Ophthalmology Department, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Umm AlHamam AlGharbi, AlUrubah road, Riyadh, Saudi Arabia.
Int Ophthalmol. 2021 Jul;41(7):2609-2618. doi: 10.1007/s10792-021-01820-2. Epub 2021 Mar 27.
To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Monrovia, CA, USA) in mild to advance keratoconus patients with myopia and myopic astigmatism.
This retrospective study evaluated all patients who underwent ICL implantation for the management of keratoconus at a tertiary care eye hospital from January 2012 to January 2018. The mean duration of follow-up was 15.3 months (range, 3.13 to 38.97 months). Data were collected on preoperative and postoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction was compared, and adverse effects were evaluated.
Thirty-two eyes (32 patients) were evaluated. The median CDVA was 20/30 preoperatively and 20/20 at last follow-up. The median UDVA was 20/25 at last follow-up. Thirteen patients (40.6%) had 20/20 UDVA in comparison to none at baseline. The median spherical equivalent in diopters (D) was -7.875 D (-4.125 to -10.0 D) preoperatively and decreased to -0.3125 D at last follow-up. The median manifest refractive cylinder was 3.00 D (2.25 to 5.25 D) preoperatively and decreased to 1.125 D postoperatively. Cylinder axis rotation of 10° or greater occurred in 3 eyes (9.375%) and required repositioning of the ICL. One patient (3%) developed nonvisually significant anterior subcapsular cataract. One ICL (3.125%) had to be explanted due to residual refractive error and unsatisfactory vision.
ICLs are a suitable refractive option for the correction of refractive error associated with stable, nonprogressive keratoconus even in advance cases. However, the risk of ICL rotation and subsequent repositioning remain. Careful patient selection is necessary for achieving good outcomes and mitigating intraoperative and postoperative complications.
评估可植入式胶原透镜（ICL；（Visian，STAAR Surgical，Monrovia，CA，USA）在轻至进展性圆锥角膜伴近视和近视散光患者中的疗效和安全性。
本回顾性研究评估了 2012 年 1 月至 2018 年 1 月在一家三级眼科医院因圆锥角膜接受 ICL 植入治疗的所有患者。平均随访时间为 15.3 个月（范围，3.13 至 38.97 个月）。收集术前和术后未矫正距离视力（UDVA）和矫正距离视力（CDVA）的数据，比较屈光度，并评估不良反应。
共评估了 32 只眼（32 例患者）。术前 CDVA 的中位数为 20/30，末次随访时为 20/20。末次随访时 UDVA 的中位数为 20/25。与基线时相比，13 例（40.6%）患者 UDVA 达到 20/20。术前等效球镜度中位数为-7.875 D（-4.125 至-10.0 D），末次随访时降至-0.3125 D。术前平均角膜散光为 3.00 D（2.25 至 5.25 D），术后降至 1.125 D。3 只眼（9.375%）发生 10°或更大的散光轴旋转，需要重新定位 ICL。1 例（3%）患者出现非视觉显著的前囊下白内障。1 例 ICL（3.125%）因残留屈光误差和不满意的视力而不得不取出。
ICL 是治疗稳定、非进展性圆锥角膜伴近视散光的一种合适的屈光选择，即使是在进展期病例中。然而，ICL 旋转和随后的重新定位的风险仍然存在。仔细选择患者对于获得良好的结果和减轻术中及术后并发症至关重要。
