Objective and Subjective Outcome of Clear Lensectomy With Toric IOL Implantation After Corneal Collagen Cross Linking in Selected Cases of Keratoconus
Aim: To evaluate the visual and topographic outcomes of a two stage approach treatment for selected cases of progressive keratoconus (KC) corneal collagen cross linking (CXL) followed by phacoemulsification with toric intraocular lens (IOL) implantation. Methods: The study included 9 eyes of 6 patients diagnosed with progressive KC, aged from 35 to 47 years (41.6+ 11.2 years) All studied eyes underwent a two stage approach treatment: first corneal collagen CXL followed after at least 6 months by phacoemulsification with foldable toric IOL implantation in both eyes of three patients and only one eye of the other three patients. A complete ophthalmological examination was performed preoperatively and postoperatively. Topographical and visual outcomes were evaluated during 1 year follow up period. Results: At baseline, seven eyes had mild and two eyes had moderate KC. Sphere ranged from 3.00 to 8.00 diopter (D) and cylinder from 3.50 to 5.50 D. All eyes could be corrected by glasses to 0.50 (log of minimal angle of resolution [logMAR] or more. At 6 months after CXL, only Kmax decreased significantly from baseline, with no change in visual acuity or manifest refraction. After phacoemulsification with toric IOL implantation, sphere changed from 5.74+ 1.88 D preoperatively to 0.33+ 0.72 D 12 months postoperatively (P<0.001) and cylinder changed from 4.53+ 0.98 to 1.10+ 0.76 D (P<0.001) There was significant improvement in mean uncorrected distance visual acuity from logMAR 1.43+ 0.51 preoperatively to 0.30+ 0.09 postoperatively (P<0.001) and the mean corrected distance visual acuity (CDVA) from 0.34+ 0.12 preoperatively to 0.24+ 0.13 (P=0.03) 1 year after IOL implantation. All patients were satisfied with their visual improvement. Conclusions: This two stage approach in selected cases of progressive KC is a safe and effective procedure regarding keratometric stability, and visual and refractive results.
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