Long-term efficacy and safety of iris-claw phakic intraocular lens in the management of postkeratoplasty astigmatism.

PURPOSE: To demonstrate the efficacy and safety of iris-claw phakic intraocular lens (pIOL) in the treatment of postkeratoplasty astigmatism.

SETTING

Cornea Unit, Ophthalmology Department, Unidade Local de Saúde de Santo António, Porto, Portugal.

DESIGN

Retrospective longitudinal study.

METHODS

Analysis of patients submitted to iris-claw pIOL implantation after previous penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) between January 2013 and December 2023. Patients submitted to other refractive procedures and without minimum 1-year follow-up were excluded. Demographic data, spherical equivalent, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were registered preoperatively, at the intermediate visit (12 to 18 months), 5 years, and 10 years postoperatively. Vector analysis to plot corneal surgically induced astigmatism was performed. Endothelial cell density (ECD) was evaluated at each visit using the same specular microscope.

RESULTS

We enrolled 39 eyes of 29 patients submitted to keratoplasty due to keratoconus (71.8% [n = 28] DALK). At the intermediate visit, 19 eyes (49%) had a postoperative UDVA ≥20/32 and 6 (15%) had ≥20/20. The efficacy index was 0.83. 16 (11%) achieved full refractive correction without loss of CDVA, and 9 (23%) gained ≥1 lines of vision. 28 (72%) eyes were within ±1.00 diopter (D) of planorefraction. Globally, 25 (64%) eyes showed a residual astigmatism ≤1.00 D. Average annual ECD loss was 3.07% for DALK and 9.34% for PK ( P = .006).

CONCLUSIONS

Iris-claw pIOL is effective for treating postkeratoplasty astigmatism. Given the risk for progressive endothelial cell loss, strict follow-up is mandatory, especially after PK.