Outcomes of Toric Iris-Claw Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty for Keratoconus.

PURPOSE: To assess visual and refractive outcomes of toric iris-claw phakic intraocular lens (IOL) implantation in patients who had previously undergone deep anterior lamellar keratoplasty (DALK). METHODS: Retrospective case series including 24 eyes of 24 patients implanted with toric Artiflex or Artisan (Ophtec BV, Groningen, Holland) phakic IOL following DALK for keratoconus. During a 12-month follow-up, the main outcome measures were uncorrected and corrected distance visual acuities (UDVA and CDVA), refractive error components, topographic parameters, and endothelial cell count. Alpins vectorial analysis was performed. RESULTS: At the last follow-up, the spherical equivalent (SE) was within ±0.50 diopters (D) in 71% of eyes and within ±1.00 D in 92% of eyes. Mean refractive astigmatism was reduced from -4.92 ± 1.55 D (range: -2.50 to -8.00 D) preoperatively to -0.66 ± 0.61 D (range: -2.00 to 0.00 D) after treatment, and 76.5% of cases were within ±1.00 D. No significant differences (P = .123) were detected in spherical equivalent values between 3- and 12-month follow-up visits. No eyes lost lines in CDVA, and 54% of eyes gained one or more lines. Postoperative UDVA was 20/40 or better in 88% of eyes. Efficacy and safety indexes at 12 months were 0.93 and 1.00, respectively. Mean endothelial cell loss was 6.10% at 12 months postoperatively. No intraoperative or postoperative complications were noted over the follow-up period. CONCLUSIONS: The implantation of a toric iris-claw phakic IOL has shown high efficacy and safety in this series and may be considered as a reasonable option for the management of refractive errors after DALK. [J Refract Surg. 2017;33(8):538-544.].

Topographic outcomes after corneal collagen crosslinking in progressive keratoconus: 1-year follow-up.

PURPOSE:: We aimed to report and analyze topographic and refractive outcomes following corneal collagen crosslinking (CXL) in patients with progressive keratoconus (KC). METHODS:: We performed a retrospective, analytical, and observational study of 100 eyes from 74 progressive KC patients who underwent CXL at the Eye Hospital of Paraná. Keratometric values were analyzed preoperatively as well as 3 and 12 months postoperatively. RESULTS:: For a total of 100 eyes, 68 belonged to male patients. The mean age of our study population was 19.9 ± 5.61 years. The average visual acuity and topographic parameters overall were stable after 1 year (p<0.05). After 3 months, steepest keratometry reading (K2) and maximum keratometry (Kmax) were significantly decreased (p<0.05). Regarding topographic astigmatism (dK), there was no significant difference between the 3-month and 12-month follow-ups. When we made comparisons between genders following CXL, there were no significant differences related to the changes in Kmax, K2, and spectacle-corrected distance visual acuity (SCDVA). CONCLUSIONS:: CXL promoted stabilization or improvement of keratometric values and visual acuity. We found that keratoconus apex stability may be achieved 3 months after the procedure. There was no significant difference in keratometric and refractive values measured between male and female patients.

Multifocal intraocular lenses: Types, outcomes, complications and how to solve them.

The multifocal intraocular lenses (IOLs) available are often able to restore visual function and allow spectacle independence after their implantation with great levels of patient satisfaction. The factors associated with the postoperatory success include the careful selection of the patient, the knowledge about the IOLs' design, and their visual performance added to the proper surgical technique and management of possible complications as demonstrated by the evidence available.