title: Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia.
abstract: OBJECTIVE
  To evaluate the visual results and complications of angle-supported phakic intraocular lenses (IOLs) to correct myopia associated with early-stage keratoconus.
  
  
  METHODS
  Private practice, Siena, Italy.
  
  
  METHODS
  In a prospective noncomparative single-surgeon interventional case series, outcomes in 12 consecutive eyes of 8 patients with stage I to II keratoconus, myopia from -6.50 to -14.00 diopters (D), and astigmatism from -1.00 to -5.00 D were analyzed after the implantation of angle-supported phakic IOLs (ZSAL-4, Morcher). The minimum follow-up was 12 months. Implantation was performed through a sclerocorneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, after which a surgical basal iridectomy was created.
  
  
  RESULTS
  The spherical error in all cases was corrected within +/-1.00 D. Astigmatism magnitude did not significantly improve. The uncorrected visual acuity (UCVA) was 20/40 or better in all cases. The best spectacle-corrected visual acuity (BSCVA) was equal or improved in all cases. The safety index (postoperative BSCVA/preoperative BSCVA) was 1.18; the efficacy index (postoperative UCVA/preoperative BSCVA) was 0.77. Three eyes had significant halos that improved considerably over 3 months. Spectacles were permanently used by 1 patient (2 eyes in the study) and only for driving by 5 patients. Complications were limited to 3 cases of mild pupil ovalization and 1 case of IOL rotation. Endothelial loss at 12 months was 7.2%.
  
  
  CONCLUSIONS
  Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.
authors.affiliation: Ophthalmic Surgery Unit, Casa di Cura Rugani, Siena, Italy. leccisotti@libero.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Leccisotti
authors.forename: Stefania V
authors.initials: SV
authors.lastname: Fields
mesh_terms: D000328:Adult; D000869:Anterior Eye Segment / Q000601:surgery; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000150:complications / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007908:Lens, Crystalline / Q000502:physiology*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D014792:Visual Acuity