Clear Lensectomy With Toric Iol Implantation After Corneal Collagen Cross-Linking In Selected Cases Of Progressive Keratoconus

To evaluate the visual and topographic outcomes of a two-stage approach treatment for selected cases of progressive keratoconus (KC); Corneal Collagen Cross-Linking (CXL) followed by phacoemulsification with toric IOL implantation 

All studied eyes underwent a 2-stage approach treatment: first corneal collagen cross-linking (CXL) followed after at least 6 months by phacoemulsification with foldable toric intraocular lens (IOL) implantation in both eyes of 3 patients and only one eye of the other 3 patients. A complete ophthalmological examination was performed preoperatively and postoperatively. Topographical and visual outcome were evaluated during one-year follow up period.

At baseline, sphere ranged from -3.00 to -8.00 diopter and cylinder from -3.50 to -5.50 diopter. All eyes could be corrected to 6/18 or more. At 6 months after CXL, steep K and K max decreased significantly from baseline, with no change in visual acuity or refraction. After phacoemulsification with toric IOL implantation, sphere changed from -5.74 ± 1.88D preoperatively to 0.33 ± 0.72D postoperatively (p<0.001), and cylinder changed from -4.53 ± 0.98 D to -1.10 ± 0.76 D (p<0.01). There was significant improvement in mean uncorrected and corrected distance visual acuity. All patients were satisfied with the visual improvement.

This 2-stage approach in selected cases of progressive keratoconus is safe and effective procedure regarding keratometric stability, visual and refractive results.