Hgell2013

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Güell JL (ed): Cataract. ESASO Course Series. Basel, Karger, 2013, vol 3, pp 100–115 DOI: 10.1159/000350912

Phakic Intraocular Lenses in Keratoconus Jose L. Güell  ·  Daniel Elies  ·  Paula Verdaguer  ·  Oscar Gris  ·   Felicidad Manero  ·   Merce Morral

Abstract There are several circumstances where phakic intrao­ cular lenses (IOLs) might be considered in the manage­ ment of the keratoconic patient, obviously only in the case of a stable refractive situation, sometimes difficult to be defined in this setting. Taking into account that the IOLs will only correct the sphere and the regular com­ ponent of the astigmatism, sometimes they will be used in combination with other surgical strategies such as col­ lagen crosslinking and/or intracorneal ring segments. In this chapter, we will evaluate the conceptual possible ­indications for them and review the published data as well as our own experience during these last 15 years. Copyright © 2013 S. Karger AG, Basel

Keratoconus (KC), with a reported incidence of 1 per 2,000 in the general population, is a noninflammatory corneal disease that develops progressive thinning and anterior bulging of the cornea. Corneal ectasia frequently induces varied degrees of myopia and/or astigmatism [1]. In early stages, spectacles and contact lenses (CL) are the treatment of choice [2–4]. However, a considerable amount of patients with progressive KC have not only reduced visual acuity with spectacles due to irregular astigmatism [5, 6], but also reduced tolerance to CL [7–10].

Before the advent of modern refractive surgery techniques, penetrating keratoplasty or deep anterior lamellar keratoplasty was the treatment of choice when a patient with KC became CL intolerant or had poor best spectacle-corrected visual acuity. This is still true in advanced stages of the disease, where severe thinning and/or corneal scarring occurs. Because refractive anisometropia and high postoperative astigmatism are common pro­ blems after penetrating keratoplasty, visual rehabilitation and return to binocular function may be slow [11–15]. Moreover, complications related to corneal transplant surgery itself, such as endophthalmitis or rejection episodes, should also be taken into account [16–21]. Therefore, in the early stages of KC when the central cornea remains clear, other options should be considered to avoid or delay keratoplasty. With the exception of some anecdotal repor­ ts, corneal incisional (radial keratotomy, or arcuate keratotomy) and ablative refractive approaches such as photorefractive keratectomy (PRK) or LASIK are contraindicated in KC, as they increa­ se the risk of progressive, irreversible corneal ectasia [22–25]. Available refractive procedures include intrastromal corneal ring segments (ICRS), and toric phakic intraocular lenses (TPIOLs). The

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Instituto Microcirugía Ocular, Universidad Autónoma de Barcelona, Barcelona, Spain


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