Surgery to improve contact lens wear in keratoconus

Contact lens intolerance in keratoconus may be due to the formation of a proud nebula at or near the apex of the cone that gives rise to contact lens related abrasions. These nebulae do not flatten when contact lens wear is discontinued. We describe a simple technique of superficial keratectomy to remove proud nebulae in which the resulting defect healed quickly under a therapeutic hydrogel lens. In all of the six cases described patients were able to resume contact lens wear within one month of the procedure. One case was lost to follow-up. Of the remaining five (follow-up 3-9 months), all achieved comfortable wearing times of 8 hours or more and visual acuities of 20/40 or better. One patient developed a recurrent epithelial defect that resolved on discontinuing lens wear for one week. Corneal transplantation was thus avoided.