Cross-linking plus phakic IOL

Correcting refractive errors with phakic IOLs in cases of progressive keratoconus has hitherto not been considered a good idea because the refractive correction and uncorrected distance visual acuity achieved would not be maintained over the long term. However, with the advent of corneal collagen cross-linking for the treatment of keratoconus, researchers are reconsidering this dogma. Guell and colleagues report medium-term outcomes in 17 eyes of nine keratoconus patients who underwent cross-linking, and then, once the cornea stabilised, also underwent toric Artiflex/Artisan phakic IOL implantation for cataract. With a  median follow-up of three years, 14 eyes (82 per cent) were within ±0.50 D of the attempted SE correction and 13 eyes (76 per cent) were within ±1.00 D of the attempted cylinder correction. The mean difference in simulated keratometry between preoperatively and the last follow-up was 0.17 ± 0.45 D (range -0.55 to 1.45 D). The postoperative UDVA was 20/40 or better in 16 eyes (94 per cent). No eye lost lines of CDVA. No significant decrease in central endothelial cell count occurred (P>.05). The researchers believe this combination approach can effectively and safely correct myopic astigmatism in selected patients with progressive mild to moderate keratoconus.

JL Güell, et al., JCRS, “Collagen crosslinking and toric iris-claw phakic intraocular lens for myopic astigmatism in progressive mild to moderate keratoconusâ€, Volume 38, Issue 3, 475-484.