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    Posterior IOLs effective in keratoconus


    In one of the larger studies that followed, Alfonso et al. reported on 30 eyes of 21 patients with a follow-up of 12 months. Preoperatively, the mean SE was -5.38 D and the mean cylinder was -3.48. Postoperatively, the mean SE was -0.08 D and the mean cylinder was 0.41 D.

    No consensus has emerged on inclusion criteria for implanting posterior chamber pIOLs, Dr Esteve-Taboada and colleagues report. Some authors have included only patients with a corrected distance visual acuity of 20/50 or better and some with a corrected distance visual acuity of 40/50 or better.

    While they agree on the need for a stable refraction, these authors have listed periods of stability from 6 months to 2 years. The time for discontinuation of rigid gas-permeable contact lens ranges from 2 weeks to 6 months before corneal topography is performed. The authors gave minimum patient ages from 20 years to 30 years or older.

    However, there is consensus on the minimum anterior chamber depth being 2.8 mm; that there should be no corneal opacification or scars; and that the endothelial cell density should be greater than 1,800 cells/mm2 or greater than 2,000 cell/mm2.

    All the authors agreed that cataract, history of glaucoma or retinal detachment, macular degeneration or retinopathy, neuro-ophthalmic disease, and history of ocular inflammation are the main exclusion criteria.

    Dr Esteve-Taboada et al. concluded that controlled studies with larger cohorts and longer-follow-periods are necessary to determine which refractive procedure and which sequence are most suitable in combination with CXL for the various stages of corneal ectasia.

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