Efficacy of implantable Collamer lens after corneal cross-linking in patients with keratoconus: a systematic review and meta-analysis.

PURPOSE: To determine the efficacy of implantable Collamer lens (ICL) implantation after corneal collagen cross-linking in keratoconus.

METHODS

We searched PubMed, Cochrane CENTRAL, SCOPUS, Web of Science, and Google Scholar from inception until October 2022. We included the relevant studies that assessed ICL implantation post-corneal collagen cross-linking in patients with keratoconus. The efficacy endpoints were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction (sphere, cylinder, spherical equivalent), and keratometry.

RESULTS

Seven observational studies were eligible for this systematic review and meta-analysis. ICL implantation showed an improvement in UDVA, 6 months postoperative, with a mean change of - 1.27 log MAR (95% CI [- 1.63 to - 0.9]. However, there was a non-significant improvement in CDVA with a mean change of - 0.04 log MAR (95% CI [- 0.11 to 0.02]. A trend toward the improved sphere and spherical equivalent was observed for all eyes after the ICL implantation approach: mean change of 6.82 diopters (95% CI 3.24 to 10.4) for the sphere and 7.30 diopters (95% CI [4.18 to 10.43]) for the spherical equivalent. The refractive cylinder was not improved after ICL implantation 0.62 diopters (95% CI [- 0.53 to 1.77].

CONCLUSION

The ICL implantation approach appears to be effective for improving visual acuity in patients with keratoconus without adversely affecting corneal keratometry after crosslinking.