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Visian Toric ICL implantation for residual refractive errors after intracorneal ring segment implantation and corneal collagen cross-linking in keratoconus

Session Details

Session Title: Phakic IOLs and keratoconus or high astigmatism

Session Date/Time: Sunday 06/10/2013 | 17:00-18:30

Paper Time: 18:08

Venue: Elicium 1 (First Floor)

First Author: : E.Jarade LEBANON

Co Author(s): :    A. Fadlallah   A. Dirani   Z. Khoueir   J. Antoun   G. Cherfan  

Abstract Details


To evaluate the safety and clinical outcome of Visian Toric ICL Implantation for the treatment of residual refractive errors 6 months after sequential Intracorneal Ring segments (ICRS) and corneal collagen UVA cross-linking (CXL) in stable keratoconus


University Hospital, Beirut Eye Specialist Hospital, Beirut, Lebanon.


A retrospective study examined the results of a 3-step ICRS-CXL-TICL in 11 eyes of 7 patients with moderate to severe keratoconus. The two procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and TICL implantation was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after TICL implantation


ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 45.19± 3.98 D vs. 48.51±4.26 D preoperatively (p=0.022) and mean Ksteep was 50.41± 4.32 D vs. 54.24±4.96 D preoperatively (p=0.032). Uncorrected distance visual acuity (UCVA) significantly improved from 1.47±0.38 logMAR before ICRS-CXL to 0.27±0.20 logMAR 6 months after (p = 0.002). Corrected distance visual acuity (CDVA) significantly improved from 0.50±0.22 logMAR to 0.29±0.23 logMAR (p=0.001). The mean spherical error decreased from -11.61±3.33 D -9.68± 4.19 D (p=0.032), and the mean cylinder from 3.81±1.15 D to 4.06± 1.58 D (p=0.684). At 6-month post TICL implantation, UCVA improved significantly to 0.27±0.20 logMAR and the CDVA was 0.19±0.11 logMAR. The mean spherical error decreased significantly to -1.50± 1.06 D (p=0.001), and the mean cylinder decreased significantly to 1.84± 0.35 D (p=0.002). The safety and efficacy indices of TICL after ICRS-CXL were 1.33±0.59 and 1.06±0.23 respectively. No intraoperative or postoperative complications occurred


TICL implantation after sequential Intracorneal Ring Segments and corneal collagen cross-linking is an effective and safe option for correcting high residual refractive error and improving visual acuity in patients with moderate to severe keratoconus

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