Three-Step Treatment of Keratoconus and Post-LASIK Ectasia: Implantation of ICRS, Corneal Cross-linking, and Implantation of Toric Posterior Chamber Phakic IOLs

PURPOSE: To evaluate vision and corneal surface regularity after each step of a three-step surgical treatment of keratoconus and post-laser in situ keratomileusis (LASIK) ectasia (implantation of intracorneal ring segments [ICRS], corneal cross-linking [CXL], and implantation of toric intraocular contact lenses [ICLs]). METHODS: Thirty-one eyes of 24 patients with moderate to severe keratoconus and post-LASIK ectasia (stages II and III of Amster-Krumeich classification) were included. All eyes underwent all three steps. The time interval between ICRS implantation and CXL was 4 to 6 weeks, and ICL implantation was performed 6 to 8 months after CXL. Visual acuity, refraction, and corneal topometric indices were evaluated with the Pentacam system (index of surface variance [ISV], index of vertical asymmetry [IVA], keratoconus index [KI], central keratoconus index [CKI], index of height asymmetry [IHA], index of height decentration [IHD], and corneal. wavefront parameters leg, higher order aberrations, spherical aberration, and coma]). RESULTS: Decimal uncorrected distance visual acuity (UDVA) improved from 0.13 +/- 0.17 preoperatively to 0.69 +/- 0.18 at 1 year, whereas corrected distance visual acuity (CDVA) improved from 0.56 +/- 0.24 to 0.80 +/- 0.18, respectively. The topometric indices ISV, IVA, KI, and IHD also improved significantly, whereas CKI and IHA showed no significant improvement. Higher order aberrations, spherical aberration, and coma improved significantly compared to baseline. CONCLUSIONS: The combined use of ICRS, CXL, and ICL implantation significantly improves visual acuity, higher order aberrations, and corneal shape in moderate and severe keratoconus and post-LASIK ectasia.