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Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and
José F Alfonso1, Carlos Lisa1, Luis Fernández-Vega Cueto1
1From the Fernández-Vega Ophthalmological Institute (Alfonso, Lisa, Fernández-Vega Cueto, Poo-López, Fernández-Vega) and the Surgery Department (Alfonso, Fernández-Vega), School of Medicine, University of Oviedo, Oviedo, and the Optics II Department (Madrid-Costa), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
Purpose:
To evaluate the efficacy, safety, predictability, and stability of sequential Ferrara intrastromal corneal ring segment (ICRS) and intraocular lens (IOL) implantation in patients with keratoconus and cataract.
Setting:
Fernández-Vega Ophthalmological Institute, Oviedo, Spain.
Design:
Retrospective case series.
Methods:
This study comprised patients with keratoconus and cataract who had ICRS implantation followed 6 months later by IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors, analyzed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, 6 months after IOL implantation, and 3 years and 5 years thereafter.
Results:
Seventy eyes of 47 patients were studied. The mean UDVA was 1.08 logMAR ± 0.24 (SD) preoperatively, 0.95 ± 0.31 logMAR 6 months after ICRS implantation (P = .03), and 0.44 ± 0.29 logMAR 6 months after IOL implantation (P < .0001). The mean CDVA changed from 0.35 ± 0.23 logMAR before surgery to 0.28 ± 0.22 logMAR 6 months after ICRS implantation (P < .0001) and to 0.11 ± 0.16 logMAR 6 months after IOL implantation (P < .0001). The UDVA and CDVA were stable over the period after the second procedure (P > .05). The spherical equivalent (SE) and the refractive cylinder declined steeply after IOL implantation (P < .001) and then were stable (P > .05).
Conclusion:
Sequential ICRS and IOL implantation provided good visual and refractive outcomes and was an effective, safe, predictable, and stable procedure for the treatment of patients with keratoconus and cataract.