Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up

Abstract

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 baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, only K (steep) and K (max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, P < 0.001) and mean corrected distance visual acuity (0.17 ± 0.08 to 0.11 ± 0.05 logMAR, P < 0.001) at 12 months after ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes. Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years.

Long‐term outcomes of posterior chamber phakic intraocular lens implantation in keratoconus

“…Antonios et al evaluated the long‐term safety and clinical outcomes of phakic Visian toric ICL insertion after corneal collagen cross‐linking in progressive keratoconus in 30 eyes. They found significant improvement in mean UDVA (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, p < 0.001) and mean corrected distance VA (0.17 ± 0.08 to 0.11 ± 0.05 logMAR, p < 0.001) at 12 months that was maintained at the two‐year follow‐up.…”

Combining corneal crosslinking and phakic toric Implantable Collamer Lenses for the treatment of keratectasia: A case report

“…In a previous study, Antonios et al (20) implanted ICL after CXL in a patient with keratoconus. Spherical and cylinder powers were demonstrated to be -9.55±4.67 and 2.38±1.29 D, respectively, 6-month after CXL, and decreased to −1.63±0.95 and 1.05±0.55 D 24-month following ICL implantation.…”

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

“…The authors concluded that this combined procedure in a 2-step procedure seemed to be an effective method for correcting keratoconus in patients with high myopia and astigmatism. Favourable outcomes have since been reported in keratoconic patients who underwent this combined procedure (corneal CXL and PC pIOL implantation) [ 37 , 120 – 122 ], with all studies reporting that PC pIOLs or toric PC pIOLs were a predictable, safe, and effective way to correct refractive error in patients with keratoconus following corneal CXL. Fadlallah et al [ 120 ] evaluated the safety and clinical outcomes of toric PC pIOL implantation 6 months after corneal CXL in 16 eyes of 10 patients.…”