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First Author: S.Yukawa JAPAN
Co Author(s): M. Mita A. Ando Y. Yamamoto M. Tomita
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Recently, Collagen Crosslinking (CXL) has gained recognition as a method to treat keratoconus and keratoectasia. Accelerated CXL is the latest version and provides significant time saving benefits to both patients and surgeons. When this halts the progression of the condition or an improvement in the topography is observed, Phakic Intraoculer Lens (PIOL) implantation can be performed. Herein we report the clinical results of PIOL implantation after Accelerated CXL.
Shinagawa LASIK Center, Tokyo, Japan
A prospective, IRB approved evaluation of Accelerated CXL was performed. 10 eyes of 7 keratoconus/ keratoectasia patients had Accelerated CXL then PIOL implantation. Accelerated CXL was performed as follows; after soaking the eyes in a 20% alcohol solution for 30 seconds, the corneal epithelium was removed and an 8 minute riboflavin pre-soak was applied to the corneal bed followed by 3 minutes of ultraviolet A light (30mW/cm2). Waiting at least 6 months after the Accelerated CXL was performed and only when the stabilization of the corneal curvature was confirmed, PIOL implantation (foldable anterior iris-claw PIOL or implantable collarmer lens) was performed. The visual acuity and manifest refractions before and after each treatment were evaluated.
The PIOL implantation after Accelerated CXL greatly improved the visual acuity and refraction. Before PIOL implantation, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 1.10 LogMAR and -0.14 LogMAR respectively. Three months after PIOL, they improved to -0.12 LogMAR and -0.19 LogMAR, respectively. The manifest refraction spherical equivalent (MRSE) was -6.26 ±3.90 D before PIOL implantation. Three months after PIOL, it improved to -0.04 ±0.25 D.
The three month results of PIOL after Accelerated CXL show that this combination is an effective treatment for this subset of eyes with keratoconus/keratoectasia. Good results in terms of visual acuity and postoperative refraction were observed. Long term follow-up is necessary to confirm this conclusion.