International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 7 , ISSUE 1 ( 2018 ) > List of Articles

REVIEW ARTICLE

Role of Corneal Cross-linking and Phakic Intraocular Lens Implantation in Progressive Keratoconus

Oscar Gris, Daniel Elies, Felicidad Manero, Jose L Güell, Merce Morral, Miriam Barbany

Keywords : Astigmatism, Corneal Crosslinking, Ectasia, Irregular astigmatism, Keratoconus, Phakic Intraocular Lenses, Progression.

Citation Information : Gris O, Elies D, Manero F, Güell JL, Morral M, Barbany M. Role of Corneal Cross-linking and Phakic Intraocular Lens Implantation in Progressive Keratoconus. Int J Kerat Ect Cor Dis 2018; 7 (1):26-30.

DOI: 10.5005/jp-journals-10025-1156

License: CC BY-SA 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The two most important goals of management of keratoconus and other corneal ectatic diseases are halting disease progression and visual rehabilitation. Several treatment strategies to skip corneal transplantation have been developed but controversies of the best treatment option for a given patient still exist. The combination of CXL and PIOL implantation has been proposed for visual rehabilitation in patients with progressive keratoconus. Aim: To review the published clinical evidence on the combination of corneal cross-linking (CXL) and phakic intraocular lenses (PIOLs) in patients with keratoconus. Results: No randomized controlled trials and only four retrospective case series were identified. The progression of keratoconus was stopped in all eyes and satisfactory visual rehabilitation was achieved both in terms of uncorrected and corrected distance visual acuity (CDVA) and predictability of refractive correction. Conclusion: Corneal cross-linking combined with PIOL implantation is a valid therapeutic approach for progressive keratoconus with moderate-to-high refractive errors, regular or mildly irregular astigmatism, and good CDVA, especially in the face of significant anisometropia. Clinical significance: The combination of CXL and PIOL implantation is a valid therapeutic approach for visual rehabilitation of progressive keratoconus. Although longer-term follow-up clinical data from prospective randomized clinical trials (RCTs) are needed, clinical outcomes are excellent and equivalent to nonkeratoconic eyes up to 3 years after surgery.


