Abstract
AbstractCorneal ectasia includes primary corneal ectasia (keratoconous, pellucid marginal corneal degeneration (PMD), and keratoglobus) and secondary corneal ectasia (postlaser vision correction corneal ectasia, postcorneal trauma). Keratoconous is a bilateral progressive corneal disease mostly. It could result in unavoidable conical protrusion, irregular astigmatism, and decreased visual acuity and quality.In early stages, keratoconous visual symptoms could be managed with spectacles, and contact lenses. However, as keratoconous progresses to severe stages, surgical intervention will be warranted to gain appropriate vision. Most patients seek treatment for keratoconous for cessation of ectasia and improvement of refractive errors and aberrations. However, correction of corneal irregularity and reduction of higher-order and lower-order aberrations seem to be a very challenging aim to achieve in the cornea with irregular astigmatism.The multiple alternative options for patients with contact lens intolerance have evolved and include stabilizing the cornea with corneal collagen cross-linking (CXL), regularizing the cornea with intracorneal ring segment (ICRS) implantation and performing topography-guided excimer laser ablation, and treating myopic astigmatism with toric phakic intraocular lens (pIOL). Also, for refractive management of keratoconus, PMD and postlaser vision correction corneal ectasia, multiple procedures suggested to improve visual and refractive status and stabilizing corneal structure together comprise of CXL plus intracorneal ring segments implantation (ICRS); CXL plus phakic intraocular lens implantation (pIOL); CXL plus photorefractive keratectomy (PRK); and CXL plus ICRS plus pIOLs implantation. In this chapter, latest advances in the refractive management of keratoconus by pIOLs implantation, preoperative evaluations, patient selection, indications, surgical technique, and complications will be reviewed.KeywordsKeratoconusPhakic IOLMyopiaAstigmatismICL
Published Version
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