Outcomes of Toric Iris-Claw Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty for Keratoconus

PURPOSE: To assess visual and refractive outcomes of toric iris-claw phakic intraocular lens (IOL) implantation in patients who had previously undergone deep anterior lamellar keratoplasty (DALK). METHODS: Retrospective case series including 24 eyes of 24 patients implanted with toric Artiflex or Artisan (Ophtec BV, Groningen, Holland) phakic IOL following DALK for keratoconus. During a 12-month follow-up, the main outcome measures were uncorrected and corrected distance visual acuities (UDVA and CDVA), refractive error components, topographic parameters, and endothelial cell count. Alpins vectorial analysis was performed. RESULTS: At the last follow-up, the spherical equivalent (SE) was within +/- 0.50 diopters (D) in 71% of eyes and within +/- 1.00 D in 92% of eyes. Mean refractive astigmatism was reduced from -4.92 +/- 1.55 D (range: -2.50 to -8.00 D) preoperatively to -0.66 +/- 0.61 D (range: -2.00 to 0.00 D) after treatment, and 76.5% of cases were within +/- 1.00 D. No significant differences (P =.123) were detected in spherical equivalent values between 3-and 12-month follow-up visits. No eyes lost lines in CDVA, and 54% of eyes gained one or more lines. Postoperative UDVA was 20/40 or better in 88% of eyes. Efficacy and safety indexes at 12 months were 0.93 and 1.00, respectively. Mean endothelial cell loss was 6.10% at 12 months postoperatively. No intraoperative or postoperative complications were noted over the follow-up period. CONCLUSIONS: The implantation of a toric iris-claw phakic IOL has shown high efficacy and safety in this series and may be considered as a reasonable option for the management of refractive errors after DALK.