ABSTRACT
Objective: This case report aims to explore the use of Objectif : Cette tude de cas vise explorer l'utilisation de
large diameter rigid gas permeable lenses (LDRGP) lentilles de grand diamtre rigides permables aux gaz (LDRGP)
for the treatment of ocular and visual complications in afin de traiter les complications oculaires et visuelles dune jeune
a young patient presenting with neurotrophic corneas. patiente prsentant un problme de kratite neurotrophique.
Methods: After a comprehensive eye exam and specific Mthodes : Aprs un examen de la vue complet et des tests
testing for contact lens fitting, LDRGP lenses were fitted with spcialiss pour ladaptation en lentilles cornennes, des lentilles
success and dispensed. RESULTS. Prescribed contact LDRGP ont t adaptes avec succs et livres. RSULTATS. Les
lenses helped the patient achieve optimal visual correction lentilles prescrites ont aid la patiente atteindre une correction
(6/6) as well as ocular protection for the cornea. visuelle optimale (6/6) et ont protg la surface oculaire.
Conclusion: Neurotrophic keratopathy is a challenging Conclusion : La kratite neurotrophique est une condition difficile
condition due to its impact on ocular health and vision. LDRGP grer a cause de son impact sur la sant oculaire et la vision.
offer a unique way of addressing many issues raised in this case La correction avec des lentilles LDRGP offre une solution unique
report such as corneal healing and visual restoration. This lens aux nombreux dfis soulevs dans ce rapport tels que la
modality may be considered for any other case involving cicatrisation de la corne et la restauration visuelle. Ce type de
abnormal corneal tissue healing and reduced visual acuity. lentille peut tre envisag afin de solutionner les cas de gurison
anormale de la corne avec baisse dacuit visuelle.
Key words: large diameter rigid gas permeable lenses
(LDRGP), Mbius syndrome, neurotrophic keratopathy Mots cls : kratite neurotrophique, lentilles de grand diamtre
inferior margins margins the rigid center off the corneal surface
so that it never has to interact with it.
Dilated Fundus Optic nerve: Optic nerve:
However, there have been some
examination Unremarkable Unremarkable
Lens trials Figure 2 Similar appearance of the One Fit lens on another pediatric patient. One
The patient was fitted successfully can appreciate the diameter of the lens, exceeding the visible cornea by at least 1mm.
with a relatively new LDRGP on the
market (One Fit P&A, Tyro 97
Blanchard Laboratories, Sherbrooke, This can be efficiently re-evaluated and +3.75 OS with base curves of
Quebec.). The apical clearance and at subsequent follow-up visits. The lens 7.80 mm and diameters of 14.0 mm
peripheral edge of this mini-scleral lens diameter should exceed the cornea by at OU. The lenses were made of Tyro
are designed to correct regular least 1 mm in every quadrant (Figure 97, a fluoro-silicone material with
ametropia (high refractive errors, 2). The lens should offer no resistance a Dk of 97 and a wetting angle of less
astigmatism, dryness related to con-tact on push-up, compression (blanching of than 10 degrees. This was the only
lens wear (P&A profile) and are very the con-junctival vessels) or contact lens, among all that were
successful in correcting irregu-lar impingement (pinching of the attempted, that satisfied both the
corneas (KC profile). The fitting conjunctival tissue resulting in physiological requirements of the
process is simple and easy to learn. staining).8 The lens is inserted into the ocular surface and the visual needs of
They are proven as easy to wear and as eye once it has been filled with fluid the patient. In theory, the lifespan of
comfortable, once properly fitted, as a (non preserved saline solution or these lenses is two years. An example
soft lens.11 Based on the fitting guide, artificial tears). With LDRGP wear, of a One Fit lens in a pediatric patient
the initial base curve is selected 0.3 the need for topical ocular lubricants can be appreciated above. (Figure 2)
mm steeper than flat K, to provide a during the day can be substantially
central clearance of 150 m after 30 decreased because the fluid inside With these lenses, the visual acu-ity
minutes of wear. This can be directly the lens constantly surrounds and was OD 6/7.5+2 and OS 6/6-1. After
assessed at the slit lamp, using the lubricates the cornea. It was educating the patient and her parents on
known or esti-mated corneal thickness recommended that the patient wear the handling and cleaning the lenses, they
(555 m on average), by comparing the contact lenses the majority of the time were dispensed. According to a study
width of the space between the lens and with the option of spectacle wear when conducted in 2008 by Gungor et al,
the cornea (the green fluorescein the lenses were removed. The final there are no age restrictions in scleral
layer) to the slit width of the cornea.12 prescription was made with the lenses.13 Nevertheless, fitting a
following parameters: +4.25 OD patient of this young age did not come
without its