Fluid filled scleral contact lens in pediatric patients: challenges and outcome

PurposeTo study the indications and the challenges while fitting scleral contact lens (ScCL) filled with fluid prior to lens insertion in pediatric patients.MethodsWe retrospectively reviewed charts of patients of 16 years or less who received ScCL (PROSE – Prosthetic Replacement of the Ocular Surface Ecosystem, Boston Foundation for Sight, Needham Heights, MA, USA) that were filled with fluid (Normal saline) before lens insertion during July 2006 to April 2010. The main goal of ScCL fitting was to improve vision in patients having keratoconus (KC) and improve the ocular microenvironment in ocular surface disease (OSD). Visual acuity before and after lens wear was noted.ResultsFluid-filled ScCL were dispensed to 15 patients (20 eyes). The indications for ScCL fitting were KC (n = 3 eyes), Stevens Johnson syndrome (SJS, n = 13 eyes), radiation keratopathy (n = 1 eye), combined KC and SJS (n = 1 eye) and KC and vernal keratoconjunctivitis (VKC, n = 2 eyes). Mean age of the patients was 12.85 years. The average daily lens wear was 9 h. The vision improved by 2 lines or more in 85% and dropped by 2 lines or more in 45% eyes after 4 h of lens wear due to tear debris collection. None of the patients had any complications. Patients were self sufficient inserting and removing ScCL. Two patients had broken lenses during the follow-up.ConclusionsScCL are useful for pediatric patients who have OSD, irregular astigmatism or the two coexisting; KC combined with VKC or SJS, helping to maintain the health of the ocular surface and improves vision in these patients.