Supplementary Material for: Posterior chamber phakic intraocular lenses for correcting ametropia in stable keratoconus

Introduction: The use of posterior chamber phakic intraocular lenses are a reasonable option in the armamentarium to treat refractive error in patients with keratoconus. We present our experience with the use of posterior chamber phakic intraocular lens (PCPIOL) for the management of ametropia in patients with keratoconus. Methods: Patients included those with stable keratoconus treated in the Corneoplastic Unit, Queen Victoria Hospital. East Grinstead, United Kingdom, with PCPIOL (ICL Staar Surgical and IPCL Care Group) to improve their visual acuity. Data were obtained from preoperative visit and 1, 3, 6 and 12 months after surgery. Clinical characteristics, pre- and postoperative uncorrected (UDVA) and best corrected (CDVA) logMAR visual acuities and perioperative complications were analyzed. Results: 23 eyes of 21 patients were included. UDVA changed from 0.75 preoperatively to 0.18 post-surgery (P = < 0.001) and CDVA from 0.07 to 0.12 (P = 0.12). Seventy percent of the cases increased 3 or more lines of UDVA while none of the eyes lost more than 2 lines of CDVA. No significant difference in final UDVA was found between patients with and without previous keratoplasty (0.27 and 0.18, P=0.38), previous corneal collagen crosslinking (0.16 and 0.3, P=0.24), intracorneal ring segments (0.2 and 0.2, P=0.94) or type of lens implanted (0.2 ICL and IPCL. P = 0.94). One intraoperative complication reported was an inverted PCPIOL insertion and postoperatively 4 axis rotations and 1 cataract were observed. Conclusions: The use of PCPIOL in patients with stable keratoconus is effective in improving their UDVA, even in cases with previous corneal procedures such as keratoplasty, crosslinking and intracorneal rings. Rotation is the most common postoperative complication.

引言：后房型有晶状体眼人工晶状体（posterior chamber phakic intraocular lens, PCPIOL）是圆锥角膜患者屈光不正治疗的合理可选方案之一。本文介绍了我们应用后房型有晶状体眼人工晶状体（PCPIOL）治疗圆锥角膜患者屈光不正的临床经验。方法：研究对象为英国东格林斯特德市维多利亚女王医院角膜整形诊疗单元收治的稳定型圆锥角膜患者，均接受后房型有晶状体眼人工晶状体（PCPIOL，包括Staar Surgical公司ICL及IPCL Care Group产品）植入术以改善视力。数据采集自术前随访及术后1、3、6、12个月的随访资料。本研究分析了患者的临床特征、术前与术后的裸眼远视力（uncorrected distance visual acuity, UDVA）、最佳矫正远视力（corrected distance visual acuity, CDVA）的logMAR值，以及围手术期并发症情况。结果：本研究共纳入21例患者的23只患眼。术后裸眼远视力（UDVA）从术前的0.75提升至0.18（P<0.001），最佳矫正远视力（CDVA）从术前的0.07提升至0.12（P=0.12）。70%的患者术后裸眼远视力提升至少3行，且无患眼的最佳矫正远视力下降超过2行。对比既往接受过角膜移植、角膜胶原交联术、角膜基质环植入术的患者与未接受过上述手术的患者，其最终裸眼远视力无显著差异（分别为0.27与0.18，P=0.38；0.16与0.3，P=0.24；0.2与0.2，P=0.94）；不同植入晶状体类型（ICL与IPCL）患者的最终裸眼远视力亦无显著差异（分别为0.2与0.2，P=0.94）。术中并发症1例，为后房型有晶状体眼人工晶状体植入反转；术后并发症包括4例晶状体轴位旋转及1例白内障。结论：对于稳定型圆锥角膜患者，应用后房型有晶状体眼人工晶状体（PCPIOL）可有效提升其裸眼远视力，即便患者既往已接受角膜移植、角膜胶原交联术或角膜基质环植入术等角膜手术。术后最常见的并发症为晶状体轴位旋转。