Posterior chamber phakic intraocular lenses after penetrating keratoplasty

PURPOSE: To evaluate the efficacy, predictability, and safety of a phakic posterior chamber intraocular Collamer lens (ICL) after penetrating keratoplasty (PKP). SETTING: Fernandez-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: A myopic or toric ICL was implanted after PKP in eyes unable to wear glasses or contact lenses and for which corneal laser surgery was contraindicated. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and endothelial cell count were recorded preoperatively and 24 months postoperatively. RESULTS: Preoperatively, the 15 eyes had myopia from -2.00 to -17.00 diopters (D) or astigmatism from -1.50 to -7.00 D. Twenty-tour months postoperatively, the mean Snellen decimal UDVA was 0.51 +/- 0.30 (SO). The UDVA was 20/40 or better in 7 eyes (46.6%). The mean CDVA was 0.79 +/- 0.22. The CDVA was 20/40 or better in 12 eyes (80%) and 20/25 in 6 eyes (40%). No eye lost more than 1 line of acuity, 2 eyes gained 1 line, and 5 eyes gained more than 2 lines; 8 eyes were unchanged. The safety index was 1.58. The spherical equivalent (SE) was within +/- 1.00 D in 80% of eyes and within +/- 0.50 D in 66.6% of eyes. The mean postoperative SE was -0.95 +/- 1.12 D. At 24 months, the mean vault was 2.06 +/- 0.96 and the mean endothelial cell loss, 8.1%. CONCLUSION: Results indicate that phakic intraocular lens implantation is a viable treatment for myopia and astigmatism after PKP in patients for whom glasses, contact lenses, or corneal refractive surgery are contraindicated.