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Phakic intraocular lens implantation after intracorneal ring segment: combined treatment for keratoconus

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Session Details

Session Title: Presented Poster Session: Intraocular Refractive Results

Venue: Poster Village: Pod 2

First Author: : T.Fernandes PORTUGAL

Co Author(s): :    T. Monteiro   F. Faria Correia   N. Franqueira   F. Vaz     

Abstract Details


To evaluate the efficacy and safety of sequential phakic intraocular lens (IOL) surgery after implantation of intracorneal ring segments (ICRS) in eyes with keratoconus.


Department of Ophthalmology, Hospital de Braga, Portugal


A retrospective study was conducted in 25 eyes of 25 patients with keratoconus with spherical ametropia after implantation of Ferrara-ICRS for irregular astigmatism. The phakic IOL implantation was performed at least 6 months after ICRS surgery; two types of IOLs were used: implantable collamer posterior chamber IOL (ICL, V4C STAAR Surgical, Monrovia, CA, USA) and anterior chamber iris-claw IOL Artisan® and Artiflex® (Ophtec, Groningen, Netherlands). Preoperatively and follow-up parameters analyzed: best-corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA); refractive sphere and cylinder; topography (k1, k2, kmax) and corneal endothelial cells count (CECC).


18 V4C ICL, 6 Artiflex and 1 Artisan IOL were implanted. Mean UCVA was 0.09±0.06 before ICRS implantation; 0.16±0.12 after ICRS implantation; and 0.56±0.25 after phakic IOL, with significant improvement after all procedures (p<0.01). Mean BCVA was 0.39±0.28 before ICRS implantation; 0.56±0.24 after ICRS implantation; and 0.69±0.25 after phakic IOL surgery; with significant improvement after all procedures (p<0.05). Spherical equivalent changed from -8,87D±4.82 to -0.49D±1.17 after phakic IOL surgery (p<0.01). No eye lost 2 or more lines of BCVA; 44% of eyes gained 2 or more lines of BCVA.


The sequential phakic IOL implant after ICRS implantation in patients with keratoconus with residual ametropia is a safe and effective procedure, with significant improvement in UCVA and BCVA. Refractive predictability is lower than the one observed if phakic IOL implantation as a primary procedure in non-keratoconus patients.

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