title: Evaluation of a toric implantable collamer lens after corneal collagen crosslinking in treatment of early-stage keratoconus: 3-year follow-up.
abstract: OBJECTIVE
  The aim of this study was to assess the predictability, efficacy, safety, and stability in patients who received a toric implantable collamer lens (TICL) after collagen crosslinking in early-stage keratoconus.
  
  
  METHODS
  This prospective interventional case series study was conducted at the Alexandria Main University hospitals, University of Alexandria, Egypt. Sixteen eyes underwent implantation of a TICL (STAAR Surgical Inc) after crosslinking. The mean spherical refraction was -5.98 ± 4.39 diopters (D) (range, -0.50 to -14.50 D), and the mean cylinder was -4.91 ± 1.51 D (range, -2.50 to -7.75 D). Uncorrected distance visual acuity (UDVA), manifest and cycloplegic refraction, corrected distance visual acuity (CDVA), vault, intraocular pressure, and endothelial cell count (using specular microscopy) were evaluated during a 3-year follow-up.
  
  
  RESULTS
  The mean Snellen decimal CDVA improved from 0.56 ± 0.13 (range, 0.40-0.80) preoperatively to 0.89 ± 0.17 (range, 0.60-1.20) at 3 years of the follow-up (P < 0.0001). The mean UDVA also improved significantly from 0.63 ± 0.14 before ICL implantation to 0.88 ± 0.18 after 3 years of the follow-up (P < 0.001). At 3 years, the mean spherical and cylindrical manifest refractions were 0.00 ± 0.18 D and -0.05 ± 0.14 D, respectively. At the end of the follow-up, the vault was 509.75 ± 141.47 μm (range, 320-900) and the intraocular pressure was 11.94 ± 1.12 mm Hg. No complications occurred during the surgical procedures. No eye needed explantation or repositioning of the TICL. The endothelial cell count loss after 3 years was -8.98%.
  
  
  CONCLUSIONS
  Correction of spherical and cylindrical refractive errors in keratoconic eyes by TICL implantation 12 months after crosslinking gave significantly promising outcomes, particularly in the astigmatic component of refraction.
authors.affiliation: *Department of Ophthalmology, University of Alexandria, Alexandria, Egypt; and †Armed Forces Hospitals, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shafik Shaheen
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Kateb
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El-Samadouny
authors.forename: Hussam
authors.initials: H
authors.lastname: Zaghloul
mesh_terms: D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure; D007640:Keratoconus / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D054120:Phakic Intraocular Lenses; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin