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    Posterior IOLs effective in keratoconus


    Measuring success

    To get a perspective on the success of these posterior chamber pIOLs, Dr Esteve-Taboada and colleagues searched for studies. They found 33 of which 22 were clinical reports, 5 were overviews of keratoconus solutions and 2 were brief reviews.

    The manufacturer usually performs the power calculation for pIOLs, using the astigmatism decomposition method or an online calculator provided by the manufacturer that can be accessed by the surgeons.

    They often select emmetropia as the target refraction to reduce the preoperative refractive errors.

    The manufacturer typically chooses the pIOL size based on the horizontal corneal diameter and anterior chamber depth determined with scanning-slit topography.

    The posterior chamber pIOL is inserted into the anterior chamber using an injector cartridge. It unfolds slowly and the surgeon places 4 footplates under the iris.

    Generally, the best outcomes are thought to be achieved when CXL is performed prior to pIOL implantation. Combining ICRS with pIOLs may offer the benefits of both. Inserting both simultaneously provides a better view for the pIOL insertion. On the other hand, inserting the ICRS insertion first produces keratometry readings to ensure better prediction of the pIOL power.

    Potential long-term complications following posterior chamber pIOL implantation include cataract, pigment dispersion syndrome, pupillary block glaucoma, chronic uveitis, posterior dislocation of the pIOL to the vitreous, and iris ovalisation.

    Researchers have reported attempts to improve vision in keratoconic patients since 2007, with a wide range of adults.

    In the first study, Coskunseven et al. evaluated the results of combined ICRS and toric pIOL implantation in 3 eyes of 2 keratoconic patients with extreme myopia and irregular astigmatism. Both corrected and uncorrected distance visual acuity improved in all patients. The mean manifest refractive spherical equivalent (SE) refractive error decreased from -18.50 D to 0.42 D. The mean improvement in CDVA was 4.33 lines.

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