Toric phakic IOLs in keratoconus—evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus

Purpose To evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus. Methods In this retrospective study, iris-fixated pIOLs (Artisan/Art...

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Published in:Graefe's archive for clinical and experimental ophthalmology 2021-06, Vol.259 (6), p.1643-1649
Main Authors: Fischinger, Isaak R., Wendelstein, Jascha, Tetz, Kristin, Bolz, Matthias, Tetz, Manfred R.
Format: Article
Language:English
Subjects:
Acuity
Anterior chamber
Cornea
Degeneration
Endothelial cells
Eye
Intraocular lenses
Iris
Keratoconus
Medicine
Medicine & Public Health
Ophthalmology
Refractive Surgery
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Summary:Purpose To evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus. Methods In this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed. Results The mean postoperative uncorrected distance visual acuity (UDVA post ) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVA pre ), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVA post /CDVA pre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia ( n  = 14) showed significantly ( p  = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus ( n  = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index ( p  = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVA post . The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D ( p  
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-020-05041-8