Visual And Refractive Outcomes Of Phakic Intraocular Lenses In Eyes With Stable Mild-To-Moderate Keratoconus

Optimizing vision in patients with keratoconus remains a considerable challenge. Though many patients with mild-moderate disease achieve functional vision in rigid gas permeable or scleral contact lenses, these carry risks of iatrogenic injury and require strict patient compliance. The advent of newer generation phakic posterior chamber implantable collamer lenses (ICLs) offers a new avenue for visual rehabilitation in patients with stable keratoconus. The purpose of this study is to examine the safety and efficacy of ICLs in patients with stable mild-moderate keratoconus.

Retrospective cohort study.

We conducted a retrospective review of patients with mild-moderate keratoconus who underwent implantation of an ICL. Patients were eligible if they had a minimum corrected distance visual acuity (CDVA) of 0.30 logMAR or better and a clearly identifiable cylinder axis on refraction in the setting of stable mild-moderate keratoconus. All patients underwent placement of a toric implantable collamer lens (STAAR Surgical). Our primary outcome was the uncorrected distance visual acuity (UDVA). We also evaluated pre- and post-operative CDVA, spherical equivalent (SE), and refractive cylinder, as well as the incidence of significant complications. Analyses were summarized by calculating means with associated standard deviations and t-testing.

12 eyes were eligible for inclusion. UDVA decreased significantly from 1.19 (0.55) logMAR preoperatively to 0.24 (0.29) logMAR postoperatively (p<0.05). CDVA was also noted to improve after ICL placement from 0.08 (0.11) logMAR preoperatively to 0.05 (0.18) logMAR, though this was not statistically significant (p=0.34). SE decreased significantly from -6.68 (4.37) diopters (D) to 0.80 (1.15) D (p<0.05), as did refractive cylinder, from 2.60 (2.23) D to 1.23 (1.08) D following placement of an ICL (p<0.05). No significant complications occurred in any patients.

ICLs offer a safe, effective, and accessible option for visual rehabilitation in patients with stable mild-moderate keratoconus.