title: Sequential Intacs and Verisyse phakic intraocular lens for refractive improvement in keratoconic eyes.
abstract: OBJECTIVE
  To evaluate the safety, efficacy, and stability of sequential Intacs (Addition Technology, Inc.) insertion and Verisyse phakic intraocular lens (pIOL) (AMO) implantation in selected cases of keratoconus.
  
  
  METHODS
  Magrabi Eye Hospital, Cairo, Egypt.
  
  
  METHODS
  Prospective data were collected from 8 eyes of 6 keratoconus patients with contact lens intolerance, clear corneas, a maximum K-value less than 60.0 diopters (D), and minimum corneal thickness greater than 400 mum. Two 0.45 mm Intacs were inserted through a 1.8 mm radial incision created at 70% of the corneal depth opposite the cone apex. The 2 rings were pushed to meet and embrace the cone apex. Refraction 6 months after Intacs insertion showed residual myopia greater than 6.0 D and residual astigmatism not more than 2.0 D. Thus, a phakic Verisyse IOL was implanted horizontally in the anterior chamber through a 6.5 mm superior clear corneal incision, which was closed with 3, 10-0 nylon sutures after a peripheral iridectomy was created. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, and topographic profiles were taken 1 week and 1, 3, 6, 9, 12, 18, and 24 months after the second surgery.
  
  
  RESULTS
  All eyes achieved UCVA of 20/40 or better. The final spherical error ranged from -1.75 to +1.00 D and the cylindrical error, from 1.25 to 2.50 D. No eye lost lines of preoperative BCVA. These results were relatively stable throughout the follow-up period.
  
  
  CONCLUSIONS
  Sequential Intacs and a Verisyse pIOL implantation was safe, stable, and effective in selected cases of keratoconus. It is a reversible surgery that is less invasive than penetrating keratoplasty (PKP). It can avoid or postpone the need for PKP, although it is not an alternative.
authors.affiliation: Magrabi Eye Hospital, Ain Shams University, 2 Nakhla El-Moteae Street, Heliopolis, Cairo, Egypt. telragal@hotmail.com
authors.forename: Tamer M
authors.initials: TM
authors.lastname: El-Raggal
authors.forename: Adel A
authors.initials: AA
authors.lastname: Abdel Fattah
mesh_terms: D000328:Adult; D000867:Anterior Chamber / Q000601:surgery; D003315:Cornea / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D007908:Lens, Crystalline / Q000502:physiology*; D008297:Male; D019904:Polymethyl Methacrylate; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D014786:Vision Disorders / Q000534:rehabilitation; D014792:Visual Acuity
chemical_list: D019904:Polymethyl Methacrylate