Visian toric ICL implantation for residual refractive errors after ICRS implantation and corneal collagen cross-linking in keratoconus.
نویسندگان
چکیده
To the Editor: Some patients with keratoconus have poor corrected distance visual acuity (CDVA) associated with high refractive errors. According to our treatment protocol,1 the best approach for these cases is intracorneal ring segments (ICRS) implantation (usually one segment) to improve CDVA followed by corneal collagen cross-linking (CXL) treatment 4 weeks later to stabilize the cornea and phakic toric implantable collamer lens (TICL) (Visian Toric V4b ICL; STAAR Surgical, Monrovia, CA) implantation 4 to 6 months after CXL to correct the residual refractive errors. We conducted a retrospective analysis of 11 eyes of 7 patients with moderate to severe keratoconus (according to the Amsler–Krumeich classifi cation2, 4 eyes had stage II keratoconus and 7 eyes had stage III) and poor CDVA who underwent three-step ICRS implantationCXL-TICL implantation procedures at our eye hospital. The two procedures (ICRS implantation-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 implantation-CXL, and at the 6-month follow-up visit after TICL implantation. Mean age was 29.20 years (range: 22 to 46 years). Uncorrected distance visual acuity (UDVA) showed signifi cant improvement after three sequential procedures (mean UDVA improved from 1.47 ± 0.38 logMAR at baseline to 1.13 ± 0.50 logMAR after ICRS implantation-CXL procedures and to 0.27 ± 0.20 logMAR after ICL implantation). Overall, 63.7% of eyes (7 of 11) had UDVA greater than 20/40 by 6 months after ICL insertion. CDVA also showed signifi cant change 6 months after ICRS implantation-CXL (CDVA improved from 0.50 ± 0.22 logMAR at baseline to 0.29 ± 0.23 logMAR 6 months after ICRS implantation-CXL). However, CDVA did not show any signifi cant improvement after ICL insertion (0.19 ± 0.11 logMAR). Refraction signifi cantly improved after the three procedures. The spherical equivalent changed signifi cantly from -9.70 ± 3.1 diopters (D) at baseline to -7.65 ± 3.23 D 6 months after ICRS implantation-CXL and to -0.58 ± 1.01 D 6 months after TICL implantation. The cylindrical component also changed signifi cantly from 3.81 ± 1.15 D at baseline to 1.84 ± 0.35 D 6 months after ICL insertion. However, no signifi cant change was noted in cylindrical component 6 months after ICRS implantation-CXL (3.81 ± 1.15 D at baseline vs 4.06 ± 1.58 D 6 months after ICRS implantation-CXL). Keratometric readings (central corneal power obtained by topography) decreased after ICRS implantation-CXL: mean K (fl at) decreased from 48.51 ± 4.26 D at baseline to 45.19 ± 3.98 D 6 months after ICRS implantationCXL and mean K (steep) decreased from 54.24 ± 4.96 D at baseline to 50.41 ± 4.32 D 6 months after ICRS implantation-CXL. Mean K (max) decreased from 57.41 ± 6.32 D at baseline to 54.01 ± 4.75 D 6 months after ICRS implantation-CXL. In this retrospective study, all patients had poor CDVA and ICRS insertion (performed using femtosecond laser to create the tunnel) was effective in decreasing corneal distortion and improving CDVA; CXL treatment after ICRS insertion and before ICL implantation has the advantage of stabilizing the corneal topographic properties and providing greater stability of refraction without compromising safety and effi cacy of TICL implantation that decreased signifi cantly the refractive errors and improved signifi cantly the UDVA. No complications occurred during surgery or over the entire follow-up (6 months after the third procedure). Our results indicate that this three-step procedure is safe, effective, and predictable in the treatment of selected cases of keratoconus with poor CDVA and high refractive errors. However, a larger number of patients and a longer follow-up period are needed to further assess the safety and effi cacy of phakic TICLs in the management of keratoconus with high refractive errors and poor CDVA.
منابع مشابه
Safety and visual outcome of Visian toric ICL implantation after corneal collagen cross-linking in keratoconus.
PURPOSE To evaluate the safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. METHODS A retrospective study examined the results of the two-step CXL and Visian toric ICL implantation in 16 eyes of 10 patients with keratoconus. The two procedures were don...
متن کاملSafety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up
Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months. Results. At bas...
متن کاملCollagen 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.
PURPOSE 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. SETTING Large private ophthalmic hospital system. DESIGN Case series. METHODS Eyes with progres...
متن کاملIntrastromal Corneal Ring Segment and intraocular lens implantation in patients with keratoconus and cataract
METHODS: is study comprised patients with keratoconus and cataract who had ICRS implantation , followed 6 months later by IOL implantation with corneal relaxing incisions. e uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors, analyzed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, and 6 months after IOL implant...
متن کاملIntrastromal corneal ring segments and posterior chamber phakic intraocular lens implantation for keratoconus correction.
PURPOSE To evaluate the efficacy, safety, and predictability of sequential implantation of Keraring intrastromal corneal ring segments (ICRS) and an Implantable Collamer Lens phakic intraocular lens (pIOL) with corneal relaxing incisions for refractive correction of keratoconus. SETTING Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN Cohort study. METHODS This study compr...
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ورودعنوان ژورنال:
- Journal of refractive surgery
دوره 29 7 شماره
صفحات -
تاریخ انتشار 2013