Implantation of a customized toric intraocular lens for correction of post-keratoplasty astigmatism
- PMID: 23348728
- PMCID: PMC3626004
- DOI: 10.1038/eye.2012.300
Implantation of a customized toric intraocular lens for correction of post-keratoplasty astigmatism
Abstract
Purpose: To report visual and refractive outcomes, and endothelial cell loss following primary and secondary 'piggyback' toric intraocular lens (IOL) implantation in patients with high post-penetrating keratoplasty (PK) astigmatism.
Methods: Prospective case series. Nine eyes of nine patients with post-PK astigmatism were consecutively recruited for implantation of a customized toric IOL. Six underwent simultaneous phacoemulsification (PE) and three pseudophakic eyes had a secondary 'piggyback' toric IOL implanted in the ciliary sulcus. Mean follow-up time was 17.2±7.7 months. Pre- and post-operative uncorrected (UDVA) and best-corrected (BDVA) distance visual acuities and refractive errors were collected for comparison. Cartesian astigmatic vectors were calculated to identify a change in the magnitude of astigmatism pre- compared to postoperatively. Pre- and post-operative endothelial cell counts were also collected for analysis.
Results: UDVA (logMAR) improved from 1.13±0.51 preoperatively to 0.48±0.24 postoperatively (P-value=0.003). There was no significant change in BDVA (P-value=0.905) from 0.31±0.27 to 0.26±0.19. Corneal astigmatism preoperatively was 6.57±4.40 diopters (D). Post-operative refractive cylinder was 0.83±1.09 D compared to 3.89±4.01 D preoperatively (P=0.039). Analysis of astigmatic Cartesian x and y coordinates found a significant reduction postoperatively compared to preoperatively (P=0.005 and P=0.002), respectively. Mean endothelial cell loss was 9.9%.
Conclusion: Implantation of a customized primary or secondary 'piggyback' toric IOL serves as an effective modality in treating patients with high post-PK astigmatism.
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References
-
- Binder PS. The effect of suture removal on post postkeratoplasty astigmatism. Am J Ophthalmol. 1988;106:507. - PubMed
-
- Mendicute J, Irigoyen C, Ruiz M, Illarramendi I, Ferrer-Blasco T, Montes-Mico R. Toric intraocular lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery. J Cataract Refract Surg. 2009;35:451–458. - PubMed
-
- Raviv T, Epstein RJ. Astigmatism management. Int Ophthalmol Clin. 2000;40:183–198. - PubMed
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