Management of Limbal Stem Cell Deficiency by Using Scleral Contact Lenses for Optical Correction and as a Treatment of Dry Eye Syndrome

Objective: to describe the clinical and functional results of using scleral contact lenses (SCL) in patients with limbal stem cell deficiency (LSCD) to correct refractive errors, also as a therapeutic system to manage chronic dry eye syndrome.
Materials and methods. The study included 22 patients, 25 eyes with diagnosed LSCD with various etiology and laterality, who had undergone SCL fittings for daily use. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer test 1 and lens parameters: diameter (D), base curvature radii (BC), average ratio of lens thickness to apical clearance (AK), duration of lens wear before and after fitting SCL were analyzed. Subjectively, the severity of complaints to redness, lacrimation, photophobia, and dryness in the eyes was assessed on a 5-point scale in all patients before and after fitting.
Results. BCVA before fitting SCL was 0.10 (0.05; 0.50), in the SCL 0.60 (0.20; 0.70), the average sphere is 0 dpt, and the cylind is -0.5 dpt, the significance of the difference between pre- and post-SCL wear was assessed by the paired t test (p < 0.05) which is considered statistically significant. The average D was 15.2 mm, BC 8.35 mm, the average ratio of lens thickness to AK after “shrinkage” was 1:1. The average time of wearing lenses during the day was 7 hours. There was a statistically significant decrease in the intensity of complaints to lacrimation, photophobia, dry eyes, and redness before SCL fitting and after 1 month of active wear (p < 0.05). The severity of dry eye syndrome was assessed using the Schirmer-1 test, according to which the average tear production before SCL fitting and 3 months after increased from 4.0 (2.0; 5.0) mm to 7.0 (5.0; 8.0) mm, respectively.
Conclusion. The use of SCL, considering the anatomical eye’s features and ocular surface in patients with stable LSCD or with LSCD after surgical treatment provides a double effect — increased visual acuity and constant moistening of the ocular surface.

1. Deng SX, Borderie V, Chan CC, Dana R, Figueiredo FC, Gomes JAP, Pellegrini G, Shimmura S, Kruse FE; and The International Limbal Stem Cell Deficiency Working Group. Global Consensus on Definition, Classification, Diagnosis, and Staging of Limbal Stem Cell Deficiency. Cornea. 2019 Mar;38(3):364–375. doi: 10.1097/ICO.0000000000001820.

2. Vazirani J, Mariappan I, Ramamurthy S, Fatima S, Basu S, Sangwan VS. Surgical Management of Bilateral Limbal Stem Cell Deficiency. Ocul Surf. 2016 Jul;14(3):350–364. doi: 10.1016/j.jtos.2016.02.006.

3. Sangwan VS, Basu S, MacNeil S, Balasubramanian D. Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol. 2012 Jul;96(7):931–934. doi: 10.1136/bjophthalmol-2011-301164.

4. Lim P, Fuchsluger TA, Jurkunas UV. Limbal stem cell deficiency and corneal neovascularization. SeminOphthalmol. 2009 May-Jun;24(3):139–148. doi: 10.1080/08820530902801478.

5. Petraevskiy AV, Gndoian IA, Trishkin KS, Vinogradov AR. Ocular traumatism in Russian Federation. The Russian Annals of Ophthalmology. 2018;134(4):80–83 (In Russ.). doi: 10.17116/ oftalma201813404180.

6. Borzenok SA, Malyugin BE, Gerasimov MYu, Ostrovsky DS. Cultivated autologous oral mucosal epithelial transplantation. Russian Journal of Transplantology and Artificial Organs. 2021;23(1):171–177 (In Russ.). doi: 10.15825/1995-11912021-1-171-177.

7. Pozdeeva NA, Tonaeva HD, Borzenok SA. Allolimbal transplantation in the treatment of patients with insufficiency of limbal stem cells in case of congenital aniridia. Medical almanac. 2014;1(31):74–77 (In Russ.).

