title: Artiflex phakic intraocular lens implantation after corneal collagen cross-linking in keratoconic eyes.
abstract: OBJECTIVE
  To evaluate the safety, efficacy, and stability of the Artiflex (Ophtec BV) foldable anterior iris-claw phakic intraocular lens (PIOL) following corneal collagen cross-linking (CXL) in select cases of progressive keratoconus.
  
  
  METHODS
  This prospective, comparative study, conducted between March 2007 and June 2008, involved 11 eyes with progressive keratoconus. Inclusion criteria were progressive keratoconus (Amsler-Krumeich classification grades I and II) with no corneal opacities, corneal thickness >450 μm, endothelial cell count >2500 cells/mm(2), anterior chamber depth >3.2 mm, spherical equivalent refraction >4.50 diopters (D) (with a cylinder component <2.00 D), and no other treatment for keratoconus other than contact lens. Each patient underwent CXL in the keratoconic eye with implantation of the Artiflex IOL 6 months thereafter. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction and topographic profiles were examined at 1, 6, and 12 months after the CXL procedure.
  
  
  RESULTS
  All eyes achieved UDVA of 0.3 logMAR or better. Final spherical and cylindrical error ranged from 0 to -1.50 D and 0 to -1.75 D, respectively. No eyes lost lines of preoperative CDVA. Statistically significant reductions in mean maximum (2.14 D, P<.001) and minimum (1.17 D, P=.02) keratometry values were present 12 months after the CXL procedure. No complications were observed.
  
  
  CONCLUSIONS
  Combined CXL and Artiflex implantation was a safe and effective treatment in this subset of eyes with progressive keratoconus. Good results in terms of visual acuity, postoperative residual refractive error, and keratometry values were identified.
authors.affiliation: Research Department, Instituto de Ojos Oftalmosalud Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Izquierdo
authors.forename: Maria A
authors.initials: MA
authors.lastname: Henriquez
authors.forename: Martin
authors.initials: M
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism* / Q000528:radiation effects; D003315:Cornea / Q000378:metabolism*; D003432:Cross-Linking Reagents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery* / Q000628:therapy; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D054120:Phakic Intraocular Lenses; D011446:Prospective Studies; D011474:Prosthesis Design; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D003094:Collagen