Sequential Intacs and Verisyse phakic intraocular lens for refractive improvement in keratoconic eyes

PURPOSE: To evaluate the safety, efficacy, and stability of sequential Intacs (Addition Technology, Inc.) insertion and Verisyse phakic intraocular lens (pIOL) (AMO) implantation in selected cases of keratoconus. SETTING: Magrabi Eye Hospital, Cairo, Egypt. METHODS: Prospective data were collected from 8 eyes of 6 keratoconus patients with contact lens intolerance, clear corneas, a maximum K-value less than 60.0 diopters (D), and minimum corneal thickness greater than 400 mu m. Two 0.45 mm Intacs were inserted through a 1.8 mm radial incision created at 70% of the corneal depth opposite the cone apex. The 2 rings were pushed to meet and embrace the cone apex. Refraction 6 months after Intacs insertion showed residual myopia greater than 6.0 D and residual astigmatism not more than 2.0 D. Thus, a phakic Verisyse IOL was implanted horizontally in the anterior chamber through a 6.5 mm superior clear corneal incision, which was closed with 3, 10-0 nylon sutures after a peripheral iridectomy was created. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, and topographic profiles were taken 1 week and 1, 3, 6, 9, 12, 18, and 24 months after the second surgery. RESULTS: All eyes achieved UCVA of 20/40 or better. The final spherical error ranged from -1.75 to +1.00 D and the cylindrical error, from 1.25 to 2.50 D. No eye lost lines of preoperative BCVA. These results were relatively stable throughout the follow-up period. CONCLUSIONS: Sequential Intacs and a Verisyse pIOL implantation was safe, stable, and effective in selected cases of keratoconus. It is a reversible surgery that is less invasive than penetrating keratoplasty (PKP). It can avoid or postpone the need for PKP, although it is not an alternative.