Correction of postkeratoplasty ametropia in keratoconus patients using a toric implantable Collamer lens

PURPOSE. To evaluate the efficacy and safety of a toric implantable Collamer lens (Visian TICL(R)) for correction of high postkeratoplasty ametropia in patients with keratoconus. METHODS. Seven eyes of 7 keratoconus patients postkeratoplasty (5 M, 2 F; mean age 34.1 +/- 5.9 years, range 28-44) unable to wear glasses or contact lenses were included in the study. A foldable phakic posterior chamber Collamer toric lens was injected through a standard 3.0-mm clear corneal temporal incision. Uncorrected distance visual acuity (UCDVA, logMAR), best-corrected distance visual acuity (BCDVA, logMAR), spherical refraction, cylindrical refraction, and refractive spherical equivalent (RSE) were measured preoperatively and postoperatively. Postoperative adverse events were recorded. RESULTS. The mean follow-up was 12.8 +/- 8.8 months (range 4-30). A significant (p<0.01) improvement was observed postoperatively in mean UCDVA (1.18 +/- 0.4 vs 0.2 +/- 0.1), spherical refraction (-5.89 +/- 3.43 vs 0.53 +/- 0.75), cylindrical refraction (-4.39 +/- 0.75 vs -1.74 +/- 0.84), and RSE (-8.09 +/- 3.77 vs -0.33 +/- 0.54). The BCDVA changes were not significant (0.09 +/- 0.11 vs 0.05 +/- 0.08). All patients gained 25 lines of UCDVA (average 7.6 +/- 1.9 lines). The number of patients with UCDVA >= 6/12 (0.3 logMAR) increased after surgery (0% vs 87.5%; p<0.01), while the number of patients with BCDVA > 6/12 was unchanged (100% vs 100%; NS), with 0% (0/7) of patients losing >= 2 BCDVA lines. No complications were observed postoperatively. CONCLUSIONS. Toric implantable Collamer lens was safe and effective in correcting postkeratoplasty myopia and astigmatism in keratoconus patients.