Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and cataract: Long-term follow-up

• Published in: Journal of cataract and refractive surgery Vol. 43; no. 2; pp. 246 - 254
• Main Authors: Alfonso, José F., MD, PhD, Lisa, Carlos, MD, Fernández-Vega Cueto, Luis, MD, Poo-López, Arancha, OD, Madrid-Costa, David, PhD, Fernández-Vega, Luis, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2017
• Subjects: Cataract; Corneal Stroma - surgery; Follow-Up Studies; Humans; Keratoconus - surgery; Lens Implantation, Intraocular; Ophthalmology; Refractive Errors; Retrospective Studies; Visual Acuity
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2016.11.044

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.