Açık Glob Yaralanması Sonrasında Travmaya Bağlı Korneal Düzensizliği Bulunan Çocuklarda Mini-Skleral Lenslerle Görsel Rehabilitasyon

Öz

Bu çalışmanın amacı, açık glob yaralanması sonrasında travmaya bağlı korneal düzensizlik gelişen pediatrik hastalarda mini-skleral lens rehabilitasyonunun görsel ve refraktif sonuçlarını değerlendirmektir. Bu tek merkezli retrospektif olgu serisine, Ocak 2023 ile Nisan 2026 arasında açık glob yaralanması sonrasında mini-skleral lens ile rehabilite edilen 18 yaş ve altındaki hastalar dahil edildi. Taranan 80 pediatrik açık glob yaralanması olgusundan 13 göz kontakt lens rehabilitasyonuna uygun bulundu; yumuşak kontakt lens ile rehabilite edilen iki göz dışlandı ve 11 hastanın 11 gözü analiz edildi. Demografik ve travmayla ilişkili veriler ile görme, refraksiyon, topografi, keratometri, lens uyarlaması ve klinik sonuçlara ilişkin veriler incelendi. Görme keskinliği minimum rezolüsyon açısının logaritmasına dönüştürüldü ve uyarlama öncesi ile sonrası değerler Wilcoxon işaretli sıralar testiyle karşılaştırıldı. Lens uyarlaması sırasındaki medyan yaş 9 yıldı. Medyan düzeltilmiş görme keskinliği, uyarlama öncesinde 1,30 logMAR iken mini-skleral lensle 0,40 logMAR'a yükseldi (p = 0,002) ve 10 gözde artış izlendi. Uyarlama öncesi medyan refraktif silindir -3,75 D, medyan topografik astigmatizma 4,57 D idi. Hiçbir hastada korneal rijit gaz geçirgen lens gereksinimi veya keratoplasti olmadı ve ciddi lens ilişkili komplikasyon nedeniyle lens kullanımı bırakılmadı. Mini-skleral lensler anlamlı görsel iyileşme sağlamış olup, travmaya bağlı korneal düzensizliği bulunan seçilmiş pediatrik gözlerde yararlı bir cerrahi dışı rehabilitasyon seçeneği olabilir.

Anahtar Kelimeler

• kontakt lens
• açık glob yaralanması
• korneal skar

Etik Beyan

Bu retrospektif çalışma, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüş ve Bursa Uludağ Üniversitesi Sağlık Araştırmaları Etik Kurulu tarafından onaylanmıştır (Tarih: 08.04.2026; Karar No: 2026/223/7-24).

Visual Rehabilitation With Mini-Scleral Lenses in Children With Post-Traumatic Corneal Irregularity After Open Globe Injury

Öz

The aim of this study was to evaluate the visual and refractive outcomes of mini-scleral lens rehabilitation in pediatric patients with post-traumatic corneal irregularity after open globe injury. This single-center retrospective case series included patients aged 18 years or younger who underwent mini-scleral lens rehabilitation after open globe injury between January 2023 and April 2026. Of 80 pediatric open globe injury cases screened, 13 eyes were considered suitable for contact lens rehabilitation; two eyes rehabilitated with soft contact lenses were excluded, leaving 11 eyes of 11 patients for analysis. Demographic, trauma-related, visual, refractive, topographic, keratometric, lens-fitting, and clinical outcome data were reviewed. Visual acuity was converted to logarithm of the minimum angle of resolution units, and pre-fitting and post-fitting values were compared using the Wilcoxon signed-rank test. Median age at fitting was 9 years. Median corrected visual acuity improved from 1.30 logMAR before fitting to 0.40 logMAR with mini-scleral lens wear (p = 0.002), with improvement in 10 eyes. Median pre-fitting refractive cylinder was -3.75 D, and median topographic astigmatism was 4.57 D. No patient required corneal rigid gas-permeable lens wear, underwent keratoplasty, or discontinued lens wear because of a severe lens-related complication. Mini-scleral lenses provided significant visual improvement and may be a useful non-surgical rehabilitation option in selected pediatric eyes with post-traumatic corneal irregularity.

Anahtar Kelimeler

• contact lens
• open glob injury
• corneal scar

Etik Beyan

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Bursa Uludag University Health Research Ethics Committee (Date: April 8, 2026; Decision No.: 2026/223/7-24).

