Visual rehabilitation with scleral lenses after corneal transplantation

Background: Patients undergoing corneal transplantation often present with high astigmatism and corneal irregularity, making conventional contact lens fitting difficult and limiting tolerance to standard optical correction. We aimed to evaluate the effect of scleral lens fitting on visual rehabilitation in patients following lamellar or penetrating keratoplasty by assessing visual acuity, contrast sensitivity, and patient satisfaction. Methods: Patients who had undergone keratoplasty and were considered suitable candidates for scleral lens fitting were enrolled in this prospective interventional study. All participants underwent comprehensive ophthalmic and optometric examinations prior to lens fitting. Visual acuity and contrast sensitivity were measured using a standard Snellen visual acuity chart and the Melbourne Edge Test under standardized back-illuminated conditions, with results recorded in decimal notation and decibels (dB), respectively. Refractive error was assessed by autorefractometry, followed by over-refraction and subjective and objective refinement to determine the final lens power. Diagnostic fitting was performed using trial scleral lenses, and anterior segment optical coherence tomography was utilized to assess lens fit. Visual and refractive parameters were recorded before and after optimal scleral lens fitting. Patient-reported satisfaction was assessed 1–2 weeks after lens dispensing using a 0–10 subjective rating scale, where scores 8–10 indicated complete satisfaction, 5–7 satisfaction, 2–4 dissatisfaction, and 0–1 complete dissatisfaction. Results: Eighteen eyes of 12 post-keratoplasty patients, 7 (58%) men and 5 (42%) women, were evaluated. Mean (standard deviation [SD], range) age was 45.6 (3.9, 22–67) years. Mean (SD) visual acuity improved significantly from 0.15 (0.12) decimal before lens fitting to 0.77 (0.33) decimal after scleral lens wear (P < 0.001). Mean contrast sensitivity increased significantly from 14.55 (3.82) dB to 20.33 (2.35) dB following scleral lens fitting (P < 0.001). All patients reported satisfaction with scleral lens wear, including complete satisfaction in nine (75%) patients and satisfaction in three (25%) patients. Conclusions: Post-keratoplasty ametropia and irregular astigmatism frequently limit visual rehabilitation with conventional optical correction methods. Scleral lenses offer an effective approach for correcting postoperative refractive irregularities and significantly enhance visual acuity and contrast sensitivity, while yielding high patient satisfaction at two weeks after lens fitting.