{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:09:18Z","timestamp":1789063758877,"version":"build-2803163510"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johannes Kepler University Linz"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this retrospective study, iris-fixated pIOLs (Artisan\/Artiflex (Ophtec\u00ae), Verisyse\/Veriflex (AMO\u00ae)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6\u00a0weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The mean postoperative uncorrected distance visual acuity (UDVA<jats:sub>post<\/jats:sub>) was 0.25\u2009\u00b1\u20090.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVA<jats:sub>pre<\/jats:sub>), which was 0.24\u2009\u00b1\u20090.13 logMAR. Twenty-seven eyes (71%) reached UDVA<jats:sub>post<\/jats:sub>\/CDVA<jats:sub>pre<\/jats:sub> \u2265\u20091 (efficacy index), whereas patients with PMD-like ectasia (<jats:italic>n<\/jats:italic>\u2009=\u200914) showed significantly (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) higher efficacy index (100%) than patients diagnosed with keratoconus (<jats:italic>n<\/jats:italic>\u2009=\u200924) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (<jats:italic>p<\/jats:italic>\u2009=\u20090.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVA<jats:sub>post<\/jats:sub>. The mean absolute spherical equivalent was significantly decreased from 5.71\u2009\u00b1\u20094.96 D to 1.25\u2009\u00b1\u20091.20 D (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). No significant difference was found in endothelial cell count.<\/jats:p>\n                \n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-020-05041-8","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T08:03:43Z","timestamp":1611043423000},"page":"1643-1649","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Toric phakic IOLs in keratoconus\u2014evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus"],"prefix":"10.1007","volume":"259","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-2605","authenticated-orcid":false,"given":"Isaak R.","family":"Fischinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jascha","family":"Wendelstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Tetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Bolz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred R.","family":"Tetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"issue":"1","key":"5041_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/eye.1987.2","volume":"1","author":"Y Pouliquen","year":"1987","unstructured":"Pouliquen Y (1987) Keratoconus. Eye 1(1):1\u201314","journal-title":"Eye"},{"issue":"4","key":"5041_CR2","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/S0014-4835(80)80027-3","volume":"31","author":"TT Andreassen","year":"1980","unstructured":"Andreassen TT, Simonsen AH, Oxlund H (1980) Biomechanical properties of keratoconus and normal corneas. Exp Eye Res 31(4):435\u2013441","journal-title":"Exp Eye Res"},{"issue":"1","key":"5041_CR3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1038\/eye.2017.198","volume":"32","author":"M Koc","year":"2018","unstructured":"Koc M, Tekin K, Inanc M, Kosekahya P, Yilmazbas P (2018) Crab claw pattern on corneal topography: pellucid marginal degeneration or inferior keratoconus? Eye 32(1):11\u201318","journal-title":"Eye"},{"issue":"4","key":"5041_CR4","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1038\/eye.1996.99","volume":"10","author":"CH Karabatsas","year":"1996","unstructured":"Karabatsas CH, Cook SD (1996) Topographic analysis in pellucid marginal corneal degeneration and keratoglobus. Eye 10(4):451\u2013455","journal-title":"Eye"},{"issue":"8","key":"5041_CR5","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1007\/s00417-018-3978-9","volume":"256","author":"I Fischinger","year":"2018","unstructured":"Fischinger I, Seiler TG, Santhirasegaram K, Pettenkofer M, Lohmann CP, Zapp D (2018) Corneal crosslinking (CXL) with 18-mW\/cm2 irradiance and 5.4-J\/cm2 radiant exposure\u2014early postoperative safety. Graefes Arch Clin Exp Ophthalmol 256(8):1521\u20131525","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"8","key":"5041_CR6","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1016\/j.jcrs.2019.03.018","volume":"45","author":"N Pircher","year":"2019","unstructured":"Pircher N, Lammer J, Holzer S, Gschlie\u00dfer A, Schmidinger G (2019) Corneal