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Corneal Transplant and Aniridia

Saw one of our favorite patients today!

We fit her right eye with a custom scleral multifocal (this eye is normal), and we've been patiently waiting for her left eye to heal up from her most recent corneal transplant.

Her left eye suffered a trauma, which resulted in multiple surgeries and multiple corneal transplants. A corneal transplant requires an invasive surgery in which the patient's cornea is replaced with a donor cornea. The most recent corneal transplant was performed earlier this year by Dr. Casey, and it has been healing perfectly the past few months.

Each time he sees her, he removes some sutures and a few weeks ago he finished removing all of the sutures and gave her the ok to be fit with a contact lens. She sees Hand Motion with the left eye currently.

She also has a large fixed pupil from the trauma, so she is very light sensitive. You can see in the photos that her pupil does not have a normal round shape. This is due to the fact that some of the muscle fibers within the iris were damaged during the trauma. Because the iris fibers are damaged, her pupil is an irregular shape and it is very large. Her pupil is stuck in this shape forever, so her pupil cannot constrict when there is a lot of light. This results in extreme light sensitivity called photophobia. Patients with iris defects, irregular pupils, or aniridia are very sensitive to light. Many of them must wear very dark sunglasses, even indoors. Luckily, there are custom prosthetic contact lens options that can create an artificial pupil. The artificial pupil not only helps the eye look more normal from a cosmetic stand point, but it can also limit the amount of light that enters into the eye. This results in much less light sensitivity, which can be life changing for a patient.

She also complains that it always feels like there is an "eyelash" in her left eye, which is quite annoying. After discussing the different options, we decided to fit her with the EyePrint Prosthetic. The EyePrint uses a special material to take an impression of the entire eye surface. This allows the lab to design and fabricate a very custom scleral lens.

With a diagnostic scleral lens, she was able to achieve 20/40 vision! She has amblyopia in the left eye, and she was able to see 20/40 prior to all of her surgeries. She also noticed that her left eye felt much better with the lens on, and she noticed a huge decrease in foreign body sensation. Her eyelid was able to open a bit more too, so it looks more aligned with the right eye. Scleral lenses create a barrier between the eyeball and the eyelid, which can help patients who have irritated and sore eyes. In this patient’s case, her eyelids are constantly touching and rubbing the graft of the corneal transplant. Imagine if you had a open wound and someone kept ripping it open. This is somewhat similar when the eyes are suffering from a damaged surface. When we apply a scleral lens to the eye, it can help act as a barrier between the eyeball and the eyelid, resulting in much better comfort. When we inserted the scleral lens onto this patient’s eye, she noticed a huge improvement in comfort right away. Her eye was also able to open a bit more, too!

We will see her in one week for her dispense! Super excited to see how she does with her custom scleral lens. Thanks again Dr. Casey for thinking of us!