title: Objective and Subjective Outcome of Clear Lensectomy With Toric IOL Implantation After Corneal Collagen Cross-Linking in Selected Cases of Keratoconus.
abstract: OBJECTIVE
  To evaluate the visual and topographic outcomes of a two-stage approach treatment for selected cases of progressive keratoconus (KC); corneal collagen cross-linking (CXL) followed by phacoemulsification with toric intraocular lens (IOL) implantation.
  
  
  METHODS
  The study included 9 eyes of 6 patients diagnosed with progressive KC, aged from 35 to 47 years (41.6±11.2 years). All studied eyes underwent a two-stage approach treatment: first corneal collagen CXL followed after at least 6 months by phacoemulsification with foldable toric IOL implantation in both eyes of three patients and only one eye of the other three patients. A complete ophthalmological examination was performed preoperatively and postoperatively. Topographical and visual outcomes were evaluated during 1-year follow-up period.
  
  
  RESULTS
  At baseline, seven eyes had mild and two eyes had moderate KC. Sphere ranged from -3.00 to -8.00 diopter (D) and cylinder from -3.50 to -5.50 D. All eyes could be corrected by glasses to 0.50 (log of minimal angle of resolution [logMAR]) or more. At 6 months after CXL, only Kmax decreased significantly from baseline, with no change in visual acuity or manifest refraction. After phacoemulsification with toric IOL implantation, sphere changed from -5.74±1.88 D preoperatively to 0.33±0.72 D 12 months postoperatively (P<0.001), and cylinder changed from -4.53±0.98 to -1.10±0.76 D (P<0.001). There was significant improvement in mean uncorrected distance visual acuity from logMAR 1.43±0.51 preoperatively to 0.30±0.09 postoperatively (P<0.001) and the mean corrected distance visual acuity (CDVA) from 0.34±0.12 preoperatively to 0.24±0.13 (P=0.03) 1 year after IOL implantation. All patients were satisfied with their visual improvement.
  
  
  CONCLUSIONS
  This two-stage approach in selected cases of progressive KC is a safe and effective procedure regarding keratometric stability, and visual and refractive results.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Waleed Ali
authors.initials: WA
authors.lastname: Abou Samra
authors.forename: Eman Azmy
authors.initials: EA
authors.lastname: Awad
authors.forename: Amr Hassan
authors.initials: AH
authors.lastname: El Kannishy
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007908:Lens, Crystalline / Q000601:surgery*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D014792:Visual Acuity
chemical_list: D003432:Cross-Linking Reagents; D003094:Collagen