Outcomes of refractive implantable lens implantation after deep anterior lamellar keratoplasty

PURPOSE: To assess the refractive outcomes and effect on endothelial cell density of refractive implantable lens (RIL) implantation following deep anterior lamellar keratoplasty (DALK). METHODS: A retrospective study was conducted on 10 eyes of 10 patients who had undergone DALK and subsequently underwent toric RIL implantation. The patients were followed up over a period of 1 year. The parameters compared were uncorrected and best corrected visual acuity, spherical and cylindrical acceptance, mean refractive spherical equivalent, and endothelial cell counts. RESULTS: There was a significant improvement (P < 0.05) from preoperatively to 1 month postoperatively in the mean log of minimum angle of resolution (logMAR) uncorrected distance visual acuity (UCVA; 1.1 ± 0.1 to 0.3 ± 0.1), spherical refraction (5.4 ± 3.8 to 0.3 ± 0.1 D), cylindrical refraction (5.4 ± 3.2 to 0.8 ± 0.7 D), and MRSE (7.4 ± 3.5 to 0.5 ± 0.4 D). Three patients achieved spectacle independence for distance vision with a residual MRSE less than 1 D in the other cases. A stable refraction was maintained up to 1 year follow-up in all cases. There was a 2.3% mean decline in endothelial cell counts at 1 year of follow-up. No intraoperative or postoperative complications were seen in any case up to 1 year of follow-up. CONCLUSION: RIL implantation is an effective and safe procedure for the correction of high ametropia post-DALK.