Visual and Refractive Outcomes of Toric Implantable Collamer Lens Implantation in Stable Keratoconus After Combined Topography-Guided PRK and CXL

PURPOSE: To evaluate the safety and efficacy of toric implantable Collamer lens (ICL) (STAAR Surgical) implanted at least 6 months after combined topography-guided photorefractive keratotomy (TG-PRK) and corneal cross-linking (CXL) in keratoconus. METHODS: This retrospective study included 46 eyes with keratoconus of 31 patients who underwent toric ICL implantation after previous TG-PRK+CXL. Patients were examined for uncorrected (UDVA) and corrected (CDVA) distance visual acuity, flat and steep keratometry, and manifest refraction spherical equivalent preoperatively and 12 months postoperatively. RESULTS: At 12 months postoperatively, there was a statistically significant improvement in visual and refractive outcomes (all P < .001). Mean UDVA improved to 0.17 +/- 0.14 logMAR (vs 1.00 +/- 0.38 logMAR preoperatively) and mean manifest refraction spherical equivalent improved to-0.32 +/- 1.42 diopters (D) (vs-7.35 +/- 5.20 D preoperatively). At 12 months, 63% of eyes achieved UDVA of 20/32 or better and 60.9% of eyes were within +/- 0.50 D of manifest refraction spherical equivalent. Mean refractive astigmatism improved from-2.90 +/- 2.21 D preoperatively to-1.47 +/- 1.46 D at postoperative 12 months (P < .001), with 30.4% and 45.7% of eyes having a postoperative astigmatic error within +/- 0.50 and +/- 1.00 D, respectively. No complications were observed. CONCLUSIONS: Toric ICL implantation was found to be safe and effective for the correction of myopia and myopic astigmatism in patients with stable keratoconus who had undergone TG-PRK+CXL, as revealed by the statistically significant improvement in visual and refractive outcomes at 12 months after toric ICL implantation. [J Refract Surg. 2021;37(12):824-829.]

Automated summary

The study demonstrated that toric implantable Collamer lens implantation in patients with keratoconus resulted in significant improvement in visual and refractive outcomes at 12 months postoperatively, indicating a safe and effective correction for myopia and myopic astigmatism.