The aim was to evaluate the long-term safety, efficacy, stability and predictability of posterior chamber phakic intraocular lens (pIOL) implantation to correct myopia and myopic astigmatism associated with keratoconus.

Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction, and adverse effects were evaluated in 23 keratoconic eyes of 13 patients after 5 years with Visian ICMV4 pIOL (STAAR Surgical Inc.).

The mean pre-operative spherical equivalent (SE) and cylinder changed from -5.35  2.82 diopters (D) and -3.14 1.58 D to -.78  1.31 D and -1.56  1.53 D, respectively 5 years postoperatively. Before the surgery the mean Snellen decimal CDVA was .60  0.20. The mean UDVA and CDVA changed to 0.74  0.22 and 0.88  0.16, respectively. 82.5% of eyes achieved 20/40 or better UDVA postoperatively. The mean safety and efficacy indices were 1.47  0.32 and 1.24  0.34, respectively. No eye lost a line of visual acuity and 19 eyes gained one or more lines. 11% Endothelial cell loose was occurred. No significant changes in intraocular pressure, steep, flat and mean keratometry was seen during the study. Crystalline lens was clear.

The clinical outcomes of the current study demonstrate the safety, efficacy and predictability of toric implantable collamer lens in the correction of myopia and myopic astigmatism associated with keratoconus. The patients’ refractions achieved early stability and remained stable during the course of the study.