Current Trends in Modern Visual Intraocular Lens Enhancement Surgery in Stable Keratoconus: A Synopsis of Do’s, Don’ts and Pitfalls

Vastardis, Iraklis; Sagri, Despoina; Fili, Sofia; Wölfelschneider, Peter; Kohlhaas, M.

doi:10.1007/s40123-019-00212-1

Cited by 9 publications

(5 citation statements)

References 71 publications

(85 reference statements)

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“…Toric IOL implant remains a controversial option; however, patient selection has demonstrated to be a crucial factor in achieving an optimal refractive postoperative outcome. 13 A major finding in our study was that we fail to find a statistically significant change in refractive astigmatism between the postsurgical day 30 follow-up visit and the UDVA: uncorrected distance visual acuity; Sph Eq: spherical equivalent.…”

Section: Discussionmentioning

confidence: 56%

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant

Fernández-Muñoz

Blanco-Gómez

Vázquez-Rojas

et al. 2020

European Journal of Ophthalmology

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Purpose: To determine the refractive stability of patients with keratoconus and cataracts after the implantation of a toric intraocular lens. Methods: This is a cross-sectional, retrospectivestudy. Clinical records from patients with non-progressive keratoconus and cataracts that underwent non-complicated phacoemulsification with toric IOL implantation were reviewed. Mean keratometry (Km), refractive cylinder (RC), spherical equivalent (SE), steeper keratometry (K), and axis were evaluated at the 1-month, 6-month, 12-month, and 24-month follow-up visits. Results: Fifty-four eyes from 41 patients were included. Thirty-seven (68.5%) female and 17 (31.5%) male patients, with a mean age of 67.52 ± 8.22. Refractive cylinder at postoperative 30 days was −1.61 ± 1.23, 6-month −1.22 ± 0.80, 12-month −1.10 ± 0.83 and 24-month visit after surgery was −1.37 ± 0.77( p = 0.290). SE at the 30-day visit was −0.82 ± 1.90, 6-month −0.64 ± 1.23, 12-month −0.78 ± 1.91 and at 24-month postoperative visit −1.02 ± 1.87 ( p = 0.210). Km value at the 1-month visit was 47.23 ± 1.95, 6-month 47.87 ± 1.61, 12-month 46.39 ± 2.52 and 24-month postoperative visit 46.92 ± 1.26 ( p = 0.877). The steeper K axis in the 30-day control was 78.53 ± 30.12, 6-month 77.29± 37.68, 1-year 93.13 ± 62.42, 24-month 67.31 ± 38.49 ( p = 0.632). Conclusions: Our findings suggest a low variation in the refractive outcome for patients with mild and moderate keratoconus and cataracts, without evident progression signals, a demonstrated keratoconus clinical stability. No statistically significant postoperative changes in the refractive cylinder, SE, mean K, and steeper K axis were observed, which suggests good predictability for toric IOL implant.

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Section: Discussionmentioning

confidence: 56%

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant

Fernández-Muñoz

Blanco-Gómez

Vázquez-Rojas

et al. 2020

European Journal of Ophthalmology

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“…In addition, highly irregular astigmatism affects IOL power calculation and lens alignment, decreasing the correction of astigmatism. The residual astigmatism may induce further higher order aberrations secondary to the combination of the toricity of the lens and corneal irregularities, potentially worsening vision [42]. Given the absence of adequate evidence of toric lens outcomes in patients with severe keratoconus and the potential complications outlined above, we suggest consideration of nontoric spherical lens placement in advanced keratoconus.…”

Section: Preoperative Considerationsmentioning

confidence: 98%

Cataract surgery considerations in patients with prior history of keratoconus and ectasia

Moshirfar

Ziari

Ronquillo

2022

Current Opinion in Ophthalmology

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Purpose of reviewPreoperative workup for cataract surgery in patients with keratoconus poses certain challenges, particularly in patients with moderate-to-severe disease. This review aims to outline the appropriate preoperative, intraoperative, and postoperative considerations and provides an algorithm to help guide the workup prior to surgery.Recent findingsA new system for keratoconus progression and staging has been proposed and additional studies comparing intraocular lens (IOL) formulas calculations and biometry devices have been conducted.SummaryPatients with severe keratoconus have unpredictable results and have an increased risk of a hyperopic refraction postoperatively. Although studies have compared IOL calculation formulas, there is no consensus on management. Clinical considerations and an approach to the workup are presented; however, additional studies are required to determine the most appropriate management of cataracts in severe keratoconus.

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“…Toric IOLs are most commonly used, as they can correct for high levels of astigmatism when combined with other procedures [9 ▪▪ ,27]. Successful anterior and posterior phakic IOL implantation has been reported in contact-lens intolerant patients with low degrees of irregular astigmatism [28,29 ▪ ].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Indications for keratoplasty in management of corneal ectasia

Choi¹,

Jeng²

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current review aims to describe recent advancements in treatment of corneal ectasias and its effect on indications for corneal transplantation.Recent findingsThe majority of patients affected by ectatic corneal disease use contact lenses to correct resulting astigmatism. Patients who are intolerant of contact lenses or cannot achieve acceptable vision through conservative measures could consider keratoplasty. However, continuing advancements in both nonsurgical and surgical treatments are either reducing or delaying the need for keratoplasty in patients affected by ectatic corneal disease.SummaryCorneal transplantation has been the mainstay of treatment for patients with advanced ectatic corneal disease. In the past decade, numerous improvements have been occurred to make contact lenses not only more effective for visual correction, but also more comfortable. Although corneal cross-linking is the only proven treatment known to prevent progression of disease, several other therapies show early potential for those in which cross-linking is contraindicated. Patients now have access to a wider range of therapies before considering keratoplasty.

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Current Trends in Modern Visual Intraocular Lens Enhancement Surgery in Stable Keratoconus: A Synopsis of Do’s, Don’ts and Pitfalls

Cited by 9 publications

References 71 publications

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant

Cataract surgery considerations in patients with prior history of keratoconus and ectasia

Indications for keratoplasty in management of corneal ectasia

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