8. Malyugin BE, Gerasimov MY, Borzenok SA. Glueless Simple Limbal Epithelial Transplantation: The Report of the First 2 Cases. Cornea. 2020 Dec;39(12):1588– 1591. doi: 10.1097/ICO.0000000000002467.

9. Malyugin BE, Kalinnikova SY, Knyazer B, Gerasimov MY. Midterm Outcomes of Autologous Glueless Simple Limbal Epithelial Transplantation for Unilateral Limbal Stem Cell Deficiency. Cornea. 2024 Jan 1;43(1):45–51. doi: 10.1097/ICO.0000000000003279.

10. Nakamura T, Inatomi T, Sotozono C, Amemiya T, Kanamura N, Kinoshita S. Transplantation of cultivated autologous oral mucosal epithelial cells in patients with severe ocular surface disorders. Br J Ophthalmol. 2004 Oct;88:15377551; PMCID: PMC1772364.

11. Malyugin BE, Borzenok SA, Gerasimov MYu. Clinical outcomes of autologous cultured oral mucosal epithelium transplantation for treatment of limbal stem cell deficiency. Fyodorov J. OphthalmicSurg. 2020;4:77–85 (In Russ.). doi: 10.25276/02354160-2020-4-77-85.

12. Malyugin B, Kalinnikova S, Isabekov R, Ostrovskiy D, Knyazer B, Gerasimov M. Diagnostic Algorithm for Surgical Management of Limbal Stem Cell Deficiency. Diagnostics (Basel). 2023 Jan 5;13(2):199. doi: 10.3390/diagnostics13020199.

13. Holland EJ. Management of Limbal Stem Cell Deficiency: A Historical Perspective, Past, Present, and Future. Cornea. 2015 Oct;34 Suppl 10:S9–15. doi: 10.1097/ICO.0000000000000534.

14. Kalinnikov YuYu, Izmailova SB, Ragimova LF, Ismailova ZM, Kalinnikova SYu, Sagonenko DA. Clinical and Functional Results of Combined Surgical Treatment of a Patient with Keratoconus: 10-year Follow-up Experience. Ophthalmology in Russia. 2025;22(1):191–199 (In Russ.). doi: 10.18008/1816-5095-2025-1-191-199.

15. Nguyen MTB, Thakrar V, Chan CC. EyePrintPRO therapeutic scleral contact lens: indications and outcomes. Can J Ophthalmol. 2018 Feb;53(1):66–70. doi: 10.1016/j.jcjo.2017.07.026.

16. Stepanova LI, Alekseeva MS. Clinical experience with scleral lensesfor correction of induced ametropia. The EYE GLAZ. 2020;2:16–20 (In Russ.). doi: 10.33791/22224408-2020-2-16-20.

17. Yusef YuN, Osipyan GA, Averich VV, Budnikova EA, AbaevAZ. Optionsfor contact correction after keratoplasty. Russian Annals of Ophthalmology. 2024;140(4):98– 103 (In Russ.). doi: 10.17116/oftalma202414004198.

18. Bakalova NA. “OKVision® SMARTFITTM” customizable mini-scleral lenses fitting guide. The EYE GLAZ. 2021;23(1):41–51 (In Russ.). doi: 10.33791/22224408-2021-1-41-51.

19. Dimit R, GireA, Pflugfelder SC, Bergmanson JP. Patient ocular conditions and clinical outcomes using a PROSE scleral device. Cont LensAnterior Eye. 2013 Aug;36(4):159–163. doi: 10.1016/j.clae.2013.02.004.

20. Myagkov AV, Ignatova NV. Our experience in optical correction of radial keratotomy consequences by scleral lenses. Clinical cases. Russian Ophthalmological Journal. 2017;10(2):92–96 (In Russ.). doi: 10.21516/2072-0076-2017-10-2-92-96.

