Four-Stage Procedure for Keratoconus: ICRS Implantation, Corneal Cross-linking, Toric Phakic Intraocular Lens Implantation, and Topography-Guided Photorefractive Keratectomy.

Abstract

PURPOSE:

To evaluate a four-stage combined treatment for keratoconus including intrastromal corneal ring segment (ICRS) implantation followed by corneal cross-linking (CXL), toric phakic intraocular lens (IOL) implantation, and topography-guided photorefractive keratectomy (TG-PRK).

METHODS:

In this retrospective interventional case series, 11 eyes of 7 patients with progressive keratoconus were treated with a four-stage procedure including the following: Keraring ICRS (Mediphacos Ltda, Belo Horizonte, Brazil) implantation followed by CXL, phakic IOL implantation, and TG-PRK (minimum 6 months between each stage). Minimum follow-up was 12 months after TG-PRK.

RESULTS:

Both mean uncorrected distance visual acuity and corrected distance visual acuity (CDVA) improved from 0.025 decimal (20/800 Snellen) and 0.093 decimal (20/215 Snellen) preoperatively to 0.68 decimal (20/30 Snellen) and 0.73 decimal (20/27 Snellen), respectively, after the combined treatment (P < .0001). Mean postoperative CDVA of 0.73 decimal (20/27 Snellen) was similar to preoperative contact lens CDVA of 0.72 decimal (20/28 Snellen). Mean manifest refraction spherical equivalent reduced from 16.78 ± 3.58 to 0.59 ± 0.89 diopters (P < .0001) and mean refractive astigmatism reduced from 5.16 ± 1.86 to 0.82 ± 0.28 diopters (P < .0001).

CONCLUSIONS:

This four-stage procedure appears to be an effective and safe approach for corneal stabilization and improvement of functional vision in patients with keratoconus. Larger case series with a longer follow-up are required to thoroughly evaluate the efficacy, safety, and stability of this combined approach. [J Refract Surg. 2017;33(10):683-689.].

• Authors: Efekan Coskunseven, Daya Papalkar Sharma, Michael A Grentzelos, Onurcan Sahin, George D Kymionis, Ioannis Pallikaris
• Journal: Journal of refractive surgery (Thorofare, N.J. : 1995) (J Refract Surg) Vol. 33 Issue 10 Pg. 683-689 (Oct 01 2017) ISSN: 1938-2391 [Electronic] United States
• PMID: 28991336 (Publication Type: Journal Article)
• Copyright: Copyright 2017, SLACK Incorporated.

Chemical References

• Cross-Linking Reagents
• Photosensitizing Agents
• Collagen
• Riboflavin

Topics

• Adult
• Collagen (therapeutic use)
• Corneal Topography
• Cross-Linking Reagents (therapeutic use)
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Keratoconus (diagnosis, physiopathology, therapy)
• Lasers, Excimer (therapeutic use)
• Male
• Phakic Intraocular Lenses
• Photorefractive Keratectomy (methods)
• Photosensitizing Agents (therapeutic use)
• Prosthesis Design
• Refraction, Ocular
• Retrospective Studies
• Riboflavin (therapeutic use)
• Time Factors
• Treatment Outcome
• Ultraviolet Rays
• Visual Acuity
• Young Adult