Management of a post-ELLKAT keratectasia with a gas permeable contact lens

The Excimer laser keratoplasty of augmented thickness for keratoconus (ELLKAT) has been proposed for the refractive management of keratoconus.

A 41-year-old man with a history of bilateral keratoconus came to the clinic for a contact lens. He had undergone an ELLKAT procedure in his right eye some months earlier in an attempt to obtain acceptable unaided vision. As the result in this eye was not positive, the surgery in the fellow eye was cancelled. On examination, I diagnosed a centrally located keratectasia (KE) in his RE. After surgery, the corneal shape presented some complications in relation to contact lens fitting. The patient was able to achieve 6/9.6 acuity with adequate comfort with a Soper lens using a "modified three-point touch" relationship.

The surgical procedure of ELLKAT can exhibit some advantages with regard to the penetrating keratoplasty. In this case, because a keratectasia was induced, a contact lens fitting was needed to restore vision. A gas permeable contact lens with a Soper design and with a "modified three-point touch" fitting was a viable clinical solution. The fitting of contact lenses in cases of keratectasia can be a practical solution that may avoid the need for further surgery.