Mini-scleral Contact Lens for Management of Poor Visual Outcomes after Intrastromal Corneal Ring Segments Implantation in Keratoconus

Purpose: To evaluate the feasibility and efficacy of mini‑scleral design (MSD) contact lenses to treat keratoconus patients who were unsatisfied with the results of corneal inlay. Methods: In this prospective interventional case series, 9 eyes of 6 keratoconus patients who were unsatisfied with the results of corneal inlay were fitted with MSD contact lenses. Demographic data, uncorrected visual acuity (UCVA), best spectacle‑corrected visual acuity (BSCVA), and higher order aberrations (HOAs) were evaluated before contact lens fitting. Corrected visual acuity by placing the MSD contact lens with or without over-refraction, and HOAs were measured one hour after contact lens fitting. One month after contact lens wearing, corrected visual acuity by placing the MSD contact lens with over-refraction and possible contact lens related problems were assessed. Ocular comfort and contact lens handling problems were asked in follow‑up visits. The data was analyzed using descriptive statistical tests. Results: Nine eyes of 6 patients were successfully fitted with the mini-scleral lens. Fitting was ideal in 7 eyes and acceptable in 2 eyes. Mean corrected visual acuity by placing the MSD lens without over-refraction was 0.09 (range, 0.00‑0.15) LogMAR which was significantly better than the mean BSCVA of 0.38 (range, 0.2‑0.6) LogMAR (P = 0.007). The mean root mean square (RMS) of third‑order coma and trefoil significantly decreased after MSD contact lens fitting (P = 0.012 and P = 0.015, respectively); however, changes in the fourth‑order spherical aberration were not statistically significant (P = 0.336). Conclusion: Mini-scleral contact lenses may be helpful in the management of visually unsatisfied patients after corneal inlay.