Visian toric ICL implantation after intracorneal ring segments implantation and corneal collagen crosslinking in keratoconus.
OBJECTIVE
To evaluate the safety and clinical outcome of Visian toric implantable collamer lens (TICL) implantation for the treatment of residual refractive errors 6 months after sequential intracorneal ring segments (ICRS) and corneal collagen UVA crosslinking (CXL) in stable keratoconus.


METHODS
This retrospective study examined the results of a 3-step ICRS-CXL-TICL in 11 eyes of 7 patients with moderate to severe keratoconus. The 2 procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and TICL implantation was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after TICL implantation.


RESULTS
The ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity, and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 45.19 ± 3.98 D vs 48.51 ± 4.26 D preoperatively (p = 0.022) and mean Ksteep was 50.41 ± 4.32 D vs 54.24 ± 4.96 D preoperatively (p = 0.032). Uncorrected distance visual acuity (UCVA) significantly improved from 1.47 ± 0.38 logMAR before ICRS-CXL to 0.27 ± 0.20 logMAR 6 months after (p = 0.002). Corrected distance visual acuity (CDVA) significantly improved from 0.50 ± 0.22 logMAR to 0.29 ± 0.23 logMAR (p = 0.001). At 6 months post TICL implantation, UCVA improved significantly to 0.27 ± 0.20 logMAR and the CDVA was 0.19 ± 0.11 logMAR. No intraoperative or postoperative complications occurred.


CONCLUSIONS
Toric ICL implantation after sequential ICRS implantation and CXL is an effective and safe option for correcting high residual refractive error and improving visual acuity in patients with moderate to severe keratoconus.
2 Saint-Joseph University, Faculty of Medicine, Beirut - Lebanon.
Ali
A
Dirani
Ali
A
Fadlallah
Ziad
Z
Khoueir
Joelle
J
Antoun
George
G
Cherfan
Elias
E
Jarade
D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000378:metabolism / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D054120:Phakic Intraocular Lenses; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin