The use of contact lenses in patients with prior bleb-forming glaucoma surgery

This study aims to investigate the success of contact lens (CL) wear in patients who have had bleb-forming glaucoma surgeries and to assess the rate of CL related complications.

Patients who received any type of CL services at an academic center and who had a bleb-forming glaucoma surgery were identified by billing records over a 15-year period. Patients were included if they had CL fitting after bleb-forming surgery with follow-up ≥ 1 year. Information regarding patient demographics, type of bleb-forming surgery, type of CL, best corrected visual acuity (BCVA), length of follow-up, reasons for failure, and complications related to CL wear was collected. The primary outcome measure was successful CL wear for ≥ 1 year. Secondary outcome measures included complications, type of CL in success groups, reasons for CL failure, and visual acuity (VA).

39 eyes of 32 patients met the inclusion criteria (age, 6 months to 81 years). 20/39 eyes (51%) had successful CL wear for ≥ 1 year. No difference existed between the proportion of trabeculectomy or glaucoma drainage devices (GDD) in the CL success versus failure groups. Among the eyes that successfully wore CL, 5/20 (20%) had complications which included failed bleb, corneal edema, keratoconjunctivitis sicca, filamentary keratitis, corneal irritation, punctate epithelial keratitis, and epithelial abrasion. Within the CL failure group, one eye (1/19) developed an acute iritis directly related to CL wear. Rigid gas permeable lenses were more prevalent in the CL success group, whereas non-impression fitted scleral lenses were more prevalent in the CL failure group. At 1 year, no difference existed in BCVA for eyes that succeeded in wearing CLs and for those who did not.

More than half of individuals with bleb-forming glaucoma surgeries were able to continue CL wear 1 year after fitting, and rigid gas permeable lenses were the most common type of lens in the CL success group. Keratopathies were the most common type of complication recorded.