Visual Rehabilitation in Keratokonus After Crosslinking With Toric Phakic IOL: A Case Presentation
Narrative Responses:
Purpose
Today corneal crosslinking is an established method to treat patients with progressing Keratokonus. After this treatment often the refractive error remains a problem. We demonstrate the possibility of correcting myopia and astigmatism in keratokonus after corneal crossliniking in selected patients by implanting a phakic toric IOL.
Methods
After bilateral corneal crosslinking and stabilisation of the progressive keratokonus a phakic toric IOL (Staar) was implanted two years later in both eyes without complications. The postoperative healing process was free of complications too. The follow up is now three years-
Results
Preoperative visual acuity before crosslinking: RA cc -6,00 -3,00 165° = 0,6; LA cc-7,00 -2,75 13° = 0,9. Visual acuity after two years: RA sc 0,1; RA cc : -2,25 -3,75 170° = 0,8; LA sc <0,05; LA cc -7,25 -3,00 5° = 1,0. After ICL implantation visual acuity was one month postoperatively: RA sc 0,7; LA sc 1,0. Visual acuity three years postoperativly: RA sc 1.0; RA cc +0.25 -0.75 30 ° = 1.2; LA sc 1,0; LA cc +0.25 -0.50 115 ° = 1.2. No phakic IOL related complications occurred.
Conclusion
Our case shows that the combination of UV-Riboflavin-Collagen-Crosslinking and toric ICL implantation in patient with keratoconus may be an effective and safe surgical method for recovery of visual acuity. This method should be provided only in selected patients with regular central astigmatism. Reversibility and emmetropic target refraction, are the advantages.