{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:13:03Z","timestamp":1794003183703,"version":"4.8.0"},"reference-count":63,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Ophth"],"accepted":{"date-parts":[[2017,8,24]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To report on 4-year postoperative visual performance with the toric implantable collamer lens (TICL) for stable keratoconus after sequential procedure (corneal collagen crosslinking plus TICL implantation).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Forty eyes of 24 patients with stable keratoconus with myopia between 0.00 and \u221218.00 dioptres (D) and astigmatism between 1.25 and 8.00 D were evaluated in this prospective interventional study (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02833649\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02833649<\/jats:ext-link>). We evaluated refraction, visual outcomes, astigmatic changes analysed by Alpins vector, contrast sensitivity, aberrometry, modulation transfer functions (MTFs), defocus curve, and operative and postoperative complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At 4-year follow-up, 45% had 20\/20 vision or better and 100% had 20\/40 or better uncorrected visual acuity (UCVA). Vector analysis of refractive astigmatism shows that the surgically induced astigmatism (SIA) (3.20\u00b11.46 D) was not significantly different from the target induced astigmatism (TIA) (3.14\u00b11.42 D) (p=0.620). At 4 years postoperatively, none of the eyes showed a decrease in UCVA, in contrast to 24 eyes in which UCVA was increased by \u22651 lines, with contrast sensitivity and improvement in total aberrations and MTF value at 5 per degree (*p=0.004) after TICL implantation. The cumulative 4-year corneal endothelial cell loss was \u22645%. No patients reported dissatisfaction. At the end of follow-up, the vault was 658\u00b154.33m (range, 500\u2013711) and the intraocular pressure was 11.7\u00b12.08 mm Hg. Occurrences of glare and night-driving troubles diminished after TICL surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The results from this standardised clinical investigation support TICL implantation from clinical and optical viewpoints in patients with stable keratoconus.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>NCT02833649, Pre-results<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjophth-2017-000090","type":"journal-article","created":{"date-parts":[[2017,9,29]],"date-time":"2017-09-29T20:20:13Z","timestamp":1506716413000},"page":"e000090","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Comparative analysis of the visual performance after implantation of the toric implantable collamer lens in stable keratoconus: a 4-year follow-up after sequential procedure (CXL+TICL implantation)"],"prefix":"10.1136","volume":"2","author":[{"given":"Farideh","family":"Doroodgar","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Eye Research Center Tehran University of Medical Sciences, Tehran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feazollah","family":"Niazi","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Thran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azad","family":"Sanginabadi","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Eye Research Center Tehran University of Medical Sciences, Tehran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Niazi","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Baradaran-Rafii","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Alinia","sequence":"additional","affiliation":[{"name":"Department of Public Health, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eznollah","family":"Azargashb","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences and Health Services , Chamran Highway, Daneshjoo Street, Tehran, Iran, Tehran, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ghoreishi","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,28]]},"reference":[{"key":"2025090110113736000_2.1.e000090.1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000094"},{"key":"2025090110113736000_2.1.e000090.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305612"},{"key":"2025090110113736000_2.1.e000090.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0896-1549(03)00099-3"},{"key":"2025090110113736000_2.1.e000090.4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/0301-4738.151468","article-title":"Current review and a simplified \u201cfive-point management algorithm\u201d for keratoconus","volume":"63","author":"Shetty","year":"2015","journal-title":"Indian J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1444-0938.2012.00800.x"},{"key":"2025090110113736000_2.1.e000090.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.07.052"},{"key":"2025090110113736000_2.1.e000090.7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40662-016-0038-6","article-title":"Assessing progression of keratoconus: novel tomographic determinants","volume":"3","author":"Duncan","year":"2016","journal-title":"Eye Vis"},{"key":"2025090110113736000_2.1.e000090.8","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.ajo.2015.08.023","article-title":"Corneal cross-linking to halt the progression of keratoconus and corneal ectasia: seven-year follow-up","volume":"160","author":"O\u2019Brart","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.9","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20130117-01"},{"key":"2025090110113736000_2.1.e000090.10","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.07-0762"},{"key":"2025090110113736000_2.1.e000090.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2004.03.026"},{"key":"2025090110113736000_2.1.e000090.12","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.1016\/j.jcrs.2015.05.025","article-title":"Visual outcomes in adult amblyopic eyes with moderate myopia after corneal laser surgery versus copolymer phakic intraocular lens implant","volume":"41","author":"Gonzalez-Lopez","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0886-3350(89)80002-1"},{"key":"2025090110113736000_2.1.e000090.