Comparación clínica entre lentes RGP esféricas y asféricas versus lentes de apoyo escleral en paciente con anillos intraestomales: reporte de caso

Abstract

This research paper presents the clinical case of a patient with moderate keratoconus and a history of intracorneal ring segment (ICRS) implantation, who presented with decreased visual acuity and ocular discomfort. Through a comprehensive evaluation, including slit-lamp biomicroscopy, corneal topography, and contact lens fitting trials, three types of rigid gas permeable (RGP) lenses were assessed: spherical, aspheric, and scleral designs. Spherical and aspheric lenses demonstrated limitations in both stability and comfort. In contrast, scleral lenses provided superior interaction with the ocular surface, enhanced comfort, and improved visual acuity. Clinical findings revealed that scleral lenses, due to their vaulting design and ability to create a new, regular optical surface via a tear reservoir, significantly outperformed conventional corneal lens designs. This fitting approach helped reduce optical aberrations caused by corneal irregularity, promoted epithelial hydration, and evenly distributed pressure across the ocular surface, resulting in a more stable and comfortable visual experience for the patient. Although the inclusion of scleral lenses was not the initial objective of the study, it ultimately proved to be the most effective alternative. The study concludes that, in patients with a history of corneal surgery and keratoconus, contact lens fitting must be individualized and guided by specific topographic parameters. While aspheric lenses offered better alignment than spherical designs, scleral lenses yielded the most favorable clinical outcomes. This case underscores the importance of conducting multiple fitting trials and considering alternative lens designs to ensure successful visual rehabilitation and enhance patients’ quality of life.