Clinical outcomes and complications of fluid-filled scleral lens devices for the management of limbal stem cell deficiency

Published:October 30, 2021DOI:


      • Scleral lenses are a good option in the management of limbal stem cell deficiency.
      • Limbal stem cell deficiency progression can occur possibly due to limbal hypoxia secondary to limbal compression by the lens.
      • Close monitoring after scleral lenses fit is necessary in these compromised eyes.



      To evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD).


      Retrospective consecutive case series.


      27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed.


      Baseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling.


      SL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contact Lens and Anterior Eye
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Davanger M.
        • Evensen A.
        Role of the pericorneal papillary structure in renewal of corneal epithelium.
        Nature. 1971; 229: 560-561
        • Zarei-Ghanavati S.
        • Ramirez-Miranda A.
        • Deng S.X.
        Limbal lacuna: a novel limbal structure detected by in vivo laser scanning confocal microscopy.
        Ophthalmic Surg Lasers Imaging. 2011; 42 (Online:e129-31)
        • Shortt A.J.
        • Secker G.A.
        • Munro P.M.
        • Khaw P.T.
        • Tuft S.J.
        • Daniels J.T.
        Characterization of the limbal epithelial stem cell niche: novel imaging techniques permit in vivo observation and targeted biopsy of limbal epithelial stem cells.
        Stem Cells. 2007; 25: 1402-1409
        • Dua H.S.
        • Shanmuganathan V.A.
        • Powell-Richards A.O.
        • Tighe P.J.
        • Joseph A.
        Limbal epithelial crypts: a novel anatomical structure and a putative limbal stem cell niche.
        Br J Ophthalmol. 2005; 89: 529-532
        • Deng S.X.
        • Borderie V.
        • Chan C.C.
        • Dana R.
        • Figueiredo F.C.
        • Gomes J.A.P.
        • et al.
        Global consensus on definition, classification, diagnosis, and staging of limbal stem cell deficiency.
        Cornea. 2019; 38: 364-375
        • Deng S.X.
        • Kruse F.
        • Gomes J.A.P.
        • Chan C.C.
        • Daya S.
        • Dana R.
        • et al.
        Global consensus on the management of limbal stem cell deficiency.
        Cornea. 2020; 39: 1291-1302
        • Parra A.S.
        • Roth B.M.
        • Nguyen T.M.
        • Wang L.
        • Pflugfelder S.C.
        • Al-Mohtaseb Z.
        Assessment of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) scleral lens on visual acuity for corneal irregularity and ocular surface disease.
        Ocul Surf. 2018; 16: 254-258
        • Kim K.H.
        • Deloss K.S.
        • Hood C.T.
        Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for visual rehabilitation in limbal stem cell deficiency.
        Eye Contact Lens. 2020; 46: 359-363
        • Nguyen M.T.B.
        • Thakrar V.
        • Chan C.C.
        EyePrintPRO therapeutic scleral contact lens: indications and outcomes.
        Can J Ophthalmol. 2018; 53: 66-70
        • Theophanous C.
        • Irvine J.A.
        • Parker P.
        • Chiu G.B.
        Use of prosthetic replacement of the ocular surface ecosystem scleral lenses in patients with ocular chronic graft-versus-host disease.
        Biol Blood Marrow Transplant. 2015; 21: 2180-2184
        • Heur M.
        • Bach D.
        • Theophanous C.
        • Chiu G.B.
        Prosthetic replacement of the ocular surface ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome.
        Am J Ophthalmol. 2014; 158: 49-54
        • Aravena C.
        • Bozkurt K.
        • Chuephanich P.
        • Supiyaphun C.
        • Yu F.
        • Deng S.X.
        Classification of limbal stem cell deficiency using clinical and confocal grading.
        Cornea. 2019; 38: 1-7
        • Liang Q.
        • Le Q.
        • Cordova D.W.
        • Tseng C.H.
        • Deng S.X.
        Corneal epithelial thickness measured using anterior segment optical coherence tomography as a diagnostic parameter for limbal stem cell deficiency.
        Am J Ophthalmol. 2020; 216: 132-139
        • Kuckelkorn R.
        • Remky A.
        • Wolf S.
        • Reim M.
        • Redbrake C.
        Video fluorescein angiography of the anterior eye segment in severe eye burns.
        Acta Ophthalmol Scand. 1997; 75: 675-680
        • Romero-Rangel T.
        • Stavrou P.
        • Cotter J.
        • Rosenthal P.
        • Baltatzis S.
        • Foster C.S.
        Gas-permeable scleral contact lens therapy in ocular surface disease.
        Am J Ophthalmol. 2000; 130: 25-32
        • Michaud L.
        • Lipson M.
        • Kramer E.
        • Walker M.
        The official guide to scleral lens terminology.
        Cont Lens Anterior Eye. 2020; 43: 529-534
        • Le Q.
        • Cordova D.
        • Xu J.
        • Deng S.X.
        In Vivo Evaluation of the Limbus Using Anterior Segment Optical Coherence Tomography.
        Transl Vis Sci Technol. 2018; 7: 12
        • Rochon J.
        • Gondan M.
        • Kieser M.
        To test or not to test: Preliminary assessment of normality when comparing two independent samples.
        BMC Med Res Methodol. 2012; 12: 81
        • Walker M.K.
        • Bergmanson J.P.
        • Miller W.L.
        • Marsack J.D.
        • Johnson L.A.
        Complications and fitting challenges associated with scleral contact lenses: A review.
        Cont Lens Anterior Eye. 2016; 39: 88-96
        • Rathi V.M.
        • Mandathara P.S.
        • Dumpati S.
        • Sangwan V.S.
        Change in vault during scleral lens trials assessed with anterior segment optical coherence tomography.
        Cont Lens Anterior Eye. 2017; 40: 157-161
        • Sotozono C.
        • Yamauchi N.
        • Maeda S.
        • Kinoshita S.
        Tear exchangeable limbal rigid contact lens for ocular sequelae resulting from Stevens-Johnson syndrome or toxic epidermal necrolysis.
        Am J Ophthalmol. 2014; 158: 983-993
        • Vincent S.J.
        • Alonso-Caneiro D.
        • Collins M.J.
        Optical coherence tomography and scleral contact lenses: clinical and research applications.
        Clin Exp Optom. 2019; 102: 224-241
        • Fadel D.
        The influence of limbal and scleral shape on scleral lens design.
        Cont Lens Anterior Eye. 2018; 41: 321-328
        • Fadel D.
        Scleral lens issues and complications related to a non-optimal fitting relationship between the lens and ocular surface.
        Eye Contact Lens. 2019; 45: 152-163
        • Le Q.
        • Xu J.
        • Deng S.X.
        The diagnosis of limbal stem cell deficiency.
        Ocul Surf. 2018; 16: 58-69
        • Chan E.
        • Le Q.
        • Codriansky A.
        • Hong J.
        • Xu J.
        • Deng S.X.
        Existence of normal limbal epithelium in eyes with clinical signs of total limbal stem cell deficiency.
        Cornea. 2016; 35: 1483-1487
        • Deng S.X.
        • Sejpal K.D.
        • Tang Q.
        • Aldave A.J.
        • Lee O.L.
        • Yu F.
        Characterization of limbal stem cell deficiency by in vivo laser scanning confocal microscopy: a microstructural approach.
        Arch Ophthalmol. 2012; 130: 440-445
        • Le H.-G.
        • Tang M.
        • Ridges R.
        • Huang D.
        • Jacobs D.S.
        Pilot study for OCT guided design and fit of a prosthetic device for treatment of corneal disease.
        J Ophthalmol. 2012; 2012: 1-7