Posterior Chamber Phakic Intraocular Lenses for Correcting Ametropia in Stable Keratoconus.

Abstract

Introduction: The use of posterior chamber phakic intraocular lenses (PCPIOLs) is a reasonable option in the armamentarium to treat refractive error in patients with keratoconus. We present our experience with the use of PCPIOL for the management of ametropia in patients with keratoconus.

Methods: Patients included those with stable keratoconus treated in the Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK, with PCPIOL (ICL Staar Surgical and IPCL Care Group) to improve their visual acuity. Data were obtained from preoperative visit and 1, 3, 6, and 12 months after surgery. Clinical characteristics, pre- and postoperative uncorrected (UDVA) and best corrected (CDVA) logMAR visual acuities, and perioperative complications were analysed.

Results: A total of 23 eyes of 21 patients were included. UDVA changed from 0.75 preoperatively to 0.18 post-surgery (p = <0.001) and CDVA from 0.07 to 0.12 (p = 0.12). Seventy percent of the cases increased 3 or more lines of UDVA while none of the eyes lost more than 2 lines of CDVA. No significant difference in final UDVA was found between patients with and without previous keratoplasty (0.27 and 0.18, p = 0.38), previous corneal collagen crosslinking (0.16 and 0.3, p = 0.24), intracorneal ring segments (0.2 and 0.2, p = 0.94), or type of lens implanted (0.2 implantable collamer lens and implantable phakic contact lens. p = 0.94). One intraoperative complication reported was an inverted PCPIOL insertion and postoperatively 4 axis rotations and 1 cataract were observed.

Conclusions: The use of PCPIOL in patients with stable keratoconus is effective in improving their UDVA, even in cases with previous corneal procedures such as keratoplasty, crosslinking, and intracorneal rings. Rotation is the most common postoperative complication.