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Corneal stromal augmentation followed by toric phakic intraocular lens implantation in advanced non-scarred keratoconic eyes: a conceptual analysis

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Session Details

Session Title: Presented Poster Session: Refractive Surgery New Techniques/Instrumentation/Devices II

Venue: Poster Village: Pod 2

First Author: : L.Daniel Raj Ponniah INDIA

Co Author(s): :    H. Anandan   M. Ali                    

Abstract Details


To analyze the effectiveness of implantation of Toric phakic IOL (PIOL) as an Add-on refractive measure to corneal stromal augmentation technique (CSA ) in the management of advanced non-scarred keratoconic eyes.


A prospective exploratory clinical trial at Department of Corneal Transplantation, Dr. Agarwal’s Eye Hospital, Tirunelveli, S.INDIA


In phase1, non-scarred keratoconus contraindicated for cross-linking were included. Femto assisted donor stromal lenticule (180 -220 microns thick, 7.5-8.5 mm in diameter) was fashioned, and a mid-stromal bed was created with 2 incisions 180 degrees apart in recipient cornea again using femto lasers, into which donor lenticule was transplanted for stromal augmentation. The difference in pre and post-operative vision, pachymetry, anterior and posterior corneal elevation(mm), reversal of irregular astigmatism were analyzed at 1 year. In phase2, subjects with high residual refractory errors underwent an Add-on toric phakic IOL implantation and outcomes measured at 3 months.


In phase1, 15 underwent CSA. UCVA improved from 1.2+/-0.2 to 0.8+/- 0.2 (p=0.003), BCVA from 0.9 +/-0.2 to 0.4 +/-0.1 (p<0.0001).Pachymetry restored from 359 +/-49 to 583+/-53. Cornea flattened significantly (Anterior improved from 0.067 to 0.044 and Posterior from 0.075 to 0.039). Astigmatism reduced from 9.2+/-4.3D to 4.3 +/-1.7. Post CSA inferior to superior assymetry was 3.2+/-1.4D In phase2 (n=8), Residual spherical error was -3.87+/-2.21 and cylinder was -4.18+/-0.84. UCVA improved from 1.0 +/-0.11 to 0.4+/- 0.14 (p<0.0001), BCVA from 0.63 +/-0.15 to 0.25 +/-0.05 (p<0.0001) at 1 month and 0.22 +/-0.04 at 3 months.


Corneal Stromal Augmentation Technique is effective in terms of improvement in vision, flattening of the cornea, increase in central/paracentral pachymetry (reversal of ectasias), and improvement in irregular astigmatism without sacrifice of recipient tissue and suture-related events. Add-on Toric phakic IOL implantation is found to be effective in overcoming residual high refractive errors post corneal stromal augmentation and provides a comprehensive refractive solution.

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