Toric phakic implant successfully treats refraction after cross-linking therapy for keratoconus

HONG KONG: Toric ICL implantation 1 year after corneal collagen cross-linking for patients with keratoconus improves uncorrected visual acuity, according to a study presented here.

Alaa El Danasoury, MD, FRCS, chief of refractive surgery at Maghrabi Eye Hospital in Saudi Arabia, presented results from a study on toric ICL (STAAR Surgical) implantation in 32 eyes of 22 keratoconus patients 1 year after cross-linking therapy. Dr. El Danasoury said a stable cornea is not enough to satisfy keratoconus patients.

"At about 1 year after cross-linking therapy, the keratoconus patients come in and say, 'OK, doctor, I came in originally to improve my vision. Now you are telling me my cornea is stable, and for that I thank you very much, but I still cannot see.' So we offer them a toric ICL," he said.

Dr. El Danasoury said he waits 1 year to ensure corneal stability before implanting the ICL.
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"We conducted this study 2 years ago to assess the safety, the efficacy, the stability of toric intraocular lens to correct the compound myopic astigmatism normally associated with keratoconus post corneal cross-linking," he said.

Patients ranged in age from 19 to 36 years with a mean age of 24.1 years. Fifty-eight percent were men. Baseline mean spherical equivalent was, 8.56 D, 4.38 D. Mean baseline cylinder measured, 3.44 D, 1.68 D. A total of 30 eyes completed 1 year examination.

Dr. El Danasoury performed ICL implantation through a 3-mm clear corneal incision under topical anesthesia and also performed surgical iridectomies.

"In these cases, the technique of implantation of the ICL is not much different than that in a virgin eye," he said.

According to Dr. El Danasoury, at 1 day postop 94% of uncorrected eyes could see 20/40, 81% could see 20/30 or better, and 56% could see 20/20 or better. This compares with preop best corrected visual acuity of 100% at 20/40 or better, 84% at 20/30 and 44% at 20/20 or better.

At 12 month follow-up, 30 eyes had a mean cylinder of, 0.26 D at 144.4 inches.

"The toric ICL is highly predictable in correcting compound myopic astigmatism after cross-linking," he said. "Refractive correction is stable after 1 year; the lens is stable inside the eye with no rotation occurring."