AimsTo report on 4-year postoperative visual performance with the toric implantable collamer lens (TICL) for stable keratoconus after sequential procedure (corneal collagen crosslinking plus TICL implantation).MethodsForty eyes of 24 patients with stable keratoconus with myopia between 0.00 and −18.00 dioptres (D) and astigmatism between 1.25 and 8.00 D were evaluated in this prospective interventional study (https://clinicaltrials.gov/ct2/show/NCT02833649). We evaluated refraction, visual outcomes, astigmatic changes analysed by Alpins vector, contrast sensitivity, aberrometry, modulation transfer functions (MTFs), defocus curve, and operative and postoperative complications.ResultsAt 4-year follow-up, 45% had 20/20 vision or better and 100% had 20/40 or better uncorrected visual acuity (UCVA). Vector analysis of refractive astigmatism shows that the surgically induced astigmatism (SIA) (3.20±1.46 D) was not significantly different from the target induced astigmatism (TIA) (3.14±1.42 D) (p=0.620). At 4 years postoperatively, none of the eyes showed a decrease in UCVA, in contrast to 24 eyes in which UCVA was increased by ≥1 lines, with contrast sensitivity and improvement in total aberrations and MTF value at 5 per degree (*p=0.004) after TICL implantation. The cumulative 4-year corneal endothelial cell loss was ≤5%. No patients reported dissatisfaction. At the end of follow-up, the vault was 658±54.33m (range, 500–711) and the intraocular pressure was 11.7±2.08 mm Hg. Occurrences of glare and night-driving troubles diminished after TICL surgery.ConclusionThe results from this standardised clinical investigation support TICL implantation from clinical and optical viewpoints in patients with stable keratoconus.Trial registration numberNCT02833649, Pre-results
Purpose: To evaluate probable complications of ArtificialIris implantation with iris-fixated intraocular lens. Method: Development of photophobia, glare, and psychological strain during face-to-face communication in a 23-year-old man with a widespread traumatic iris defect terminate to make a decision for performing implantation an ArtificialIris (HumanOptics, Erlangen, Germany) under the remnant iris without removing the patient’s existing Artisan lens. Results: Without any intraoperative or postoperative complications, the patient’s visual acuity increased by one line, the endothelial cell loss was comparable with the cell loss associated with standard cataract surgery, and the anterior chamber depth and anterior chamber anatomy did not change. At the final follow-up examination, the mean intraocular pressure (IOP) did not differ from baseline, and we achieved high level of patient satisfaction and subjective vision improvement. We discuss the particular importance of considering the patient’s expectations, the appropriate measurements, ways to perfect color evaluation, and the types of ArtificialIris products. Conclusion: The implantation of the ArtificialIris in patients with aphakic iris-supported lenses (i.e., preexisting Artisan lenses) is a feasible approach and a useful option for patients with thin irises and iris hypoplasia who are at risk of subluxation or the dislocation of the PCIOL as well as those with sclerally fixed PCIOLs.
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