Kaynakça

1. 1. May DR, Kuhn FP, Morris RE, et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol. Feb 2000;238(2):153-7. doi:10.1007/pl00007884
2. 1. May DR, Kuhn FP, Morris RE, et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol. Feb 2000;238(2):153-7. doi:10.1007/pl00007884
3. 2. Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Surv Ophthalmol. Sep-Oct 2013;58(5):476-85. doi:10.1016/j.survophthal.2012.10.007
4. 2. Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Surv Ophthalmol. Sep-Oct 2013;58(5):476-85. doi:10.1016/j.survophthal.2012.10.007
5. 3. Rostomian K, Thach AB, Isfahani A, Pakkar A, Pakkar R, Borchert M. Open globe injuries in children. J AAPOS. Aug 1998;2(4):234-8. doi:10.1016/s1091-8531(98)90058-1
6. 3. Rostomian K, Thach AB, Isfahani A, Pakkar A, Pakkar R, Borchert M. Open globe injuries in children. J AAPOS. Aug 1998;2(4):234-8. doi:10.1016/s1091-8531(98)90058-1
7. 4. Yildiz M, Kivanc SA, Akova-Budak B, Ozmen AT, Cevik SG. An Important Cause of Blindness in Children: Open Globe Injuries. J Ophthalmol. 2016;2016:7173515. doi:10.1155/2016/7173515
8. 4. Yildiz M, Kivanc SA, Akova-Budak B, Ozmen AT, Cevik SG. An Important Cause of Blindness in Children: Open Globe Injuries. J Ophthalmol. 2016;2016:7173515. doi:10.1155/2016/7173515

