Artisan Phakic Intraocular Lens in Patients With Keratoconus

PURPOSE: To assess the safety, efficacy, predictability, and refractive outcome of implanting Ophtec Artisan phakic intraocular lenses (pIOLs) in eyes with keratoconus. METHODS: In this retrospective study, 18 eyes of 11 patients diagnosed with keratoconus who underwent toric or myopic pIOL implantation were followed for 1 year postoperatively. Mean patient age was 41+/-10.97 years (range: 23 to 64 years). Preoperative manifest refractive sphere was -4.64+/-2.74 diopters (D) (range: -9.75 to 0.00 D) and cylinder was -3.07+/-2.04 D (range: -7.75 to -0.50 D). Inclusion criteria were preoperative best spectacle-corrected visual acuity (BSCVA) of 0.30 or better and stable refraction (</=0.50-D change in manifest refraction spherical equivalent [MRSE] yearly). Refractive outcomes and endothelial cell counts were analyzed primarily for 6-month follow-up and when available for 1-year follow-up. RESULTS: The mean postoperative MRSE was -0.46+/-0.60 D (range: -1.88 to 0.13 D). Twenty-two percent (4/18) of eyes had an uncorrected visual acuity (UCVA) of 1.0 or better and 94% (17/18) of eyes had a UCVA of 0.63 or better. Sixty-one percent (11/18) of eyes had an MRSE within +/-0.50 D of the intended correction and 72% (13/18) of eyes gained one or more lines of BSCVA and no eyes lost lines of BSCVA. Mean endothelial cell counts decreased by 23 cells/mm(2) at 6 months postoperatively. CONCLUSIONS: The implantation of Artisan iris-fixated pIOLs in patients with stable keratoconus for correction of astigmatism and myopia is safe, predictable, and effective with minimal complications. Due to the progressive nature of keratoconus, proper patient counseling is necessary.