Case Report

A 58-year-old female patient who had a history lattice corneal degeneration reported to our clinic for corneal evaluation. She also had concurrent dry eye syndrome. The patient was using Systane and Restasis twice daily OU and Genteal gel daily OU. Her vision measured OD -4.50 20/200 (pinhole 20/60) and OS -7.00 +1.25 X@ 090 20/40. Slit lamp exam showed that she had silicone plugs in all four puncta.

The corneal specialist noted moderate lattice dystrophy with mild epitheliopathy and central corneal haze OU. Corneal topography revealed (see figures 1 and 2)moderate irregular astigmatism in both eyes. The patient was advised that scleral contact lenses may improve her situation by masking her irregular astigmatism as well as managing her ocular surface disease. 

Figures 1 + 2: corneal topography OD (left) and OS (right)

The patient was diagnostically fit with 18.8mm diameter scleral lenses OU

Material: Tyro 97 (Lagado)

Right: BC= 46D/Power= -5.75 (Figure 3)

Left:  BC= 49D/Power=-10.37 (Figure 4)

Figures 3 + 4: lattice corneal degeneration OD (left) and OS (right) with scleral lens



The patient was instructed to clean/disinfect the lenses with a multipurpose disinfection solution (MPDS) and to fill the lenses with bottled non-preserved saline.

Follow-up

At the first follow-up visit, her vision with the scleral lenses measured 20/40 and 20/30 in her right and left eyes, respectively. The lenses adequately cleared her corneas other than some mild superior nasal touch secondary to lens drop that did not result in any associated corneal staining. It was noted that the left lens fit was rather steep, so another left lens was ordered with a base curve that was 2.5 diopters flatter. At her next follow-up appointment, the patient complained of increasing “red eyes.” She was still using Systane and Restasis. The patient was advised to discontinue these drops as well as use of the MPDS and bottled saline and instead she was instructed to clean/disinfect her lenses with a peroxide care system and to fill the lenses with 0.9% sodium chloride dispensed in single dose vials. At her next follow-up visit, she reported that her redness symptoms were significantly reduced.

Summary

Lattice corneal dystrophy is an autosomal dominant dystrophy that presents as a “lattice” pattern (amyloid) in the anterior stroma. This dystrophy can cause significant epitheliopathy and erosions. Patients are often managed with bandage lenses or may need a penetrating keratoplasty depending on severity. In this case, scleral lenses were used, which not only improved the patient’s vision by masking her corneal irregularity, it also helped to manage her ocular surface disease.

References:

• DeNaeyer, GW. Diagnosing and treating corneal dystrophy. Contact Lens Spectrum. June 2008.
• Kaufman HE,  Barron BA, McDonald. The Cornea. 2^nd ed. Butterworth-Heinemann; 1988. 



Greg DeNaeyer is a 1998 graduate of The Ohio State University College of Optometry. He completed a hospital based residency at the Columbus VA Medical Center. Greg joined Arena Eye Surgeons in 1999 and is currently the Clinical Director. His primary interest is specialty contact lenses.
 
Greg is the president of the Scleral Lens Education Society and is a Fellow of the American Academy of Optometry. He is a contributing editor for Contact Lens Spectrum and a contributor to Review of Cornea and Contact Lenses and Optometric Management. Currently his primary research is focused on profilometer designed scleral contact lenses, scleral lenses that correct higher order aberrations, and topical drug delivery devices. He has consulted for Visionary Optics, Essilor, Inspire Pharmaceuticals, B+L, and Aciont.