Combined Intacs and Posterior Chamber Toric Implantable Collamer Lens Implantation for Keratoconic Patients with Extreme Myopia

Abstract

To evaluate the results of combined Intacs (Addition Technology, Fremont, California, USA) and posterior chamber toric implantable Collamer lens [ICLs] (Visian ICL; STAAR Surgical, Monrovia, California, USA) implantation in keratoconic patients with extreme myopia and irregular astigmatism. Prospective, single-center, noncomparative, interventional, consecutive case series. Three eyes of two consecutive highly myopic keratoconic patients who had undergone posterior chamber toric ICLs implantation after Intacs implantation. Implantation of posterior chamber toric ICLs was performed at intervals between six and 10 months after Intacs implantation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, adverse events, and postoperative complications were noted. No intraoperative or postoperative complications were observed. An improvement in UCVA and BSCVA was found after the Intacs and toric Visian ICL procedures in all eyes. All eyes were emmetropic within 1 diopter (D), whereas the mean manifest refractive spherical equivalent refraction reduced from -18.50 +/- 2.61 D (range, -16.75 to -21.50 D) to 0.42 D (range, plano to -0.75 D). The mean difference between preoperative and last follow-up UCVA and BSCA was a gain of 6.67 +/- 1.15 lines (range, gain of six to eight lines) and 4.33 +/- 2.52 lines (range, gain of two to seven lines), respectively. Combined Intacs and posterior chamber toric phakic Visian ICL implantation in a two-step procedure is an effective method for correcting keratoconic patients with extreme myopia.