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Corneal cross-linking combined with toric IOL may be effective in managing ectasia
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 Jose L. Güell |
SAN DIEGO — Some corneal stabilization or surface regularization combined with premium IOL implantation may be a robust strategy for managing ectasia, according to a study presented here.
OSN Europe Edition Editorial Board Member Jose L. Güell, MD, said that dual corneal cross-linking and toric Artiflex IOL (Ophtec) implantation have been effective in managing unstable primary ectatic disorders with little to no irregular astigmatism, which occurs commonly in younger patients with keratoconus.
"This combination may be significant when used in a number of eyes requiring corneal transplantation in the future," he said at the American Society of Cataract and Refractive Surgery meeting.
Three-year follow-up of 17 progressive keratoconic eyes demonstrated high safety and efficacy outcomes; 94% of patients achieved at least 20/40 postop uncorrected distance visual acuity, 71% experienced no change in corrected distance visual acuity, 12% gained one Snellen line and the remainder gained two or more lines.
"Although this particular combination has shown high safety levels ... all these new approaches will need long-term follow-up before being considered a standard of care," Dr. Güell said.
- Disclosure: Dr. Güell is a paid consultant for Ophtec.
We have worked with corneal collagen cross-linking for the visual rehabilitation of keratoconus since 2002, and it has also been our experience that some patients end up with stabilized cones but large amounts of anisometropia. This is where a phakic IOL or intracorneal ring segments come into play.
The toric phakic IOL appeared to offer good visual rehabilitation comparable with penetrating keratoplasty, potentially making it a better option as far as requiring a human allograft tissue and long-term complications. However, refraction following corneal collagen cross-linking does not stabilize for several years, possibly due to epithelial adaptation or cornea re-expansion. It would therefore be prudent to evaluate phakic IOL implantation parameters (keratometry, refraction) at least 1 year postop. Additionally, cylinder correction in the IOL is regular, and keratoconus cylinder is by definition irregular, so this may result in persistent halos. A matched irregular cylindrical IOL would be a better choice, but none are currently available. Moreover, while the particular phakic IOL studied has the advantage of “flush” placement on the iris and little corneal danger due to contact, it requires a peripheral iridectomy (and may still result in pupillary block). It may also dislocate upon abrupt impact (airbag injury, etc.). Nevertheless, this study draws us one step closer to better vision for these patients.
– A. John Kanellopoulos, MD
OSN Europe
Edition Editorial Board Member
Disclosure: Dr. Kanellopoulos is a
consultant for Alcon and WaveLight.