title: Safety and visual outcome of Visian toric ICL implantation after corneal collagen cross-linking in keratoconus.
abstract: OBJECTIVE
  To evaluate the safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus.
  
  
  METHODS
  A retrospective study examined the results of the two-step CXL and Visian toric ICL implantation in 16 eyes of 10 patients with keratoconus. The two procedures were done at an interval of 6 months. Data were collected preoperatively, at the 6-month follow-up visit after CXL, and at the 6-month follow-up visit after ICL implantation.
  
  
  RESULTS
  CXL induced a statistically significant decrease in steep keratometry (50.02 ± 4.07 at baseline to 48.74 ± 4.05 at 6 months after CXL, P = .001) without any significant change in visual acuity or refraction. At 6-month follow-up after ICL implantation, mean K (max) was 50.49 ± 4.07 versus 52.29 ± 4.79 D at baseline (P = .001). Mean uncorrected distance visual acuity improved from 1.67 ± 0.49 to 0.17 ± 0.06 logMAR (P = .001) and mean corrected distance visual acuity improved from 0.15 ± 0.06 to 0.12 ± 0.04 logMAR (P = .023). Mean spherical equivalent decreased from -7.24 ± 3.53 to -0.89 ± 0.76 D (P = .001) and mean cylinder decreased from 2.64 ± 1.28 to 1.16 ± 0.64 D (P = .001). The safety and efficacy indices were 1.08 ± 0.13 and 0.97 ± 0.08, respectively. No intraoperative or postoperative complications occurred.
  
  
  CONCLUSIONS
  Implantation of the Visian toric ICL following CXL is an effective option for improving visual acuity in patients with keratoconus.
authors: Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
authors: Ali
authors: A
authors: Fadlallah
authors: Ali
authors: A
authors: Dirani
authors: Hala
authors: H
authors: El Rami
authors: Georges
authors: G
authors: Cherfane
authors: Elias
authors: E
authors: Jarade
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery; D054120:Phakic Intraocular Lenses; D010778:Photochemotherapy; 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