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.opx.0000216100.93302.2d"},{"key":"2025090110113736000_2.1.e000090.15","doi-asserted-by":"crossref","first-page":"S951","DOI":"10.3928\/1081597X-20090915-10","article-title":"Total, corneal, and internal ocular optical aberrations in patients with keratoconus","volume":"25","author":"Schlegel","year":"2009","journal-title":"J Refract Surg"},{"key":"2025090110113736000_2.1.e000090.16","doi-asserted-by":"publisher","DOI":"10.1364\/JOSAA.19.000137"},{"key":"2025090110113736000_2.1.e000090.17","doi-asserted-by":"publisher","DOI":"10.1167\/4.11.5"},{"key":"2025090110113736000_2.1.e000090.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2004.01.051"},{"key":"2025090110113736000_2.1.e000090.19","doi-asserted-by":"crossref","first-page":"S1014","DOI":"10.3928\/1081-597X-20061102-01","article-title":"Measurement of combined corneal, internal, and total ocular optical quality analysis in anterior segment pathology with the OPD-scan and OPD-station","volume":"22","author":"Gatinel","year":"2006","journal-title":"J Refract Surg"},{"key":"2025090110113736000_2.1.e000090.20","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.08-2754"},{"key":"2025090110113736000_2.1.e000090.21","doi-asserted-by":"publisher","DOI":"10.3341\/kjo.2008.22.4.210"},{"key":"2025090110113736000_2.1.e000090.22","doi-asserted-by":"publisher","DOI":"10.1364\/JOSAA.21.000355"},{"key":"2025090110113736000_2.1.e000090.23","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-4558"},{"key":"2025090110113736000_2.1.e000090.24","doi-asserted-by":"publisher","DOI":"10.1167\/4.11.2"},{"key":"2025090110113736000_2.1.e000090.25","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.visres.2007.10.016","article-title":"Balance of corneal horizontal coma by internal optics in eyes with intraocular artificial lenses: evidence of a passive mechanism","volume":"48","author":"Marcos","year":"2008","journal-title":"Vision Res"},{"key":"2025090110113736000_2.1.e000090.26","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.08-1874"},{"key":"2025090110113736000_2.1.e000090.27","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31826672e2"},{"key":"2025090110113736000_2.1.e000090.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2011.08.041"},{"key":"2025090110113736000_2.1.e000090.29","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jcrs.2008.03.029","article-title":"Metaanalysis of cataract development after phakic intraocular lens surgery","volume":"34","author":"Chen","year":"2008","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.30","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20110617-01"},{"key":"2025090110113736000_2.1.e000090.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2007.11.034"},{"key":"2025090110113736000_2.1.e000090.32","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jcrs.2011.07.035","article-title":"Central vault after phakic intraocular lens implantation: correlation with anterior chamber depth, white-to-white distance, spherical equivalent, and patient age","volume":"38","author":"Alfonso","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.33","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3928\/1081597X-20140320-08","article-title":"Multifocal toric intraocular lens implantation for forme fruste and stable keratoconus","volume":"30","author":"Montano","year":"2014","journal-title":"J Refract Surg"},{"key":"2025090110113736000_2.1.e000090.34","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ajo.2013.09.004","article-title":"Risk factors associated with night vision disturbances after phakic intraocular lens implantation","volume":"157","author":"Lim","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.35","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.ajo.2011.12.005","article-title":"Visual performance after posterior chamber phakic intraocular lens implantation and wavefront-guided laser in situ keratomileusis for low to moderate myopia","volume":"153","author":"Kamiya","year":"2012","journal-title":"Am J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.36","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s00417-012-2155-9","article-title":"Comparison of visual and refractive results of Toric Implantable Collamer Lens with bioptics for myopic astigmatism","volume":"251","author":"Alfonso","year":"2013","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.37","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1097\/ICO.0000000000000748","article-title":"Changing trends in keratoconus management","volume":"35","author":"Galvis","year":"2016","journal-title":"Cornea"},{"key":"2025090110113736000_2.1.e000090.38","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1442-9071.1997.tb01296.x","article-title":"Changing indications for penetrating keratoplasty: a newly developed country\u2019s experience","volume":"25","author":"Wong","year":"1997","journal-title":"Aust N Z J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.39","doi-asserted-by":"crossref","first-page":"e600","DOI":"10.1111\/aos.13032","article-title":"Standard corneal collagen crosslinking versus transepithelial iontophoresis-assisted corneal crosslinking, 24\u00a0months follow-up: randomized control trial","volume":"94","author":"Bikbova","year":"2016","journal-title":"Acta Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.40","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ajo.2016.02.029","article-title":"Customized corneal cross-linking: one-year results","volume":"166","author":"Seiler","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.41","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/ICO.0000000000000709","article-title":"Comparison of results of accelerated corneal cross-linking with hypo-osmolar riboflavin solution performed on corneas thicker and thinner than 400 \u03bcm","volume":"35","author":"Ko\u00e7","year":"2016","journal-title":"Cornea"},{"key":"2025090110113736000_2.1.e000090.42","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/ICO.0000000000000702","article-title":"Pediatric corneal collagen cross-linking: long-term follow-up of visual, refractive, and topographic outcomes","volume":"35","author":"U\u00e7akhan","year":"2016","journal-title":"Cornea"},{"key":"2025090110113736000_2.1.e000090.43","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jcrs.2016.05.010","article-title":"Posterior chamber phakic intraocular lenses to improve visual outcomes in keratoconus patients","volume":"43","author":"Esteve-Taboada","year":"2017","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.44","doi-asserted-by":"crossref","first-page":"840","DOI":"10.3928\/1081597X-20081001-12","article-title":"Phakic toric Implantable Collamer Lens implantation for the correction of high myopic astigmatism in eyes with keratoconus","volume":"24","author":"Kamiya","year":"2008","journal-title":"J Refract Surg"},{"key":"2025090110113736000_2.1.e000090.45","doi-asserted-by":"crossref","first-page":"867","DOI":"10.3928\/1081597X-20081101-03","article-title":"Myopic phakic STAAR collamer posterior chamber intraocular lenses for keratoconus","volume":"24","author":"Alfonso","year":"2008","journal-title":"J Refract Surg"},{"key":"2025090110113736000_2.1.e000090.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.11.032"},{"key":"2025090110113736000_2.1.e000090.47","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-010-1540-5"},{"key":"2025090110113736000_2.1.e000090.48","first-page":"e22-5","article-title":"Combined corneal collagen cross-linking and posterior chamber toric implantable collamer lens implantation for keratoconus","volume":"42 Online","author":"Kymionis","year":"2011","journal-title":"Ophthalmic Surg Lasers Imaging"},{"key":"2025090110113736000_2.1.e000090.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2007.05.035"},{"key":"2025090110113736000_2.1.e000090.50","first-page":"3475","article-title":"Intra-stromal corneal ring segment and posterior chamber phakic intraocular lens implantation for keratoconus correction","volume":"51","author":"Fernandez-Vega","year":"2010","journal-title":"Invest Ophthalmol Vis"},{"key":"2025090110113736000_2.1.e000090.51","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s10792-012-9582-9","article-title":"Implantable collamer lenses after intracorneal ring segments for keratoconus","volume":"32","author":"Navas","year":"2012","journal-title":"Int Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.52","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jcrs.2012.11.027","article-title":"Collagen copolymer toric phakic intraocular lens for residual myopic astigmatism after intrastromal corneal ring segment implantation and corneal collagen crosslinking in a 3-stage procedure for keratoconus","volume":"39","author":"Co\u015fkunseven","year":"2013","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.53","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5301\/ejo.5000232","article-title":"Correction of postkeratoplasty ametropia in keratoconus patients using a toric implantable Collamer lens","volume":"23","author":"Iovieno","year":"2013","journal-title":"Eur J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2011.12.035"},{"key":"2025090110113736000_2.1.e000090.55","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000088"},{"key":"2025090110113736000_2.1.e000090.56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/514834","article-title":"Safety and visual outcome of visian toric ICL implantation after corneal collagen cross-linking in keratoconus: up to 2 years of follow-up","volume":"2015","author":"Antonios","year":"2015","journal-title":"J Ophthalmol"},{"key":"2025090110113736000_2.1.e000090.57","doi-asserted-by":"publisher","DOI":"10.5301\/ejo.5000384"},{"key":"2025090110113736000_2.1.e000090.58","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.116064"},{"key":"2025090110113736000_2.1.e000090.59","doi-asserted-by":"publisher","DOI":"10.3341\/kjo.2013.27.3.211"},{"key":"2025090110113736000_2.1.e000090.60","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jcrs.2011.08.040","article-title":"Toric collagen copolymer phakic intraocular lens to correct myopic astigmatism in eyes with pellucid marginal degeneration","volume":"38","author":"Camoriano","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.61","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1016\/j.jcrs.2015.05.035","article-title":"Implantation of spherical and toric copolymer phackic intraocular lens to manage amblyopia due to anisometropic hyperopia and myopia in pediatric patients","volume":"41","author":"Emara","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"2025090110113736000_2.1.e000090.62","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-208862"},{"key":"2025090110113736000_2.1.e000090.63","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/j.jcrs.2010.10.060","article-title":"Intrastromal corneal ring segments and posterior chamber phakic intraocular lens implantation for keratoconus correction","volume":"37","author":"Alfonso","year":"2011","journal-title":"J Cataract Refract Surg"}],"container-title":["BMJ Open Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjophth-2017-000090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T17:11:45Z","timestamp":1756746705000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjophth.bmj.com\/lookup\/doi\/10.1136\/bmjophth-2017-000090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":63,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,9,28]]},"published-print":{"date-parts":[[2017,9]]}},"alternative-id":["10.1136\/bmjophth-2017-000090"],"URL":"https:\/\/doi.org\/10.1136\/bmjophth-2017-000090","relation":{},"ISSN":["2397-3269"],"issn-type":[{"value":"2397-3269","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9]]}}}