title: Collagen crosslinking and toric iris-claw phakic intraocular lens for myopic astigmatism in progressive mild to moderate keratoconus.
abstract: OBJECTIVE
  To report the long-term results of combined collagen crosslinking (CXL) and toric phakic intraocular lens (pIOL) implantation to correct myopic astigmatism in patients with progressive mild to moderate keratoconus.
  
  
  METHODS
  Instituto de Microcirugia Ocular, Barcelona, Spain.
  
  
  METHODS
  Case series.
  
  
  METHODS
  From November 2006 to July 2009, CXL was performed in eyes with proven progressive keratoconus. Once refraction and topography stabilized, toric Artiflex/Artisan pIOL implantation was performed to correct residual myopic astigmatism. A complete ophthalmologic examination, including manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, biomicroscopy, tonometry, fundoscopy, keratometry, corneal tomography, and central endothelial cell count (ECC), was performed before each procedure and postoperatively at 3 months and at yearly intervals up to 5 years. Main outcome measures were accuracy and stability of the spherical equivalent (SE) and cylinder, keratometry, UDVA (efficacy), CDVA (safety), central ECC, and complications.
  
  
  RESULTS
  The median follow-up in the 9 patients (17 eyes) was 36.9 months ± 15.0 (SD). The median interval between CXL and pIOL implantation was 3.9 ± 0.7 months. Fourteen eyes (82%) were within ± 0.50 diopter (D) of the attempted SE correction and 13 eyes (76%) were within ± 1.00 D of the attempted cylinder correction. The mean difference in simulated keratometry between preoperatively and the last follow-up was 0.17 ± 0.45 D (range -0.55 to 1.45 D). The postoperative UDVA was 20/40 or better in 16 eyes (94%). No eye lost lines of CDVA. No significant decrease in central ECC occurred (P>.05).
  
  
  CONCLUSIONS
  Combined CXL and toric iris-claw pIOL implantation effectively and safely corrected myopic astigmatism in progressive mild to moderate keratoconus.
  
  
  BACKGROUND
  Dr. Güell is a consultant to Ophtec. No other author has a financial or proprietary interest in any material or methods mentioned.
authors.affiliation: Instituto Microcirugia Ocular, Barcelona, Spain. guell@imo.es.
authors.forename: José L
authors.initials: JL
authors.lastname: Güell
authors.forename: Merce
authors.initials: M
authors.lastname: Morral
authors.forename: François
authors.initials: F
authors.lastname: Malecaze
authors.forename: Oscar
authors.initials: O
authors.lastname: Gris
authors.forename: Daniel
authors.initials: D
authors.lastname: Elies
authors.forename: Felicidad
authors.initials: F
authors.lastname: Manero
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007498:Iris / Q000601:surgery*; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D019654:Lens Implantation, Intraocular / Q000379:methods; D008297:Male; D009216:Myopia / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D054120:Phakic Intraocular Lenses; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin