Descemetocele Management With Therapeutic Scleral Lens Wear

Objectives: This case reports on the use of scleral lens therapy for a patient with a descemetocele secondary to exposure and neurotrophic keratopathy.

Methods: Case report and literature review.

Results: A 31-year-old man had undergone emergency surgery to repair a ruptured arteriovenous malformation resulting in left facial and trigeminal nerve palsies. The patient reported to our clinic with a central descemetocele secondary to exposure and neurotrophic keratopathy. Given the poor prognosis of a therapeutic penetrating keratoplasty in this case, the descemetocele was treated with therapeutic scleral lens wear. After 1 year, the patient has remained stable without corneal perforation.

Conclusions: This case illustrates the use of extended scleral lens wear, followed by maintenance with daily scleral lens wear, to manage a descemetocele in a patient with neurotrophic and exposure keratopathy. For patients at high risk of postsurgical complications, therapeutic scleral lens wear may be used as an alternative or as a supplement to corneal transplantation and tarsorrhaphy in patients with descemetocele formation.