PHAKICIOL IMPLANTATION(ICL) TO TREAT AMETROPIA IN EYES WITH STABILIZED KERATOCONUS(KCN),PREVIOUSLY TREATED WITH THE ATHENSPROTOCOLCXL(APCXL)

To evaluate the safety and efficacy of refractive correction with ICL implantation in eyes which have undergone Athens protocol CXL for KCN.

An observational Consecutive Case Series; 15 eyes previously treated with AP CXL for KCN were treated with ICL implantation for refractive error correction, as the residual stromal thickness was prohibitive of a cornea laser ablation. In all cases a toric phakic IOL (EVO Plus ICL, STAAR, Nidau, Switzerland) was used. UDVA, CDVA, refraction and ICL position as measured by anterior segment OCT and ICL placement were evaluated up to the 6 month follow-up. Most challenging aspect was the manifest refraction to use for ICL calculation

In all cases an ICL was uneventfully implanted and achieved good clinical position. When comparing pre-ICL to 6 month post: UDVA changed from 20/80 to 20/30, CDVA changed from 20/40 to 20/25, the refractive error in spherical equivalent from -4.5 D (range -2.5 D to -18 D) to -0.75 D (+0.50 to -1.75), refractive cylinder from -2.75 D (range -1 to - 4.25 D). All cases demonstrated effective anisometropia management and gain of at least 1 (up to 4) lines of vision (comparing pre-ICL CDVA to post ICL UDVA) Only challenge was the subjective manifest refraction, ray tracing calculation with the Alcon/Wavelight Sightmap

diagnostic was helpful

We report safe and efficient outcomes when using phakic IOL off-label (ICL-Staar) to address significant ametropia in keratoconic eyes previously treated with Athens Protocol CXL. May offer a safe and effective alternative for anisometropia in contact lens-intolerant patients