Forty of the 51 eyes with severe keratoconus that would otherwise have undergone transplant surgery were successfully treated with long-term scleral lens wear. In this way, the indication for keratoplasty was more than halved in our keratoconus population.

Spontaneous corneal perforation is a rare but more dramatic long-term complication after RK. The pivotal role of appropriately fitted soft bandage lenses in the conservative management of this type of complex perforation is highlighted. For optical correction, a scleral lens was fitted with excellent visual result, illustrating the added value of specialty contact lenses as an alternative to surgery in the management of postrefractive corneas.

To evaluate the effect of specialty contact lens (CL) wear on posterior corneal tomography in keratoconus subjects. Methods: Patients with keratoconus who were wearing specialty CL were included in this retrospective cohort study. Tomographic parameters were evaluated with Scheimpflug imaging (Pentacam HR) before lens fitting and immediately after removal of CLs worn habitually for a period of several months. Subjects were divided into groups, according to type of lens (corneal, scleral, and hybrid) and keratoconus severity based on Belin/ Ambrosio D (BAD-D) score, for further analysis. Results: Thirty-four eyes of 34 subjects diagnosed with keratoconus were included. Mean duration of habitual CL wear was 7.060.3 months. For the entire cohort, a small increase in flat keratometric reading at the anterior corneal surface (K1F; P¼0.032) and at the posterior surface (K1B; P¼0.041) was found. In the corneal CL group (10 eyes; 29.4%), flattening of the anterior corneal curvature was detected (K max ; P¼0.015). An increase in K1B value was seen in the scleral CL group (15 eyes; 44.1%) (P¼0.03). Combined topometric indices showed a small but significant difference in the entire cohort (P,0.05) and in the subgroups of corneal CL wear and of moderate keratoconus (BAD-D score$7). Conclusion: Various types of specialty CLs exert a differential influence on corneal parameters. A small steepening of keratometry at the posterior surface (K1B) was observed in the scleral lens group. Although corneal lens wear flattens the anterior cornea (K max ), it does not significantly alter the posterior corneal surface.