Visian toric ICL implantation for residual refractive errors after ICRS implantation and corneal collagen cross-linking in keratoconus

摘要

Some patients with keratoconus have poor corrected distance visual acuity (CDVA) associated with high refractive errors. According to our treatment protocol, the best approach for these cases is intra-corneal ring segments (ICRS) implantation (usually one segment) to improve CDVA followed by corneal collagen cross-linking (CXL) treatment 4 weeks later to stabilize the cornea and phakic toric implantable collamer lens (TICL) (Visian Toric V4b ICL; STAAR Surgical, Monrovia, CA) implantation 4 to 6 months after CXL to correct the residual refractive errors. We conducted a retrospective analysis of 11 eyes of 7 patients with moderate to severe keratoconus (according to the Amsler-Krumeich classification, 4 eyes had stage II keratoconus and 7 eyes had stage III) and poor CDVA who underwent three-step ICRS implantation-CXL-TICL implantation procedures at our eye hospital. The two procedures (ICRS implantation-CXL) were performed sequentially at an interval of 4 weeks and TICL implantation was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS implantation-CXL, and at the 6-month follow-up visit after TICL implantation.