Comparative Analysis of the Visual Performance after Implantation of the Toric Implantable Collamer Lens in Stable Keratoconus: A 4-Year Follow-Up after Sequential Procedure (CXL+TICL Implantation)

To report on 4-year postoperative visual performance with the toric implantable collamer lens (TICL) for stable keratoconus after sequential procedure (corneal collagen crosslinking plus TICL implantation). Methods: Five keratoconus patients (10 eyes) that had bilateral AT LISA 939 implantation of were selected and had followed in three-time horizons of 1 and 3months, and 2 years. Patients were 46 to 65 years old age, corneal astigmatism of (2.00 D at 6.75) and cataract that all of them needed cataract surgery. The distance, intermediate and near visual acuities, defocus curve, ocular aberrations, contrast sensitivity, were measured as effectiveness criteria. Results: At 4-year follow-up, 45% had 20/20 vision or better and 100% had 20/40 or better uncorrected visual acuity (UCVA). Vector analysis of refractive astigmatism shows that the surgically induced astigmatism (SIA) (3.20±1.46 D) was not significantly different from the target induced astigmatism (TIA) (3.14±1.42 D) (p=0.620). At 4 years postoperatively, none of the eyes showed a decrease in UCVA, in contrast to 24 eyes in which UCVA was increased by ≥1 lines, with contrast sensitivity and improvement in total aberrations and MTF value at 5 per degree (p=0.004) after TICL implantation. The cumulative 4-year corneal endothelial cell loss was ≤5%. No patients reported dissatisfaction. At the end of follow-up, the vault was 658±54.33m (range, 500–711) and the intraocular pressure was 11.7±2.08 mm Hg. Occurrences of glare and night-driving troubles diminished after TICL surgery.Conclusion: The results from this standardised clinical investigation support TICL implantation from clinical and optical viewpoints in patients with stable keratoconus