Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty: Retrospective Case Series Analysis With Long-Term Follow-Up

Figures & data

Table 1 Preoperative Parameters Of The Study Population

Patient	Age At The Time Of IOL Implantation (Years)	Time Between DALK And IOL Implantation (Months)	Preoperative Subjective Refraction (D)	Preoperative ECD (Cells/mm^Citation2)	Preoperative ACD (mm)
1	26	314	−5.0–4.5×170°	2674	3.59
2	27	25.9	−13.0–2.0×150°	2404	3.75
3	37	34.6	+2.5–6.5×10°	1515	3.20
4	34	42.0	−6.0×30°	2320	3.25
5	36	63.3	−7.5–10.0×145°	2915	3.70
6	42	39.3	−8.0–10.0×90°	1835	4.11
7	24	30.6	−4.0–5.0×55°	1800	3.83
8	18	30.2	−7.0–7.0×145°	2703	3.88
9	35	29.6	−1.0–8.5×50°	2250	3.31
10	23	35.9	−5.5–11.0×10°	2994	3.70
11	26	29.4	+3.0–11.0×105°	2088	3.74

Figure 1 Postoperative slit-lamp photograph 1 year after toric Artisan phakic intraocular lens implantation in eye with previous DALK.

Table 2 Mean Preoperative And 1, 3 And 5 Years Postoperative Results Of Toric Phakic IOL Implantation After DALK: Comparative Analysis

Outcomes	UDVA		CDVA		Refractive Cylinder		ECD (Cells/mm^Citation2)
	Mean±SD	p-Value	Mean±SD	p-Value	Mean±SD	p-Value	Mean±SD	p-Value
Preoperative vs 1 year postoperative (n=11)	1.27±0.90 vs 0.16±0.15	≤0.001	0.16±0.14 vs 0.07±0.09	0.008	−7.41±3.61 vs −1.00±0.95	≤0.001	2318±457 vs 2108±547	0.020
Preoperative vs 3 year postoperative (n=11)	1.27±0.90 vs 0.22±0.17	≤0.001	0.16±0.14 vs 0.08±0.10	0.011	−7.41±3.61 vs −1.63±0.90	≤0.001	2318±457 vs 1961±574	0.007
Preoperative vs 5 year postoperative (n=5)	1.30±0.0 vs 0.12±0.11	≤0.001	0.14±0.09 vs 0.02±0.04	0.033	−6.75±2.04 vs −0.85±0.49	≤0.001	2105±438 vs 1768±548	0.137
1 year postoperative vs 3 years postoperative (n=11)	0.16±0.15 vs 0.22±0.17	0.364	0.07±0.09 vs 0.08±0.10	0.341	−1.00±0.95 vs −1.63±0.90	0.006	2108±547 vs 1961±574	0.523
1 year postoperative vs 5 years postoperative (n=5)	0.16±0.21 vs 0.12±0.11	0.757	0.02±0.04 vs 0.03±0.07	0.945	−0.37±0.40 vs −0.85±0.49	0.102	2018±180 vs 1768±548	0.090
3 years postoperative vs 5 years postoperative (n=5)	0.14±0.09 vs 0.12±0.11	0.317	0.04±0.05 vs 0.03±0.07	0.317	−0.83±0.44 vs −0.85±0.49	0.921	1840±591 vs 1768±548	0.255

Note: Significant values are shown in bold.

Figure 2 Cumulative uncorrected distance visual acuity 1 year after surgery (n=11).

Figure 3 Change in corrected distance visual acuity 1 year after surgery (n=11).

Figure 4 Preoperative and 1 year postoperative refractive cylinder (n=11) in diopters.

Figure 5 Spherical equivalent refractive accuracy 1 year after surgery (n=11).

Figure 6 Stability of spherical equivalent during follow-up.

Table 3 Visual And Refractive Outcomes At 3 Years Follow-Up

Patient	Pre-UDVA (logMAR)	Pre-BDVA (logMAR)	Preoperative Refraction (D)	Type Of Toric Phakic IOL Implanted	3 Years Post-UDVA (logMAR)	3 Years Post-BDVA (logMAR)	3 Years Postoperative Refraction (D)
1	1.30	0.20	−5.0–4.5×170°	Artiflex	0.30	0.10	−0.75–2.50×100°
2	1.30	0.00	−13.0–2.0×150°	Artisan	0.00	0.00	−0.50×170°
3	1.30	0.00	+2.5–6.5×10°	Artisan	0.00	0.00	−0.50×20°
4	1.30	0.10	−6.0×30°	Artisan	0.20	0.10	−1.00–2.00×110°
5	1.30	0.20	−7.5–10.0×145°	Artisan	0.20	0.10	−2.00–2.00×55°
6	1.30	0.50	−8.0–10.0×90°	Artisan	0.50	0.30	−1.00–1.00×70°
7	1.30	0.20	−4.0–5.0×55°	Artiflex	0.20	0.00	−1.50×35°
8	1.30	0.20	−7.0–7.0×145°	Artiflex	0.20	0.10	−1.25×110°
9	1.30	0.20	−1.0–8.5×50°	Artisan	0.20	0.00	−1.00–0.50×40°
10	1.30	0.00	−5.5–11.0×10°	Artisan	0.50	0.00	−3.00–0.75×0°
11	1.00	0.20	+3.0–11.0×105°	Artisan	0.20	0.10	+1.00–2.50×100°

Table 4 Differences In Corneal Thickness, Anterior Chamber Depth And Topographic Astigmatism During Follow-Up

	Preoperative	1 Year (n=11)	3 Years (n=11)	5 Years (n=5)	p-Value 3 YearsFollow-Up (n=11)	p-Value 5 YearsFollow-Up (n=5)
Corneal thickness (um)	518±56.1	515±48.2	507±52.8	536±22.3	0.661	0.847
ACD (mm)	3.62±0.33	3.53±0.35	3.48±0.26	3.48±0.41	0.154	0.528
Topographic astigmatism (D)	6.82±2.70	5.88±3.49	5.49±3.95	5.24±2.10	0.387	0.089

Table 5 Summary Of Authors And Their Study’ Results For ECD Loss After Keratoplasty And After Phakic IOLs Implantation In Eyes With And Without Keratoplasty

Author, Year	Technique	Sample Size(n= Eyes)	Country	ECD Loss
Tiveron et al,^Citation12 2017	Artisan and Artiflex IOLs after DALK	24	Spain	1 year: 6.10%
Tahzib et al,^Citation8 2006	Artisan IOL after PK	34	The Netherlands	1 year: 21.2% (n=34) 3 years: 30.4% (n=18)
Cheng,^Citation25 2011	PK vs DALK	56	The Netherlands	1 year: 27.7% PK vs 12.9% DALK
Pop,^Citation26 2004	Artisan IOL without keratoplasty	765	Canada	1 year: 0.87%
Hashemi,^Citation27 2013	Artisan IOL without keratoplasty	53	Iran	1 year: 3.04%
Silva,^Citation28 2008	Artisan IOL without keratoplasty	26	USA	5 years: 14.0%
Guerin et al,^Citation29 2014	Artiflex IOL without keratoplasty	28	Ireland	1 year: 6.17%
Jonker,^Citation30 2018	Artiflex IOL without keratoplasty	188	The Netherlands	5 years: 10.2%
Our Center, 2018	DALK	47	Portugal	1 year: 5.3%
Current study, 2019	Toric phakic IOLs after DALK	11	Portugal	1 year: 8.7% (n=11) 3 years: 13.1% (n=11) 5 years: 14.0% (n=5)

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