Chapter 30 - Phakic Intraocular Lenses

Abstract

Visual rehabilitation of patients with keratoconus (KC) is a clinical challenge; current strategies include conservative and surgical approaches. Phakic intraocular lens (PIOL) implantation is increasingly accepted as a safe and effective strategy in eyes with stable or stabilized KC. The chapter presents a practical, clinically oriented analysis of the outcomes and safety of PIOL implantation in eyes with KC. Both anterior and posterior chamber PIOL may be considered in patients with stable, mild-moderate KC with good corrected distance visual acuity (VA) and without significant irregular astigmatism. PIOL implantation has good safety and efficacy profiles, significantly improving unaided and corrected VA and correcting moderate-high refractive error. Corneal cross-linking (CXL) should be performed before considering PIOL implantation in cases with progressive KC, and intrastromal corneal ring segments (ICRSs) should be considered before PIOL implantation in cases of high irregular astigmatism. PIOLs are also effective for the management of postkeratoplasty ametropia. PIOLs are a valid strategy for the visual rehabilitation in patients with stable KC with moderate-high ametropia, with a good safety profile. This procedure can be combined with other techniques, including CXL and ICRS implantation. Continuous follow-up is advised, particularly concerning refractive stability and endothelial cell loss.