Intracorneal ring segments and phakic intraocular lens.

To the Editor: We read with interest the article by Cakir and Utine1 regarding the results of combined intracorneal ring (KeraRing; Mediphacos Ltd, Belo Horizonte, Brazil) and anterior chamber, iris-fi xated, phakic intraocular lens (IOL) (Artisan/Artifl ex; Ophtec BV, Groningen, The Netherlands) implantation in patients with keratectasia, which appeared in the February 2011 issue of the Journal of Refractive Surgery, and would like to comment that the results and the conclusions coincide with those presented by Navas.2 In their work, Navas et al conducted a similar evaluation on seven eyes of six patients with keratoconus who underwent sequential intracorneal ring: six eyes received Intacs (Addition Technology Inc, Des Plaines, Illinois) and one eye corneal rings (Visiontech Medical Optics Ltd, Belo Horizonte, Brazil), and posterior chamber Implantable Collamer Lens (Visian ICL; STAAR Surgical, Monrovia, California). Four eyes were implanted with the toric ICL and three eyes with the spherical ICL (Fig). In our study, mean uncorrected distance visual acuity (UDVA) improved from 0.05 0.03 preoperatively to 0.57 0.13 after both procedures (P=.0001 for all). Mean manifest refraction spherical equivalent (MRSE) decreased from 11.03 4.80 diopters (D) preoperatively to 0.46 0.52 D after both procedures (P=.0003). All patients had a noticeable subjective improvement. Similar results were reported by Cakir and Utine,1 who found visual and refractive improvements after both procedures. We noticed a slightly better postoperative mean UDVA. However, Cakir and Utine reported a better postoperative MRSE with a high standard deviation. We used 6.0-mm optic diameter intrastromal rings in six cases and 5.0-mm in one case, without any difference in the fi nal outcome. Other authors have reported good results with combined intracorneal ring segments