Corneal graft-related fitting questions from fitters and replies by Paul Rose
last updated 2021.1.8
Q: What is the shorter time when we can fit CL post graft?
A: This varies dramatically. The shortest time I have ever seen was 6 months but the normal time that most Dr's feel comfortable with is 14 months. It also depends on how the graft takes and whether there are any complications.
Q: How does the fitting process differ when fitting grafted corneas? More frequent follow-ups?
A: Yes be very vigilant with follow up checks initially. Also monitor the endothelium if possible.
Q: Is there a cut off number for EDC you would look at before deciding on XL?
A: No but anything less than 1000 I would be restricting wearing hours and monitoring the cornea closely.
Q: Can a scleral lens be used over a very thin cornea - like for example in patients with very advanced keratoconus who're already waiting for a graft surgery?
A: Yes certainly it can, but with some limitations. Make sure the lens clears the apex of the cone by at least 50 microns and limit the wearing time to make sure you are not causing corneal oedema as often advanced cones have compromised endotheliums.
Q: How soon after graft surgery can you prescribe a scleral lens?
A: This depends on whether the graft is full thickness or not. Typically for full thickness grafts it will be a minimum of 12 months and normally around 14 months. For partial thickness grafts which recover more quickly, dependant on the recovery, between 6 and 12 months.