Late Spontaneous Postradial Keratotomy Corneal Perforation After Scleral Contact Lens Use—Case Report

Abstract

To describe a case of late spontaneous postradial keratotomy corneal perforation after scleral contact lens (SCL) wear for optic correction. Setting: Tertiary referral center for corneal pathology. Design: Case report. Results: A 64-year-old man presented the consequences of a late radial keratotomy (RK) surgery performed for myopia correction 26 years ago. His ophthalmologic history was a RK in both eyes (BE), previous Lasik surgery in BE and Lasik enhancement in the right eye (RE), and pterygium excision with conjunctival transplantation in RE. To improve visual acuity, SCL were fitted in both eyes. After 8 months of use, on a certain day, when removing the lens from the RE, the patient reported experiencing intense eye pain and reduced visual acuity. On ophthalmologic examination, the RE cornea was perforated in one of the previous RK incisions. An urgent corneal transplant was performed in the RE, followed by cataract surgery in the same eye. Conclusion: Corneal instability caused by RK scars and daily manipulation with the SCL use may have led to ocular perforation.

An Unusual Case of an Open Globe due to Airbag Injury and Scleral Lens Use

“…Despite this, there is a paucity of literature regarding ocular trauma with concurrent SCL use. One case report describes a case of corneal perforation due to removal of a scleral lens in the setting of prior radial keratotomy [5]. Another documents an instance in which a scleral lens protected an eye from a projectile, possibly preventing an open globe injury [6].…”

“…However, there is a documented phenomenon of "scleral cling, " wherein a scleral contact lens exerts a suction effect on the cornea [8]. This negative pressure is presumably what caused the corneal perforation in the setting of corneal thinning secondary to previous radial keratotomy [5], and it could have contributed to a more devastating injury in the setting of this airbag trauma. A review article by Wang et al highlights that the anterior sclera has the highest rigidity and requires the greatest amount of force to penetrate [9].…”