title: Combined intracorneal ring segments and iris-fixated phakic intraocular lens for keratoconus refractive and visual improvement.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of keratoconus refractive and visual improvement by combined intracorneal ring segments (ICRS; Intacs/Intacs SK, Addition Technology Inc., Des Moines, IL) and phakic intraocular lens (PIOL; Artisan/Artiflex Toric IOL, Ophtec BV, Groningen, Holland) implantation.
  
  
  METHODS
  This study comprised patients who had ICRS implantation followed by PIOL implantation 6 or more months later for the correction of keratoconus. Over a 12-month follow-up after PIOL implantation, the main outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent refraction, and central endothelial cell density. Efficacy and safety indexes were calculated.
  
  
  RESULTS
  The study included 21 eyes of 16 patients. The mean UDVA 12 months after ICRS and PIOL implantation increased from 2.0 ± 0 to 0.25 ± 0.22 logMAR (Snellen 20/2000 to 20/35) (P < .001). The mean CDVA increased from 0.31 ± 0.13 to 0.13 ± 0.13 log-MAR (Snellen 20/40 to 20/25) (P = .039). Predictability of refractive results was good, with spherical equivalent refraction within ±0.50 diopter of the attempted correction in 13 eyes (61.9%) and within ±1.00 diopter in 19 eyes (90.5%). Mean central endothelial cell density decreased from 2,513 ± 245 cells/mm(2) preoperatively to 2,312 ± 263 cells/mm(2) (P = .402). The efficacy index was 1.06 and the safety index was 1.40.
  
  
  CONCLUSIONS
  Keratoconus visual and refractive improvement by the sequential implantation of Intacs ICRS and Artisan/Artiflex Toric IOL is a safe and predictable procedure.
authors.forename: Tiago Bravo
authors.initials: TB
authors.lastname: Ferreira
authors.forename: José Luis
authors.initials: JL
authors.lastname: Güell
authors.forename: Felicidad
authors.initials: F
authors.lastname: Manero
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D054120:Phakic Intraocular Lenses; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D019904:Polymethyl Methacrylate