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    Cornea/External Disease

    This prospective, nonrandomized study found that keratoconic eyes that underwent toric implantable collamer lens (TICL) implantation 12 months after collagen crosslinking (CXL) experienced promising visual outcomes, particularly in the astigmatic component of refraction.

    These results are encouraging and hopefully can be substantiated by future larger studies. The authors suggest that there may be more options for ocular surgery after corneas have been stabilized with CXL.

    In this study, 16 eyes with early-stage keratoconus underwent CXL at least one year prior to implantation of a TICL (STAAR Surgical). Mean preoperative sphere and cylinder were –5.98 and –4.91, respectively.

    Three years postop, sphere and cylinder improved significantly, as did UDVA. Endothelial cell loss was minimal, and no complications were observed.

    The authors say the significant visual improvement seen in this study could be attributed to the effect of CXL on flattening/regularizing the cornea.

    However, they recommend against TICL implantation in keratoconus until refraction and keratometry are stable after CXL. They suggest the following indications: CDVA ≥ 20/50, clear central cornea and stable refraction for at least 12 months after CXL. They say that if these criteria are not met, a penetrating keratoplasty would probably provide better visual outcomes.