Simultaneous corneal crosslinking and surface ablation combined with phakic intraocular lens implantation for managing keratoconus

To assess the efficacy and stability of simultaneous topography-guided photorefractive keratectomy (PRK) and crosslinking (Athens protocol) followed by phakic intraocular lens (IOL) implantation for managing keratoconus. Ain-Shams University, Cairo, Egypt. Prospective non-randomized study. All patients underwent topography-guided PRK followed immediately by collagen crosslinking (Athens protocol), 2–4 months later, eyes were implanted with either an iris claw or an angle-supported phakic IOL. Statistical analysis was performed with SigmaPlot software version 11.0 (Systat Software, Inc.). This study evaluated 22 eyes of 14 patients. Follow-up interval was at least 6 months. A Veriflex phakic IOL was implanted in 14 eyes (63.6 %), and a Cachet phakic IOL was implanted in 8 eyes (36.4 %). The mean preoperative keratometric reading (45.57 ± 1.51 D) was significantly reduced at 3 months and at 6 months after treatment (43.82 ± 1.98 D, P < 0.001). The mean spherical equivalent was significantly reduced from −9.08 ± 2.5 to −0.69 ± 0.67 D, P = <0.001. The mean UCVA improved from 1.24 ± 0.49 to 0.37 ± 0.08 logMAR. The mean corrected distance visual acuity (CDVA; logMAR) improved from 0.69 ± 0.3 preoperatively to 0.35 ± 0.01 postoperatively (P = <0.001). At last follow-up, all eyes could achieve CDVA of 0.3 or better. The difference between pre- and postoperative endothelial cell counts was not statistically significant. Combining phakic IOLs and the Athens protocol improved and stabilized visual performance in patients with keratoconus. These results justify a future, large-scale study with a longer follow-up.