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AN EMERGENCY ROOM ASSIST
FOR THE HOME TEAM |
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James Deom O.D., M.P.H., F.A.A.O.
Medical Director of The Scleral Lens Institute
The Dry Eye Center of NorthEastern Pennsylvania
Hazleton and Stroudsburg Eye Specialists |
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| March 15, 2016 |
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Custom Stable vs. Cataract Surgery
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Case Background
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We were called to our local emergency
room for an eye injury case where we
removed a corneal foreign body and assisted
in an intraocular foreign body removal of
glass from a patient's eye due to a motor
vehicle accident. There was no retinal
involvement and the glass was retained
and removed from the anterior chamber
without complication. The 25 year old male
patient suffered no concussion however he
did have many shards of glass in his arm
which required removal by the ER team.
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The patient was given ocuflox qid, Pred
Forte qid and atropine bid OS and was
asked to return the following day to our
office. The patient had a full thickness corneal
laceration which was self healing and
a corneal abrasion which was still subjectively
irritating to the patient. The patient
was given an amniotic membrane for 2
days in addition to the above drops to help
heal the cornea and reduce scar formation.
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First Visit
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Review of patient's previous records
showed that the patient's previous vision
with soft contact lenses was
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OD -3.00 -0.75 x 180 20/20
OS -2.50 -0.75 X 180 20/20
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Acuity at first contact lens fitting
OD 20/20 with habitual soft contact lens
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OS 20/80 uncorrected
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OS 20/60-1 -2.75 -1.00 X 085
spectacle correction(Smeared)
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OS 20/50 -2.50-0.75 X 90
soft toric contact lens
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Figure 1. Anterior Segment Photograph of Corneal Scar
and Traumatic Cataract
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Figure 2. 14.8 Custom Stable Elite lens with 300 microns of
central clearance
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Custom Stable Lens Selection
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The patient was very afraid of cataract surgery and did not want to undergo the procedure
if there was any possible way of correcting his vision otherwise.
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The patient had small apertures and consulting the Custom Stable fitting guide led to a
Custom Stable Elite 14.8.
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The patient noted comfort with the lens on and immediate improvement in vision.
20/20
20/25 best corrected
We ordered a 14.8 Elite standard limbal zone standard scleral landing zone, over refraction
of +1.75 and and observable vault of 300 microns centrally before settling.
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Lens Evaluation
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The patient noted decreased glare when night driving, all day comfort, and improved vision
when compared to his previous soft toric lenses.
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Figure 4. Anterior Segment OCT of full thickness corneal laceration after intraocular foreign body and resultant irregular corneal shape
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Figure 5 . 14.8 Custom Stable Elite lens with aligned temporal edge
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This is a case where a Custom Stable in a smaller than average diameter is fulfilling a
need for a normal cornea in case of traumatic corneal irregularity. Although this patient has
a traumatic cataract he did not want to get it removed if he did not absolutely have to and
he was very happy we went the extra mile to give him this very durable solution.
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