t ignore the endothelium when assessing KC patients. b. Select a lens that maximizes the physiological health for the entire cornea.