Safety and visual outcome of Visian toric ICL implantation after corneal collagen cross-linking in keratoconus

PURPOSE: To evaluate the safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. METHODS: A retrospective study examined the results of the two-step CXL and Visian toric ICL implantation in 16 eyes of 10 patients with keratoconus. The two procedures were done at an interval of 6 months. Data were collected preoperatively, at the 6-month follow-up visit after CXL, and at the 6-month follow-up visit after ICL implantation. RESULTS: CXL induced a statistically significant decrease in steep keratometry (50.02 ± 4.07 at baseline to 48.74 ± 4.05 at 6 months after CXL, P = .001) without any significant change in visual acuity or refraction. At 6-month follow-up after ICL implantation, mean K (max) was 50.49 ± 4.07 versus 52.29 ± 4.79 D at baseline ( P = .001). Mean uncorrected distance visual acuity improved from 1.67 ± 0.49 to 0.17 ± 0.06 logMAR ( P = .001) and mean corrected distance visual acuity improved from 0.15 ± 0.06 to 0.12 ± 0.04 logMAR ( P = .023). Mean spherical equivalent decreased from −7.24 ± 3.53 to −0.89 ± 0.76 D ( P = .001) and mean cylinder decreased from 2.64 ± 1.28 to 1.16 ± 0.64 D ( P = .001). The safety and efficacy indices were 1.08 ± 0.13 and 0.97 ± 0.08, respectively. No intraoperative or postoperative complications occurred. CONCLUSIONS: Implantation of the Visian toric ICL following CXL is an effective option for improving visual acuity in patients with keratoconus.