TY - JOUR
TI - Four-stage procedure for keratoconus: ICRS implantation, corneal cross-linking, toric phakic intraocular lens implantation, and topography-guided Photorefractive Keratectomy
AU - Coskunseven, E.
AU - Sharma, D.P.
AU - Grentzelos, M.A.
AU - Sahin, O.
AU - Kymionis, G.D.
AU - Pallikaris, I.
JO - Journal of Refractive Surgery
PY - 2017
VL - 33
TODO - 10
SP - 683-689
PB - SLACK Incorporated
SN - 1081-597X
TODO - 10.3928/1081597X-20170807-01
TODO - mitomycin;  collagen;  cross linking reagent;  photosensitizing agent;  riboflavin, adult;  Article;  astigmatism;  case study;  clinical article;  clinical effectiveness;  cornea disease;  corneal cross linking;  corneal haze;  corrected distance visual acuity;  cross linking;  eye refraction;  female;  follow up;  human;  keratoconus;  lens implantation;  male;  patient safety;  photorefractive keratectomy;  postoperative period;  preoperative period;  priority journal;  retrospective study;  surgical technique;  topography;  topography guided photorefractive keratectomy;  treatment outcome;  visual acuity;  disease exacerbation;  excimer laser;  keratoconus;  keratometry;  pathophysiology;  phakic intraocular lens;  photorefractive keratectomy;  procedures;  prosthesis design;  therapeutic use;  time factor;  ultraviolet radiation;  young adult, Adult;  Collagen;  Corneal Topography;  Cross-Linking Reagents;  Disease Progression;  Female;  Follow-Up Studies;  Humans;  Keratoconus;  Lasers, Excimer;  Male;  Phakic Intraocular Lenses;  Photorefractive Keratectomy;  Photosensitizing Agents;  Prosthesis Design;  Refraction, Ocular;  Retrospective Studies;  Riboflavin;  Time Factors;  Treatment Outcome;  Ultraviolet Rays;  Visual Acuity;  Young Adult
TODO - PURPOSE: To evaluate a four-stage combined treatment for keratoconus including intrastromal corneal ring segment (ICRS) implantation followed by corneal cross-linking (CXL), toric phakic intraocular lens (IOL) implantation, and topography-guided photorefractive keratectomy (TG-PRK). METHODS: In this retrospective interventional case series, 11 eyes of 7 patients with progressive keratoconus were treated with a four-stage procedure including the following: Keraring ICRS (Mediphacos Ltda, Belo Horizonte, Brazil) implantation followed by CXL, phakic IOL implantation, and TG-PRK (minimum 6 months between each stage). Minimum follow-up was 12 months after TG-PRK. RESULTS: Both mean uncorrected distance visual acuity and corrected distance visual acuity (CDVA) improved from 0.025 decimal (20/800 Snellen) and 0.093 decimal (20/215 Snellen) preoperatively to 0.68 decimal (20/30 Snellen) and 0.73 decimal (20/27 Snellen), respectively, after the combined treatment (P < .0001). Mean postoperative CDVA of 0.73 decimal (20/27 Snellen) was similar to preoperative contact lens CDVA of 0.72 decimal (20/28 Snellen). Mean manifest refraction spherical equivalent reduced from 16.78 ± 3.58 to 0.59 ± 0.89 diopters (P < .0001) and mean refractive astigmatism reduced from 5.16 ± 1.86 to 0.82 ± 0.28 diopters (P < .0001). CONCLUSIONS: This four-stage procedure appears to be an effective and safe approach for corneal stabilization and improvement of functional vision in patients with keratoconus. Larger case series with a longer follow-up are required to thoroughly evaluate the efficacy, safety, and stability of this combined approach.
ER -