9. 5. Barry RJ, Sii F, Bruynseels A, et al. The UK Paediatric Ocular Trauma Study 3 (POTS3): clinical features and initial management of injuries. Clin Ophthalmol. 2019;13:1165-1172. doi:10.2147/OPTH.S201900
10. 5. Barry RJ, Sii F, Bruynseels A, et al. The UK Paediatric Ocular Trauma Study 3 (POTS3): clinical features and initial management of injuries. Clin Ophthalmol. 2019;13:1165-1172. doi:10.2147/OPTH.S201900
11. 6. Titiyal JS, Sinha R, Sharma N, Sreenivas V, Vajpayee RB. Contact lens rehabilitation following repaired corneal perforations. BMC Ophthalmol. Mar 14 2006;6:11. doi:10.1186/1471-2415-6-11
12. 6. Titiyal JS, Sinha R, Sharma N, Sreenivas V, Vajpayee RB. Contact lens rehabilitation following repaired corneal perforations. BMC Ophthalmol. Mar 14 2006;6:11. doi:10.1186/1471-2415-6-11
13. 7. Pelitli Gurlu V, Esgin H, Benian O, Erda S. [The factors affecting visual outcome in open globe injuries]. Ulus Travma Acil Cerrahi Derg. Oct 2007;13(4):294-9. Acik goz kuresi yaralanmalarinda sonuc gorme keskinligi uzerine etkisi olan faktorler.
14. 7. Pelitli Gurlu V, Esgin H, Benian O, Erda S. [The factors affecting visual outcome in open globe injuries]. Ulus Travma Acil Cerrahi Derg. Oct 2007;13(4):294-9. Acik goz kuresi yaralanmalarinda sonuc gorme keskinligi uzerine etkisi olan faktorler.
15. 8. Bunting H, Stephens D, Mireskandari K. Prediction of visual outcomes after open globe injury in children: a 17-year Canadian experience. J AAPOS. Feb 2013;17(1):43-8. doi:10.1016/j.jaapos.2012.10.012
16. 8. Bunting H, Stephens D, Mireskandari K. Prediction of visual outcomes after open globe injury in children: a 17-year Canadian experience. J AAPOS. Feb 2013;17(1):43-8. doi:10.1016/j.jaapos.2012.10.012
17. 9. Biberoglu Celik E, Ozkan G, Sahin O, Akkaya Turhan S. Visual rehabilitation with scleral lenses after open globe injury repair. Int Ophthalmol. Jan 30 2026;46(1):88. doi:10.1007/s10792-026-03965-4
18. 9. Biberoglu Celik E, Ozkan G, Sahin O, Akkaya Turhan S. Visual rehabilitation with scleral lenses after open globe injury repair. Int Ophthalmol. Jan 30 2026;46(1):88. doi:10.1007/s10792-026-03965-4
19. 10. Rathi VM, Mandathara PS, Vaddavalli PK, Srikanth D, Sangwan VS. Fluid filled scleral contact lens in pediatric patients: challenges and outcome. Cont Lens Anterior Eye. Aug 2012;35(4):189-92. doi:10.1016/j.clae.2012.03.001
20. 10. Rathi VM, Mandathara PS, Vaddavalli PK, Srikanth D, Sangwan VS. Fluid filled scleral contact lens in pediatric patients: challenges and outcome. Cont Lens Anterior Eye. Aug 2012;35(4):189-92. doi:10.1016/j.clae.2012.03.001
21. 11. Scanzera AC, Dunbar G, Shah V, Cortina MS, Leiderman YI, Shorter E. Visual Rehabilitation With Contact Lenses Following Open Globe Trauma. Eye Contact Lens. May 1 2021;47(5):288-291. doi:10.1097/ICL.0000000000000756
22. 11. Scanzera AC, Dunbar G, Shah V, Cortina MS, Leiderman YI, Shorter E. Visual Rehabilitation With Contact Lenses Following Open Globe Trauma. Eye Contact Lens. May 1 2021;47(5):288-291. doi:10.1097/ICL.0000000000000756
23. 12. Severinsky B, Lenhart P. Scleral contact lenses in the pediatric population-Indications and outcomes. Cont Lens Anterior Eye. Jun 2022;45(3):101452. doi:10.1016/j.clae.2021.101452
24. 12. Severinsky B, Lenhart P. Scleral contact lenses in the pediatric population-Indications and outcomes. Cont Lens Anterior Eye. Jun 2022;45(3):101452. doi:10.1016/j.clae.2021.101452
25. 13. Yang XD, Lyu Y. Rigid Gas-Permeable Contact Lens for Visual Rehabilitation in Children Younger Than 12 Years With Penetrative Ocular Trauma. Eye Contact Lens. Sep 1 2023;49(9):e364-e369. doi:10.1097/ICL.0000000000001015
26. 13. Yang XD, Lyu Y. Rigid Gas-Permeable Contact Lens for Visual Rehabilitation in Children Younger Than 12 Years With Penetrative Ocular Trauma. Eye Contact Lens. Sep 1 2023;49(9):e364-e369. doi:10.1097/ICL.0000000000001015
27. 14. Nau CB, Schornack M, Harthan JS, et al. SCOPE study: Experience of keratoconus patients wearing RGP or Scleral lenses. Investigative Ophthalmology & Visual Science. 2018;59(9):1778-1778.
28. 14. Nau CB, Schornack M, Harthan JS, et al. SCOPE study: Experience of keratoconus patients wearing RGP or Scleral lenses. Investigative Ophthalmology & Visual Science. 2018;59(9):1778-1778.
29. 15. Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Cont Lens Anterior Eye. Dec 2020;43(6):543-552. doi:10.1016/j.clae.2019.12.007
