Contact lens fitting for severe keratoconus with accompanying microphthalmia and ocular hypersensitivity

Purpose: This case report describes the treatment of a female patient with advanced keratoconus and a post-keratoplasty status using custom-made, rigid contact lenses with the aim of demonstrating the improvement in visual acuity and wearing comfort with these contact lenses.

Material and Methods: A 65-year-old female patient with a 40-year history of keratoconus was referred for further clincal examination. Advanced keratoconus (TKC stage 3-4) was diagnosed in the right eye, while the left eye had already been treated with a penetrating keratoplasty approximately 30 years ago. For a detailed assessment of the current corneal status, a comprehensive diagnostic evaluation was performed. Both the MS-39 (CSO, Scandicci, Italy) and the Pentacam AXL Wave (Oculus Optikgeräte GmbH, Germany) were used for this examination. As part of an interdisciplinary  co-operation between ophthalmology and optometry, a new contact lens fitting was initiated at the Kettenbrücke Eye Center in Innsbruck as a first new treatment step. This conservative approach was preferred in regard to the complex patient history and functional  potential.

Results: The visual acuity achieved with the custom made, rigid contact lenses was clinically significantly higher than with previous lenses. The wearing comfort with the new lenses was also significantly better.

Conclusion: Both eyes were fitted with custom-made, rigid contact lenses. This resulted in a clinically significant increased visual acuity. The improved lens fit caused reduced decentration and more stable positioning of the contact lenses, which also increased the wearing comfort of the lenses.