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Can Scleral Lenses Cause Corneal Edema?

While most patients will not need to worry about corneal edema, there are a few special patient populations that we need to monitor carefully. If a patient has any of the following, we should proceed with caution:

  • Fuch's dystrophy
  • Low endothelial cell count
  • Polymegathism- Pleomorphism
  • Corneal transplant
  • Any other issue that could compromise the corneal endothelium

Our particular patient had a full thickness corneal transplant (PKP) in his right eye. He also has an Ahmed valve superior temporal.

We fit him into a custom scleral lens.

At insertion, you can see the central clearance is acceptable around 200um, and the corneal thickness/pachymetry is measure upon insertion. Next, the images show that after 4 hours of wear, there is ZERO central clearance, and the cornea has swelled.

This is likely due to a compromised endothelium from the corneal transplant.

Our plan is to add in fenestrations into the scleral lens to gain more oxygen to the cornea. If that does not work, we will design a custom gas permeable lens for him.