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  1. Ferreira TB, Güell JL, Manero F. Combined intracorneal ring segments and iris-fixated phakic intraocular lens for keratoconus refractive and visual improvement. J Refract Surg 2014 May;30(5):336-341.
  2. Güell JL, Morral M, Malecaze F, Gris O, Elies D, Manero F. Collagen crosslinking and toric iris-claw phakic intraocular lens for myopic astigmatism in progressive mild to moderate keratoconus. J Cataract Refract Surg 2012 Mar;38(3): 475-484.
  3. Güell JL, Morral M, Salinas C, Elies D, Gris O, Manero F. Four-year follow-up of intrastromal corneal ring segments in patients with keratoconus. J Emmetropia 2010 Jan;1:9-15.
  4. Güell JL, Morral M, Salinas C, Elies D, Gris O, Manero F. Intrastromal corneal ring segments to correct low myopia in eyes with irregular or abnormal topography including forme fruste keratoconus: 4-year follow-up. J Cataract Refract Surg 2010 Jul;36(7):1149-1155.
  5. Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, Malecaze F, Nishida K, Sangwan VS; Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea 2015 Apr;34(4):359-369.
  6. Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK; United States Crosslinking Study Group. United States multicenter clinical trial of corneal collagen crosslinking for keratoconus treatment. Ophthalmology 2017 Sep;124(9):1259-1270.
  7. Lombardo M, Giannini D, Lombardo G, Serrao S. Randomized controlled trial comparing transepithelial corneal crosslinking using iontophoresis with the Dresden protocol in progressive keratoconus. Ophthalmology 2017 Jun;124(6): 804-812.
  8. Choi M, Kim J, Kim EK, Seo KY, Kim TI. Comparison of the conventional dresden protocol and accelerated protocol with higher ultraviolet intensity in corneal collagen cross-linking for keratoconus. Cornea 2017 May;36(5):523-529.
  9. Güell JL, Morral M, Gris O, Gaytan J, Sisquella M, Manero F. Five-year follow-up of 399 phakic Artisan-Verisyse implantation for myopia, hyperopia, and/or astigmatism. Ophthalmology 2008 Jun;115(6):1002-1012.
  10. Izquierdo L Jr, Henriquez MA, McCarthy M. Artiflex phakic intraocular lens implantation after corneal collagen crosslinking in keratoconic eyes. J Refract Surg 2011 Jul;27(7): 482-487.
  11. Kymionis GD, Grentzelos MA, Karavitaki AE, Zotta P, Yoo SH, Pallikaris IG. Combined corneal collagen cross-linking and posterior chamber toric implantable collamer lens implantation for keratoconus. Ophthalmic Surg Lasers Imaging 2011 Feb;17;42.
  12. Fadlallah A, Dirani A, El Rami H, Cherfane G, Jarade E. Safety and visual outcome of Visian toric ICL implantation after corneal collagen cross-linking in keratoconus. J Refract Surg 2013 Feb;29(2):84-89.
  13. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol 2006 Aug;17(4): 356-360.
  14. Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP. Corneal collagen crosslinking using riboflavin and ultraviolet- A light for keratoconus: one-year analysis using Scheimpflug imaging. J Cataract Refract Surg 2009 Mar;35(3):425-432.
  15. Kohnen T, Kook D, Morral M, Güell JL. Phakic intraocular lenses: part 2: results and complications. J Cataract Refract Surg 2010 Dec;36(12):2168-2194.
  16. Alfonso JF, Fernández-Vega L, Lisa C, Fernandes P, González- Méijome JM, Montés-Micó R. Collagen copolymer toric posterior chamber phakic intraocular lens in eyes with keratoconus. J Cataract Refract Surg 2010 Jun;36(6):906-916.
  17. Kamiya K, Shimizu K, Ando W, Asato Y, Fujisawa T. Phakic toric Implantable Collamer Lens for the correction of high myopic astigmatism in eyes with keratoconus. J Refract Surg 2008 Oct;24(8):840-842.
  18. Venter J. Artisan phakic intraocular lens in patients with keratoconus. J Refract Surg 2009 Sep;25(9):759-764.
  19. Budo C, Bartels MC, van Rij G. Implantation of Artisan toric phakic intraocular lenses for the correction of astigmatism and spherical errors in patients with keratoconus. J Refract Surg 2005 May-Jun;21(3):218-222.
  20. Gupta S. Implantable contact lenses in keratoconus. Int J Kerat Ect Cor Dis 2016 Jan-Apr;5(1):17-20.
  21. Kymionis GD, Grentzelos MA, Portaliou DM, Kankariya VP, Randleman JB. Corneal collagen cross-linking (CXL) combined with refractive procedures for the treatment of corneal ectatic disorders: CXL plus. J Refract Surg 2014 Aug;30(8): 566-576.
  22. Shafik Shaheen M, El-Kateb M, El-Samadouny MA, Zaghloul H. Evaluation of a toric implantable collamer lens after corneal collagen crosslinking in treatment of early-stage keratoconus: 3-year follow-up. Cornea 2014 May;33(5):475-480.
  23. Tahzib NG, Nuijts RM, Wu WY, Budo CJ. Long-term study of Artisan phakic intraocular lens implantation for the correction of moderate to high myopia: ten-year follow-up results. Ophthalmology 2007 Jun;114(6):1133-1142.
  24. Dirani A, Fadlallah A, Khoueir Z, Antoun J, Cherfan G, Jarade E. Visian toric ICL implantation after intracorneal ring segments implantation and corneal collagen crosslinking in keratoconus. Eur J Ophthalmol 2014 May-Jun;24(3):338-344.
  25. Coşkunseven E, Sharma DP, Jankov MR 2nd, Kymionis GD, Richoz O, Hafezi F. Collagen copolymer toric phakic intraocular lens for residual myopic astigmatism after intrastromal corneal ring segment implantation and corneal collagen crosslinking in a 3-stage procedure for keratoconus. J Cataract Refract Surg 2013 May;39(5):722-729.
  26. Assaf A, Kotb A. Simultaneous corneal crosslinking and surface ablation combined with phakic intraocular lens implantation for managing keratoconus. Int Ophthalmol 2015 Jun;35(3):411-419.
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