Comparison of iris-claw and posterior chamber collagen copolymer phakic intraocular lenses in keratoconus

PURPOSE: To evaluate the visual and refractive outcomes, predictability, and stability of phakic intraocular lens (pIOL) implantation in keratoconic eyes and compare the results of 2 pIOL models. SETTING: Vissum Instituto Oftalmologico, Alicante, Spain. DESIGN: Retrospective case series. METHODS: An iris-claw (Artiflex) or collagen copolymer posterior chamber pIOL (PC pIOL) (Implantable Collamer Lens) was implanted in eyes with stable keratoconus. The main outcome measures were postoperative changes from the preoperative manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, and endothelial cell count. Alpins vectorial analysis was performed. RESULTS: Twenty eyes received an iris-claw pIOL and 28 eyes, a PC pIOL. The mean spherical equivalent was -9.31 diopters (D) +/- 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 +/- 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). No patient lost lines of CDVA. The mean decimal UDVA was 0.08 +/- 0.09 preoperatively and 0.71 +/- 0.26 postoperatively and the mean decimal CDVA, 0.77 +/- 0.24 and 0.87 +/- 0.98, respectively (P<.001). The mean efficacy index was 0.90 +/- 0.26 and the mean safety index, 1.19 +/- 0.29. The mean efficacy index was not statistically different between the PC pIOL (0.88 +/- 0.28) and the iris-claw pIOL (0.96 +/- 0.22) (P=.058). Refraction was stable during the follow-up. CONCLUSIONS: Phakic IOL implantation is a suitable refractive surgical option for stable keratoconus. It may be especially indicated for the management of high ametropia and showed good efficacy and safety. Refractive and keratometric stability was confirmed.