21. Papanyan SS, Fedotova K, Grabovetsky VR, Andrienko GV, Novikov SA. Experience in the use of rigid gas permeable scleral contact lenses in patients with low visual functions. Sovremennaya optometriya. 2017;5:10–16 (In Russ.).

22. Michaud L, Lipson M, Kramer E, Walker M. The official guide to scleral lens terminology. Cont Lens Anterior Eye. 2020 Dec;43(6):529–534. doi: 10.1016/j.clae.2019.09.006.

23. Listratov SV, Bakalova NA, Averich VV. OKVision® SMARTFITTM scleral contact lens manufacturing technology. The EYE GLAZ. 2021;23(2):47–52 (In Russ.). doi: 10.33791/22224408202124752.

24. Alyaeva OO, Ryabenko OI, Tananakina EM, Yushkova IS. Zenlens scleral lenses for visual rehabilitation of patients with irregular cornea: a usage experience. Russian ophthalmological journal. 2018;11(4):68–74 (In Russ.). doi: 10.21516/2072-00762018-11-4-68-74.

25. Tougeron-Brousseau B, Delcampe A, Gueudry J, Vera L, Doan S, Hoang-Xuan T, Muraine M. Vision-related function after scleral lens fitting in ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J Ophthalmol. 2009 Dec;148(6):852–859.e2. doi: 10.1016/j.ajo.2009.07.006.

26. Ciralsky JB, Chapman KO, Rosenblatt MI, Sood P, Fernandez AG, Lee MN, Sippel KC. Treatment of Refractory Persistent Corneal Epithelial Defects: A Standardized Approach Using Continuous Wear PROSE Therapy. Ocul Immunol Inflamm. 2015 Jun;23(3):219–224. doi: 10.3109/09273948.2014.894084.

27. Bavinger JC, DeLoss K, Mian SI. Scleral lens use in dry eye syndrome. Curr Opin Ophthalmol. 2015 Jul;26(4):319–324. doi: 10.1097/ICU.0000000000000171.

28. Foulks GN, Forstot SL, Donshik PC, Forstot JZ, Goldstein MH, Lemp MA, Nelson JD, Nichols KK, Pflugfelder SC, Tanzer JM, Asbell P, Hammitt K, Jacobs DS. Clinical guidelines for management of dry eye associated with Sjögren disease. OculSurf. 2015 Apr;13(2):118–132. doi: 10.1016/j.jtos.2014.12.001.

29. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens. 2005 May;31(3):130–134. doi: 10.1097/01.icl.0000152492.98553.8d.

30. Fedotova K, Grabovetsky VR, Novikov SA, Ezugbaya M. Miniscleral lenses in the treatment of patients with dry eye syndrome (first own experience). Ophthalmology Journal. 2019;12(1):5–12 (In Russ.). doi: 10.17816/OV1215-12.

31. Tatarnikova EB, Krivosheina OI. State-of-the-art etiology and pathogenesis of dry eye. Russian Journal of Clinical Ophthalmology. 2020;20(3):128–132 (In Russ.). doi: 10.32364/2311-7729-2020-20-3-128-132.

32. Harthan J, Nau CB, BarrJ, Nau A, Shorter E, Chimato NT, Hodge DO, Schornack MM. Scleral Lens Prescription and Management Practices: The SCOPE Study. Eye Contact Lens. 2018 Sep;44 Suppl 1:S228–S232. doi: 10.1097/ICL.0000000000000387.

33. Schornack MM. Limbal stem cell disease: management with scleral lenses. Clin Exp Optom. 2011 Nov;94(6):592–594. doi: 10.1111/j.1444-0938.2011.00618.x.

34. Pullum KW, Whiting MA, Buckley RJ. Scleral contact lenses: the expanding role. Cornea. 2005 Apr;24(3):269–277. doi: 10.1097/01.ico.0000148311.94180.6b.