title: Collagen copolymer toric phakic intraocular lens for residual myopic astigmatism after intrastromal corneal ring segment implantation and corneal collagen crosslinking in a 3-stage procedure for keratoconus.
abstract: OBJECTIVE
  To evaluate staged combined treatment for keratoconus with intrastromal corneal ring segment (ICRS) implantation followed by corneal collagen crosslinking (CXL) with riboflavin-ultraviolet-A (UVA) and then toric implantable collagen copolymer phakic intraocular lens (pIOL) implantation.
  
  
  METHODS
  Large private ophthalmic hospital system.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Eyes with progressive keratoconus had ICRS implantation, then CXL, and then pIOL implantation (minimum 6 months between procedures).
  
  
  RESULTS
  The study enrolled 14 eyes (9 patients). After the combined treatments, the mean decimal uncorrected distance visual acuity (UDVA) and mean decimal corrected distance visual acuity (CDVA) were significantly improved from 0.01 and 0.14, respectively, preoperatively to 0.44 and 0.57, respectively (P<.0001). The mean manifest refraction spherical equivalent decreased from -16.40 diopters (D) ± 3.56 (SD) (range -11.50 to -22.50 D) to -0.80 ± 1.02 D (range -2.00 to +2.00 D) after the combined treatments (P<.0001). The mean refractive astigmatism decreased from -4.73 ± 1.32 D (range -3.00 to -7.00 D) to -0.96 ± 0.35 D (range -0.50 to -1.50 D) (P<.0001). The mean steep and mean flat keratometry values reduced from 60.57 D and 56.16 D, respectively, to 54.48 D and 53.57 D (P<.0001), respectively. No intraoperative or postoperative complications occurred.
  
  
  CONCLUSIONS
  A combined 3-stage-approach keratoconus treatment comprising ICRS implantation followed by CXL and then toric pIOL implantation was effective in improving functional vision and reducing disease progression. Longer term studies are required for further evaluation and comparison with other methods.
authors.affiliation: World Eye Hospital, Istanbul, Turkey. efekan.coskunseven@dunyagoz.com
authors.forename: Efekan
authors.initials: E
authors.lastname: Coşkunseven
authors.forename: Daya Papalkar
authors.initials: DP
authors.lastname: Sharma
authors.forename: Mirko R
authors.initials: MR
authors.lastname: Jankov
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Olivier
authors.initials: O
authors.lastname: Richoz
authors.forename: Farhad
authors.initials: F
authors.lastname: Hafezi
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D009216:Myopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D054120:Phakic Intraocular Lenses; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012029:Refraction, Ocular / Q000502:physiology; 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