Temporary Relief of Pain and Improved Vision in Patient with Bullous Keratopathy by Increasing Micro-Environment with a Specially Designed Soft Contact Lens Resulting in Decrease of Corneal Oedema and Pain Relief

Bullous Keratopathy is the presence of corneal epithelial bullae, resulting from corneal endothelial disease. Bullous Keratopathy is caused by oedema of the cornea, resulting from failure of the corneal endothelium to maintain the normally dehydrated state of the cornea. Most frequently, it is due to Fuchs corneal endothelial dystrophy or corneal endothelial trauma. Fuchs dystrophy is a genetic disorder that causes bilateral, progressive corneal endothelial cell loss, sometimes leading to symptomatic bullous keratopathy by age 50 to 60. Fuchs dystrophy may be autosomal dominant with incomplete penetrance. Another frequent cause of Bullous Keratopathy is corneal endothelial trauma, which can occur during intraocular surgery (e.g., cataract removal) or after placement of a poorly designed or mal-positioned intraocular lens implant. Bullous Keratopathy after cataract removal is called pseudophakic (if an intraocular lens implant is present) or aphakic (if no intraocular lens implant is present) bullous keratopathy. Sub-epithelial fluid-filled bullae form on the corneal surface as the corneal stroma (the deeper layers of the cornea) swells, leading to eye discomfort, decreased visual acuity, loss of contrast, glare and photophobia. Sometimes bullae rupture, causing pain and foreign body sensation. Bacteria can invade a ruptured bulla, leading to a corneal ulcer. The bullae and swelling of the corneal stroma can be seen on slit-lamp examination. Treatment requires an ophthalmologist and includes topical dehydrating agents (e.g., hypertonic saline), intraocular pressure– lowering agents, occasional short-term use of therapeutic soft contact lenses for some mild to moderate cases and treatment of any secondary microbial infection. Corneal transplantation is usually curative. A new modality of reducing signs and symptoms and improve living quality in Bullous Keratopathy patients has been developed by Israel based company Eye-Yon Medical, namely the Hyper CLTM. The unique structure of the Hyper-CLTM facilitates extraction of fluid from the corneal stroma and increased evaporation over the lens surface. The dual base curve combined with the groove and the holes within the lens create a micro-environment above the cornea center that will increase contact time of any solution applied to the lens surface. After 10 days of wear of the lens, the corneal oedema caused by the Bullous Keratopathy was reduced by 110μ and there was significantly less pain and slight improvement of vision.