Fitting tips and tricks of challenging cases of keratoconus

AbstractPurpose to discuss the fitting tips and tricks of challenging cases of keratoconus with a special design of RGP lens namely Rose K2 lensMethods The study was carried on 52 keratoconic eyes fitted with Rose K2 lens. They were topographically classified into low cones, small steep cones, early cones, advanced cones and toric cones. The appropriate lens parameters were selected accordingly. Successful fitting was evaluated by lens position, movement, fluorescein pattern, visual acuity, residual astigmatism, patient comfort, maximum wearing time per day and corneal integrity.Results The keratoconic eyes were successfully fitted as follow: lenses with bigger diameter and considerably flatter base curve than normal were used to fit the low cones, lenses with flatter base curve, minimum diameter and maximum edge lift were used in small steep cones. Keeping the lens as small as possible and considerably steeper base curve than normal were used in advanced cones. Early cones were fitted with larger diameter lenses with decreased edge lift. Toric or astigmatic corneas were fitted acceptably either by reducing the overall diameter of the lens or using toric RGP lens. With the previous lens parameters, most of patients (96%) tolerated their lenses with maximum wearing time per day 11± 2.5 hours. No corneal staining or abrasion was encountered in studied eyes. Lenses were centrally positioned with adequate movement and acceptable fluorescein pattern. Best corrected visual acuity was significantly increased compared to the baseline visual acuity with significantly decreased astigmatism.Conclusion Patients with keratoconic corneas are sometimes challenging to fit and time consuming, but if well fitted with appropriate lens parameters, they appreciate the benefits provided by their contact lenses i