* Sarah La Porta Weber, Rodrigo Becco de Souza, José Álvaro Pereira Gomes and Ana Luaisa Hofling-Lima

Purpose:

To evaluate the efficacy of the Esclera scleral contact lens (SCL) treatment and its impact on clinical testing for moderate to severe dry eye disease (DED).

Design:

Prospective interventional case series.

Methods:

A total of 41 eyes from 25 patients with moderate to severe DED were evaluated for the Esclera SCL treatment. Best-corrected visual acuity (BCVA), tear osmolarity, the Schirmer I test, tear film breakup time (TBUT), corneal and conjunctival staining, meibomian grading, and Ocular Surface Disease Index and SF-36v2 questionnaires were assessed before and after the SCL treatment. These values were compared to assess the real benefit of using SCL as a treatment for DED.

Results:

Forty-one eyes from 25 patients were fitted with SCL for management of DED. The underlying diseases were Stevens-Johnson syndrome (22 eyes), Sjogren syndrome (11 eyes), graft-vs-host disease (2 eyes), dry eye after keratomileusis in situ (2 eyes), and undifferentiated ocular surface disease (4 eyes). BCVA improved from 0.703 ± 0.55 logMAR with habitual correction to 0.406 ± 0.43 logMAR with SCL (P < .001). There was a significant decrease in tear osmolarity values (338.1 ± 27.1 to 314.25 ± 38.8 mOsm/L, P < .001) and van Bijsterveld scores (3.63 ± 2.33 to 2.63 ± 2.46 grade, P [ .015) between the baseline and 12 months after SCL wear. There were also significant improvements in dry eye symptoms and quality of life as assessed by the OSDI and SF-36v2 questionnaires (both with P<.001).

Conclusions:

The Esclera SCL treatment had a positive impact on tear osmolarity and van Bijsterveld score, as well as an improvement in the patients’ BCVA, dry eye symptoms, and quality of life. (Am J Ophthalmol 2016;163:167–173.
2016 by Elsevier Inc. All rights reserved.)

Dry Eye Disease (DED) is defined as “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface.’’1 DED is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface and is a common disorder that occurs more frequently in women than in men. This disorder affects a significant percentage of the population, especially among adults over 40 years of age. The prevalence is similar across countries worldwide, with rates between 7% and 33%.2

Conventional treatments for DED include the application of artificial tears, topical corticosteroids or cyclosporin
A, therapeutic soft contact lenses, and surgical procedures such as punctal occlusion and tarsorrhaphy.3,4

However, despite these therapies, many patients complain of persistent symptoms and continue to show signs associated with ocular surface changes. Additionally, the use of scleral contact lenses (SCLs) has been recognized as an alternative for the treatment of these patients.5–10

SCLs are large-diameter, rigid, gas-permeable devices that are completely supported by the sclera and that vault the cornea and limbus. SCLs maintain a fluid reservoir in the space between the posterior surface of the lens and the anterior surface of the cornea. The unique fitting characteristics of SCLs enable the protection of the ocular surface from shear forces generated by eyelid movement over the cornea and provide continuous hydration of the ocular surface.10,11

The purpose of this study was to evaluate the impact of wearing the Esclera SCL on dry eye and quality of life
in patients with moderate to severe DED.

Leia o artigo completo.