ESCRS - PP05.15 - Efficacy And Safety Of Combined Topography-Guided Photorefractive Keratectomy And Phakic Intraocular Lens After Corneal Transplantation For Keratoconus

Efficacy And Safety Of Combined Topography-Guided Photorefractive Keratectomy And Phakic Intraocular Lens After Corneal Transplantation For Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: PP05.15 | Type: Free paper | DOI: 10.82333/tpax-3n05

Authors: João Romano* 1 , Miguel Mesquita Neves 2 , Miguel Gomes 2 , Luís Oliveira 2

1Ophthalmology,Centro Hospitalar de Leiria,Leiria,Portugal, 2Ophthalmology,Centro Hospitalar e Universitário do Porto,Porto,Portugal

Purpose

To report the efficacy and safety of phakic intraocular lens (iol) implantation after topography-guided photorefractive keratectomy (TG-PRK) to treat topographic irregularities as well as to reduce higher order aberrations, irregular astigmatism and refractive errors after corneal transplantation for keratoconus.

Setting

Retrospective single center real-world analysis conducted at the Ophthalmology Department of Hospital de Santo António – Centro Hospitalar e Universitário do Porto, Portugal.

Methods

Retrospective observational case series of 7 eyes of 7 patients with irregular astigmatism after penetrating keratoplasty (PK) or Deep Anterior Lamellar Keratoplasty (DALK) treated with TG-PRK and phakic iol implantation. Uncorrected and best corrected visual acuity, manifest refraction, topographic profiles, higher order aberrations and corneal endothelial cell count were analysed.

Results

The best corrected visual acuity improved from 0.4 ± 0.22 logMAR to 0.15 ± 0.15 logMAR (p<0.05). The final uncorrected visual acuity was 0.28 ± 0.17 logMAR. Mean cylindrical error decreased from 6.43 ± 4.12 D to 1.8 ± 1.52 D (p<0.05) and the mean spherical equivalent decreased from 6.36 ± 3.48 D to 0.8 ± 0.99 D (p= 0.068). There was a significant reduction of corneal higher-order aberrations (HOA), with root mean square (RMS) reducing from 4.82 ± 1.79 to 3.04 ± 1.04 (p<0.05) after the TG-PRK. There were no significant changes in endothelial cell count during study follow-up. No complications were reported.

Conclusions

Combination of TG-PRK and phakic iol implantation in patients with highly irregular topographies after corneal transplant for keratoconus seems to be a safe and effective approach. The topography-guided customized ablation treatment had been planned to correct the topographic irregularities, irregular astigmatism and higher order aberrations and the phakic iol to reduce the resulting refractive error.