Objective and Subjective Outcome of Clear Lensectomy With Toric IOL Implantation After Corneal Collagen Cross-Linking in Selected Cases of Keratoconus

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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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