crosslinking for pellucid marginal degeneration. J Cataract Refract Surg 45(8):1163\u20131167","journal-title":"J Cataract Refract Surg"},{"issue":"4","key":"5041_CR7","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","volume":"42","author":"YS Rabinowitz","year":"1998","unstructured":"Rabinowitz YS (1998) Keratoconus. Surv Ophthalmol 42(4):297\u2013319","journal-title":"Surv Ophthalmol"},{"issue":"1","key":"5041_CR8","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1006\/exer.1997.0410","volume":"66","author":"E Spoerl","year":"1998","unstructured":"Spoerl E, Huhle M, Seiler T (1998) Induction of cross-links in corneal tissue. Exp Eye Res 66(1):97\u2013103","journal-title":"Exp Eye Res"},{"key":"5041_CR9","doi-asserted-by":"crossref","unstructured":"Randleman JB, Woodward M, Lynn MJ, Stulting RD (2008) Risk assessment for ectasia after corneal refractive surgery. Ophthalmology 115(1):37-50.e4","DOI":"10.1016\/j.ophtha.2007.03.073"},{"key":"5041_CR10","doi-asserted-by":"crossref","unstructured":"Randleman JB, Trattler WB, Stulting RD (2008) Validation of the ectasia risk score system for preoperative laser in situ Keratomileusis screening. Am J Ophthalmol 145(5):813-818.e2","DOI":"10.1016\/j.ajo.2007.12.033"},{"issue":"6","key":"5041_CR11","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.survophthal.2005.08.011","volume":"50","author":"CF Lovisolo","year":"2005","unstructured":"Lovisolo CF, Reinstein DZ (2005) Phakic intraocular lenses. Surv Ophthalmol 50(6):549\u2013587","journal-title":"Surv Ophthalmol"},{"issue":"7","key":"5041_CR12","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3928\/1081597X-20101223-02","volume":"27","author":"L Izquierdo","year":"2011","unstructured":"Izquierdo L, Henriquez MA, McCarthy M (2011) Artiflex phakic intraocular lens implantation after corneal collagen cross-linking in keratoconic eyes. J Refract Surg 27(7):482\u2013487","journal-title":"J Refract Surg"},{"issue":"3","key":"5041_CR13","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.jcrs.2011.10.031","volume":"38","author":"JL G\u00fcell","year":"2012","unstructured":"G\u00fcell JL, Morral M, Malecaze F, Gris O, Elies D, Manero F (2012) Collagen crosslinking and toric iris-claw phakic intraocular lens for myopic astigmatism in progressive mild to moderate keratoconus. J Cataract Refract Surg 38(3):475\u2013484","journal-title":"J Cataract Refract Surg"},{"issue":"3","key":"5041_CR14","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1159\/000480728","volume":"8","author":"S Hashmani","year":"2017","unstructured":"Hashmani S, Hashmani N, Memon RS (2017) Corneal collagen cross-linking combined with an artiflex iris-fixated anterior chamber phakic intraocular lens implantation in a patient with progressive Keratoconus. Case Rep Ophthalmol 8(3):482\u2013488","journal-title":"Case Rep Ophthalmol"},{"issue":"9","key":"5041_CR15","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3928\/1081597X-20090813-01","volume":"25","author":"J Venter","year":"2009","unstructured":"Venter J (2009) Artisan phakic intraocular lens in patients with keratoconus. J Refract Surg 25(9):759\u2013764","journal-title":"J Refract Surg"},{"issue":"1","key":"5041_CR16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.5005\/jp-journals-10025-1006","volume":"1","author":"JT Kim","year":"2012","unstructured":"Kim JT, Zloty P (2012) Simplified nomenclature for describing keratoconus. Int J Keratoconus Ectatic Corneal Dis 1(1):31\u201335","journal-title":"Int J Keratoconus Ectatic Corneal Dis"},{"issue":"4","key":"5041_CR17","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/S0886-3350(98)80284-8","volume":"24","author":"JH Krumeich","year":"1998","unstructured":"Krumeich JH, Daniel J, Kn\u00fclle A (1998) Live-epikeratophakia for keratoconus. J Cataract Refract Surg 24(4):456\u2013463","journal-title":"J Cataract Refract Surg"},{"issue":"7","key":"5041_CR18","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1097\/ICO.0b013e318074e424","volume":"26","author":"AJ Kanellopoulos","year":"2007","unstructured":"Kanellopoulos AJ, Binder PS (2007) Collagen cross-linking (CCL) with sequential topography-guided PRK. Cornea 26(7):891\u2013895","journal-title":"Cornea"},{"issue":"10","key":"5041_CR19","first-page":"S827","volume":"26","author":"RR Krueger","year":"2010","unstructured":"Krueger RR, Kanellopoulos AJ (2010) Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin\/UVA cross-linking for progressive keratoconus: case reports. J Refract Surg 26(10):S827\u2013S832","journal-title":"J Refract Surg"},{"issue":"9","key":"5041_CR20","doi-asserted-by":"publisher","first-page":"S807","DOI":"10.3928\/1081597X-20090813-09","volume":"25","author":"GD Kymionis","year":"2009","unstructured":"Kymionis GD, Kontadakis GA, Kounis GA, Portaliou DM, Karavitaki AE, Magarakis M, Yoo S, Pallikaris IG (2009) Simultaneous topography-guided PRK followed by corneal collagen cross-linking for keratoconus. J Refract Surg 25(9):S807\u2013S811","journal-title":"J Refract Surg"},{"key":"5041_CR21","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ajo.2016.02.029","volume":"166","author":"TG Seiler","year":"2016","unstructured":"Seiler TG, Fischinger I, Koller T, Zapp D, Frueh BE, Seiler T (2016) Customized corneal cross-linking: one-year results. Am J Ophthalmol 166:14\u201321","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"5041_CR22","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3928\/1081597X-20130117-01","volume":"29","author":"A Fadlallah","year":"2013","unstructured":"Fadlallah A, Dirani A, El Rami H, Cherfane G, Jarade E (2013) Safety and visual outcome of visian toric ICL implantation after corneal collagen cross-linking in keratoconus. J Refract Surg 29(2):84\u201389","journal-title":"J Refract Surg"},{"key":"5041_CR23","doi-asserted-by":"crossref","unstructured":"G\u00fcell JL, Morral M, Gris O, Gaytan J, Sisquella M, Manero F (2008) Five-year follow-up of 399 phakic Artisan\u2013Verisyse implantation for myopia, hyperopia, and\/or astigmatism. Ophthalmology 115(6):1002\u20131012","DOI":"10.1016\/j.ophtha.2007.08.022"},{"issue":"1","key":"5041_CR24","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/S0161-6420(02)01447-1","volume":"110","author":"HB Dick","year":"2003","unstructured":"Dick HB, Ali\u00f3 J, Bianchetti M, Budo C, Christiaans BJ, El-Danasoury MA et al (2003) Toric phakic intraocular lens: European multicenter study. Ophthalmology 110(1):150\u2013162","journal-title":"Ophthalmology"},{"key":"5041_CR25","doi-asserted-by":"crossref","unstructured":"Stulting RD, John ME, Maloney RK, Assil KK, Arrowsmith PN, Thompson VM, US Verisyse Study Group (2008) Three-year results of Artisan\/Verisyse phakic intraocular lens implantation. Ophthalmology 115(3):464\u2013472.e1","DOI":"10.1016\/j.ophtha.2007.08.039"},{"issue":"5","key":"5041_CR26","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.jcrs.2007.12.039","volume":"34","author":"F Raiskup-Wolf","year":"2008","unstructured":"Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE (2008) Collagen crosslinking with riboflavin and ultraviolet-a light in keratoconus: long-term results. J Cataract Refract Surg 34(5):796\u2013801","journal-title":"J Cataract Refract Surg"},{"issue":"8","key":"5041_CR27","doi-asserted-by":"publisher","first-page":"567","DOI":"10.3928\/1081597X-20180607-01","volume":"34","author":"IH Noor","year":"2018","unstructured":"Noor IH, Seiler TG, Noor K, Seiler T (2018) Continued long-term flattening after corneal cross-linking for keratoconus. J Refract Surg 34(8):567\u2013570","journal-title":"J Refract Surg"}],"container-title":["Graefe's Archive for Clinical and Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-020-05041-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00417-020-05041-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-020-05041-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T10:17:06Z","timestamp":1622456226000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00417-020-05041-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,19]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["5041"],"URL":"https:\/\/doi.org\/10.1007\/s00417-020-05041-8","relation":{},"ISSN":["0721-832X","1435-702X"],"issn-type":[{"value":"0721-832X","type":"print"},{"value":"1435-702X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,19]]},"assertion":[{"value":"3 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Ethical approval was waived by the local Ethics Committee (Berliner \u00c4rztekammer, Eth-36\/19) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.None of the authors has financial interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This type of study does not require informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}