A Novel Refractive Procedure for Keratoconus

Intracorneal ring segment and phakic IOL implantation: a refractive solution for patients with keratoconus and high myopia

By Francisco Sánchez León

At a Glance

  • A decade ago, keratectasia treatment required heavy-duty surgery
  • Today, most cases can be treated with corneal remodeling techniques in combination with refractive interventions
  • The combination of intracorneal ring segments and phakic IOLs is a viable option for correcting corneal irregularities and large refractive errors in keratoconus patients
  • The choice of technique(s) to use varies by a number of patient factors and the surgeon’s experience

The efficacy of this sequential approach was illustrated by one of my patients who presented with pre-operative best corrected visual acuity (BCVA) of 20/50 and a refraction -8.00 sph -8.00 cyl × 45° in his left eye. I first implanted a 90° 300 µm ICRS and six months later implanted the pIOL. Six months after the second procedure, the patient’s refraction in that eye had improved to +1.00 sph -1.00 cyl × 50° and his BCVA was 20/40 (Figure 2).

The last decade has seen a seismic shift in the treatment of keratectasia and keratoconus. Where spectacles, contact lenses, and penetrating keratoplasty for advanced keratectasia were the only treatment options available, today we have a variety of techniques at our disposal, including corneal crosslinking, intracorneal ring segments (ICRS), topography-guided photoablation, deep anterior lamellar keratoplasty (DALK), and phakic intraocular lenses/implantable collamer lens (pIOLs/ICL). Recently, I have started to combine two of these techniques, ICRS and ICL implantation. I have found that this creates a highly effective refractive intervention for the treatment of patients with keratoconus and high myopia.

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