30. 15. Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Cont Lens Anterior Eye. Dec 2020;43(6):543-552. doi:10.1016/j.clae.2019.12.007
31. 16. Shorter E, Schornack M, Harthan J, et al. Keratoconus Patient Satisfaction and Care Burden with Corneal Gas-permeable and Scleral Lenses. Optom Vis Sci. Sep 2020;97(9):790-796. doi:10.1097/OPX.0000000000001565
32. 16. Shorter E, Schornack M, Harthan J, et al. Keratoconus Patient Satisfaction and Care Burden with Corneal Gas-permeable and Scleral Lenses. Optom Vis Sci. Sep 2020;97(9):790-796. doi:10.1097/OPX.0000000000001565
33. 17. Goppalakrishnan VA, Prabhu M. Management of Pediatric Open Globe Injury With Fenestrated Scleral Lens: A Case Report From India. Clinical Insights in Eyecare. 2024/02/27 2024;2(1)
34. 17. Goppalakrishnan VA, Prabhu M. Management of Pediatric Open Globe Injury With Fenestrated Scleral Lens: A Case Report From India. Clinical Insights in Eyecare. 2024/02/27 2024;2(1)
35. 18. Alipour F, Jamshidi Gohari S, Azad N, Mehrdad R. Miniscleral Contact Lens in Pediatric Age Group: Indications, Safety, and Efficacy. Eye Contact Lens. Jul 1 2021;47(7):408-412. doi:10.1097/ICL.0000000000000798
36. 18. Alipour F, Jamshidi Gohari S, Azad N, Mehrdad R. Miniscleral Contact Lens in Pediatric Age Group: Indications, Safety, and Efficacy. Eye Contact Lens. Jul 1 2021;47(7):408-412. doi:10.1097/ICL.0000000000000798
37. 19. Alipour F, Behrouz MJ, Samet B. Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye. Feb 2015;38(1):54-8. doi:10.1016/j.clae.2014.10.001
38. 19. Alipour F, Behrouz MJ, Samet B. Mini-scleral lenses in the visual rehabilitation of patients after penetrating keratoplasty and deep lamellar anterior keratoplasty. Cont Lens Anterior Eye. Feb 2015;38(1):54-8. doi:10.1016/j.clae.2014.10.001
39. 20. Lee KE, Moon SY, Nam S, et al. Scleral Lens Applications Focused on Korean Patients with Various Corneal Disorders. Korean J Ophthalmol. Apr 2023;37(2):157-165. doi:10.3341/kjo.2022.0164
40. 20. Lee KE, Moon SY, Nam S, et al. Scleral Lens Applications Focused on Korean Patients with Various Corneal Disorders. Korean J Ophthalmol. Apr 2023;37(2):157-165. doi:10.3341/kjo.2022.0164
41. 21. Ozcelik O, Ozbek Z, Yildirim CA, Durak I. Spectrum of Scleral Lens Fit and Patient Compliance: A Single Center Retrospective Study. Turk J Ophthalmol. Aug 21 2025;55(4):186-192. doi:10.4274/tjo.galenos.2025.23238
42. 21. Ozcelik O, Ozbek Z, Yildirim CA, Durak I. Spectrum of Scleral Lens Fit and Patient Compliance: A Single Center Retrospective Study. Turk J Ophthalmol. Aug 21 2025;55(4):186-192. doi:10.4274/tjo.galenos.2025.23238
43. 22. McClellan K, Lai T, Grigg J, Billson F. Penetratingkeratoplasty in children: visual and graft outcome. Br JOphthalmol. Oct 2003;87(10):1212-4. doi:10.1136/bjo.87.10.1212
44. 22. McClellan K, Lai T, Grigg J, Billson F. Penetratingkeratoplasty in children: visual and graft outcome. Br JOphthalmol. Oct 2003;87(10):1212-4. doi:10.1136/bjo.87.10.1212
45. 23. Dana MR, Schaumberg DA, Moyes AL, et al. Outcome ofpenetrating keratoplasty after ocular trauma in children. ArchOphthalmol. Dec 1995;113(12):1503-7. doi:10.1001/archopht.1995.01100120033003
46. 23. Dana MR, Schaumberg DA, Moyes AL, et al. Outcome ofpenetrating keratoplasty after ocular trauma in children. ArchOphthalmol. Dec 1995;113(12):1503-7. doi:10.1001/archopht.1995.01100120033003
47. 24. Gungor I, Schor K, Rosenthal P, Jacobs DS. The Boston Scleral Lens in the treatment of pediatric patients. J AAPOS. Jun2008;12(3):263-7. doi:10.1016/j.jaapos.2007.11.008
48. 24. Gungor I, Schor K, Rosenthal P, Jacobs DS. The Boston Scleral Lens in the treatment of pediatric patients. J AAPOS. Jun2008;12(3):263-7. doi:10.1016/j.jaapos.2007.11.008
49. 25. Mittelviefhaus H, Mittelviefhaus K, Gerling J. [Etiology ofcontact lens failure in pediatric aphakia. Indications forintraocular lenses?]. Ophthalmologe. Apr 1998;95(4):207-12. Ursachen des Kontaktlinsen-Abbruchs bei kindlichen Aphakien. Indikation fur Intraokularlinsen?doi:10.1007/s003470050263
50. 25. Mittelviefhaus H, Mittelviefhaus K, Gerling J. [Etiology ofcontact lens failure in pediatric aphakia. Indications forintraocular lenses?]. Ophthalmologe. Apr 1998;95(4):207-12. Ursachen des Kontaktlinsen-Abbruchs bei kindlichen Aphakien. Indikation fur Intraokularlinsen?doi:10.1007/s003470050263