Case Report: Post-keratoplasty Filamentary Keratitis Managed with Scleral Lens

SIGNIFICANCE: This case report details a unique case of filamentary keratitis after penetrating keratoplasty managed with a scleral contact lens. The positive effect on vision and comfort are reported, and the challenges related to hypoxia are discussed. PURPOSE: The purpose of this study was to report the outcome of scleral lens use in the treatment of filamentary keratitis post-penetrating keratoplasty. CASE REPORT: A patient who underwent penetrating keratoplasty twice in both eyes for keratoconus presented with filamentary keratitis in the left eye. The prosthetic replacement of the ocular surface ecosystem scleral lens trial was performed for improving vision and comfort. After 6 hours of wearing prosthetic replacement of the ocular surface ecosystem device, the left eye showed complete resolution of filaments with an improved visual acuity and better comfort in both eyes. Corneal swelling indicating hypoxia was noticed in both eyes with scleral lenses and was managed accordingly. CONCLUSIONS: Scleral lenses are a viable treatment option for patients with corneal filamentary keratitis after penetrating keratoplasty for achieving better vision and improved comfort. However, the risk of hypoxia cannot be undermined, which necessitates careful evaluation, follow-up, and management for safe lens wear.