The challenges of the corneal graft

Indications for post‐graft contact lens fitting are primarily therapeutic (healing/suture problems, leaking wound, graft dehiscence) or optical (high/irregular astigmatism, anisometropia, poor vision with spectacles, lens worn on fellow eye). In therapeutic application, ‘soft’ lenses of varying thickness and water content are generally indicated and for relatively short‐term use. For optical management, rigid gas permeable corneal lenses are the mainstay although scleral lenses may be required in certain situations such as the highly irregular cornea where retention of smaller devices is problematic . There are numerous variations from the normal when considering contact lenses for the grafted cornea including physiological/metabolic (thickness variations, reduction in sensitivity, endothelial changes) and topographical (astigmatism, profile, position of graft). For example, in a patient with reduced corneal sensitivity where keratitis is a potential problem, optimising corneal oxygenation and reducing lens wear is recommended. Topographic peculiarities of the cornea can make the fitting of contact lenses a challenge – in extreme cases at best a compromise with the likelihood of limited wearing time and comfort, at worst potentially dangerous with the risk of corneal trauma and graft rejection. Liaison with the corneal surgeon in improving corneal topography by suture manipulation is essential.The practitioner must have access to a wide range of contact lens options and be mindful of lens dimensions and geometry and also material characteristics – this will give the optimal chance of success in dealing with the challenges posed.