Authors: Jaime C. Sklar, Vishakha Thakrar, Clara Chan
Author Disclosure Block: J.C. Sklar: None. V. Thakrar: Any direct financial payments including receipt of honoraria; Bausch and Lomb SVP, Precision Technology. Membership on advisory boards or speakers’ bureaus; Bausch and Lomb SVP, Precision Technology, Shire. C. Chan: Any direct financial payments including receipt of honoraria; Alcon Labs, Allergan, Bausch & Lomb, Santen, Shire, Johnson & Johnson, Labtician Thea. Membership on advisory boards or speakers’ bureaus; Alcon Labs, Allergan, Bausch & Lomb, Santen, Shire, Johnson & Johnson, Labtician Thea. Funded grants or clinical trials; Allergan, Bausch & Lomb, Shire, TearLab.

Abstract Body:

Purpose: Herpes simplex (HSV) and Varicella Zoster (VZV) viruses are part of the Herpesviridae family affecting approximately 4 billion individuals globally. These are estimated to affect the V1 nerve distribution with ocular involvement in 1.5 million patients with HSV (herpetic keratitis) and in 25% of cases of VZV (herpes zoster ophthalmicus). Both can affect all layers the cornea including the epithelium, stroma and endothelium. Scleral contact lenses (SCL) are unique in their design as they sit beyond the corneal limbus and contain a fluid interface. They are indicated for use as therapy for ocular surface disease such as severe dry eye and for corneas with significant irregular astigmatism such as those with keratoconus, corneal scarring, or after corneal transplantation. While patients with obvious corneal endothelial dysfunction may develop corneal edema with SCL wear, it has not been previously demonstrated in eyes without any evidence of endothelial compromise after HSV/VSV infection
Study Design: Retrospective chart review.
Methods: Five charts were reviewed for a total of five affected eyes in patients who developed corneal edema with SCL wear. Of those, 4 had a history of ocular HSV and one had ocular VZV. The course of their HSV/VZV, ocular co-morbidities, surgical interventions for definitive treatment, visual acuity, medications and type and duration of contact lens use were recorded.
Results: There was a range of ocular co-morbidities amongst the 5 eyes including: eye injury, keratoconus, glaucoma, and cataracts. All patients were treated with prophylactic systemic antiviral therapy. Patients used topical steroids for control of immune stromal keratitis/uveitis, or to prevent corneal transplant rejection. Mean time to development of edema after starting SCL was 8.4 ± 5 months. Prior to lens fittings, patients demonstrated no clinical evidence of stromal edema or symptoms of morning blur. Visual acuity after the development of corneal edema ranged from 20/60 - 20/400 in the affected eyes. Two patients required corneal transplantation for definitive treatment: one underwent penetrating keratoplasty (PKP) and one underwent Descemet’s stripping automated endothelial keratoplasty under pre-existing PKP. All five were fitted with gas permeable scleral contact lenses.