To evaluate the safety and efficacy of toric implantable Collamer lens (ICL) (STAAR Surgical) implanted at least 6 months after combined topography-guided photorefractive keratotomy (TG-PRK) and corneal cross-linking (CXL) in keratoconus.
This retrospective study included 46 eyes with keratoconus of 31 patients who underwent toric ICL implantation after previous TG-PRK+CXL. Patients were examined for uncorrected (UDVA) and corrected (CDVA) distance visual acuity, flat and steep keratometry, and manifest refraction spherical equivalent preoperatively and 12 months postoperatively.
At 12 months postoperatively, there was a statistically significant improvement in visual and refractive outcomes (all < .001). Mean UDVA improved to 0.17 ± 0.14 logMAR (vs 1.00 ± 0.38 logMAR preoperatively) and mean manifest refraction spherical equivalent improved to -0.32 ± 1.42 diopters (D) (vs -7.35 ± 5.20 D preoperatively). At 12 months, 63% of eyes achieved UDVA of 20/32 or better and 60.9% of eyes were within ±0.50 D of manifest refraction spherical equivalent. Mean refractive astigmatism improved from -2.90 ± 2.21 D preoperatively to -1.47 ± 1.46 D at postoperative 12 months ( < .001), with 30.4% and 45.7% of eyes having a postoperative astigmatic error within ±0.50 and ±1.00 D, respectively. No complications were observed.
Toric ICL implantation was found to be safe and effective for the correction of myopia and myopic astigmatism in patients with stable keratoconus who had undergone TG-PRK+CXL, as revealed by the statistically significant improvement in visual and refractive outcomes at 12 months after toric ICL implantation. .

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