Efficacy of scleral rigid gas-permeable contact lenses for correcting induced astigmatism after different keratoplasty techniques in patients with keratoconus

Background. Visual rehabilitation in patients with post-keratoplasty astigmatism remains a major challenge in contemporary ophthalmology. Marked irregularity of the anterior corneal surface after keratoplasty often renders conventional correction methods, including spectacles, soft contact lenses, and corneal rigid gas-permeable lenses, insufficiently effective or unsuitable. Purpose: To perform a comprehensive comparative evaluation of the effectiveness of optical correction of post-keratoplasty astigmatism with scleral rigid gas-permeable contact lenses in patients with a history of keratoconus, according to the keratoplasty technique performed. Materials and methods. This prospective comparative study included 60 patients (60 eyes) with a history of stage III–IV keratoconus who had undergone different keratoplasty procedures between September 2024 and June 2025. The patients were divided into three groups of 20 each according to the keratoplasty technique performed: penetrating keratoplasty, deep anterior lamellar keratoplasty and bandage therapeutic-optical keratoplasty. All patients were fitted with scleral rigid gas-permeable contact lenses. Spherical and cylindrical refractive error, keratometric parameters, visual acuity, and root mean square values for total, lower-order, and higher-order aberrations were assessed before lens fitting and during scleral lens wear. Results. Scleral lens wear resulted in a statistically significant reduction in cylindrical refractive error, keratometric parameters, and total, lower-order, and higher-order corneal aberrations in all three groups (p < 0.001). Visual acuity improved significantly, with a median of 0.9–1.0 across the groups (p < 0.001). Although baseline aberration values were highest in the bandage therapeutic-optical keratoplasty group, final optical correction outcomes were high and comparable with those in the other groups. Conclusion. Scleral rigid gas-permeable contact lenses are a highly effective and versatile option for correcting post-kerato plasty astigmatism in patients with keratoconus. Their efficacy is not influenced by the keratoplasty technique performed.

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