Artisan Iris-supported Phakic IOL Implantation in Patients With Keratoconus: A Review of 16 Eyes

Abstract

Implantation of the Artisan PIOL is effective in improving visual acuity in patients with stable keratoconus. Long-term safety remains to be established as no postoperative endothelial cell counts were performed.

Surgical management of astigmatism with toric intraocular lenses

“…Monofocal toric IOLs can be used to correct the patient's vision for distance, for near or for both (this latter being attained via monovision) (3)(4)(5)(6)(7)(8)(9)(10) , while multifocal toric IOLs aim at providing good uncorrected vision for near, intermediate and far (14)(15)(16)19) . Moreover, toric phakic IOLs are a largely reversible treatment option for pre-cataractous patients who are not good candidates for corneal refractive surgery and have clinically significant astigmatism (20)(21)(22) . The final visual outcomes attained with toric IOLs depend on several factors, including the visual potential of the eye.…”

“…Toric IOLs should be avoided in patients with corneal dystrophies that might need a corneal transplant in the future and should be used with caution in patients with potential capsular bag instability. toric IOLs should not be implanted in eyes with shallow anterior cham bers and low endothelial cell counts (22) . In addition, as multifocal toric IOLs split the available light between the distance and near foci, they should not be implanted in patients with ocular comorbidities that affect the visual acuity or the quality of vision, such as amblyopia, maculopathy, glaucoma, and uveitis (27) .…”

New clinical pathways for keratoconus

“…A number of recent papers have reported effective refractive correction using pIOLs in keratoconus (post-operative spherical equivalent range À 0.08 ± 0.4 to þ 0.1 ± 0.4; 64-67% within 0.5D and 84-100% within 1D of target refraction) [61][62][63][64][65][66] and for post-keratoplasty ametropia. 67 Of the pIOLs available, 68 the Visian ICL (Staar Surgical, Monrovia, CA, USA) offers the longest safety track record for an injectable pIOL and is available in a wide range of powers (including toric correction up to 6D).…”

“…After a 2-year period to allow shape stabilisation post-CXL, 19,76 further fine shape correction with topographic PRK 58-60 may therefore be required to achieve good spectacle CDVA. If CDVA is good but uncorrected distance vision remains poor (UDVA) remains poor, then patients may opt for pIOL implantation [61][62][63][64][65][66] to complete visual rehabilitation.…”

Visual and Refractive Outcome of Lens Extraction or Cataract Surgery Combined with Limbal Relaxing Insicion in Keratoconic Eyes

“…Corneal transplants routinely provide good vision, but the healing time is slow, and visual recovery may require monthly follow-up. A refractive lens exchange with a toric or phakic IOL implantation are the other choices for this purpose 19,20 . Another choice is phacoemulsification for both the cataracts and large spherical errors for patients in the presbyopic age range with keratoconus 3,4,9 .…”