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Nagpal R, Shakkarwal C, Ahsan S, Maharana PK, Goel M, Sharma N. Outcomes of preloaded toric intraocular lens implantation in eyes undergoing phacoemulsification. Indian J Ophthalmol 2023; 71:2480-2486. [PMID: 37322666 PMCID: PMC10417997 DOI: 10.4103/ijo.ijo_3068_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/01/2022] [Accepted: 02/02/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. Methods This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow-up. Results At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow-up (P < 0.001, Wilcoxon signed-rank test). The mean refractive cylinder improved from - 1.56 ± 1.25 D preoperatively to - 0.12 ± 0.31 D at 3 months follow-up (P < 0.001) while the mean spherical equivalent value changed from - 1.93 ± 3.71D preoperatively to - 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 μm while the average contrast sensitivity value (Pelli-Robson chart) was 1.56 ± 0.10 log unit, at the final follow-up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow-up. There were no intraoperative or postoperative complications. Conclusion SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability.
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Affiliation(s)
- Ritu Nagpal
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Shakkarwal
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saima Ahsan
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Goel
- Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Cataract, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant. OPHTHALMOLOGY JOURNAL 2023. [DOI: 10.17816/ov114728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND: The MyoRing implantation into a corneal transplant can significantly compensate for irregular post-keratoplastic astigmatism. However, the cataract that occurs in this category of patients and the lack of information in the literature on its phacoemulsification and the calculation of a toric intraocular lens (tIOL) power in them determines the relevance of our study.
AIM: The aim of the study is to conduct a clinical and functional analysis of phacoemulsification in patients after previously performed implantation of a MyoRing into a corneal transplant.
MATERIALS AND METHODS: We operated on 21 patients (21 eyes) who had previously undergone the MyoRing implantation into a corneal transplant. According to keratotopography, all patients were diagnosed with a regular form of corneal astigmatism. All patients underwent phacoemulsification with tIOL implantation. When calculating the tIOL power, its diopter value was corrected depending on the average value of the corneal transplant keratometry according to the keratotopogram data. The observation period duration was 6 months.
RESULTS: One month after the procedure, there was an increase in uncorrected visual acuity by 0.2 0.9 LogMAR, best corrected visual acuity by 0.3 1.0 LogMAR, the spherical component of refraction up to 0.4 0.44 D, the cylindrical component of refraction up to 0.62 0.18 D, all of which did not change later on.
CONCLUSIONS: Phacoemulsification with tIOL implantation, with its power calculated taking into account an additional correction for its diopter value, is an effective, predictable and safe method of treating patients after previously performed MyoRing implantation into a penetrating corneal transplant.
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Cid-Bertomeu P, Vilaltella M, Huerva V. Undesirable High Astigmatism after Penetrating Keratoplasty in Pseudophakia Corrected with an Add-On Toric Intraocular Lens. Case Rep Ophthalmol 2023; 14:307-313. [PMID: 37485245 PMCID: PMC10359674 DOI: 10.1159/000530281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 07/25/2023] Open
Abstract
The purpose of the present case is to report the visual outcomes of a pseudophakic patient with high post-penetrating keratoplasty astigmatism treated with implantation of toric AddOn® intraocular lens (IOL) in the sulcus. A 79-year-old man with a ophthalmologic history of pseudoexfoliative glaucoma and Fuchs endothelial dystrophy had a graft failure after Descemet's stripping automated endothelial keratoplasty procedure on his right eye. Consequently, a penetrating keratoplasty was performed, and a high corneal astigmatism of -9.8 D to 140° resulted in that eye after selective suture removal. A secondary AddOn® toric IOL customized for the patient with a manufacturer-calculated power of +11.0 D was implanted to 50° in sulcus of the right eye. Subjective refraction was used for IOL calculation. Final refraction was +1.0 D of sphere and -2.0 D of cylinder power to 105°, with spherical equivalent of 0.0 D. Best corrected visual acuity was logMAR 0.1 (20/25, 0.8 decimal) 1 year after the IOL implant. Our case report demonstrates that the toric AddOn® secondary IOL can be effective and safe in correcting residual refractive error of high regular astigmatism after keratoplasty in pseudophakic eyes.
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Affiliation(s)
- Pau Cid-Bertomeu
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Magí Vilaltella
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Valentín Huerva
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
- School of Medicine, University of Lleida, Lleida, Spain
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Bineshfar N, Tahvildari A, Feizi S. Management of post-keratoplasty ametropia. Ther Adv Ophthalmol 2023; 15:25158414231204717. [PMID: 37854948 PMCID: PMC10580728 DOI: 10.1177/25158414231204717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Even after a successful corneal transplant, patients experience severe refractive errors, impeding their rehabilitation and satisfaction. Refractive errors can be caused by recipient pathology and corneal thickness, as well as intraoperative factors such as donor-host discrepancy, recipient's eccentric trephination, vitreous length, wound apposition, technique of suturing, and suture material. Also, wound healing and the interim between keratoplasty and suture removal contribute to astigmatism. Lamellar keratoplasty outperforms penetrating keratoplasty in terms of endothelial cell loss and endothelial graft rejection, yet the risk of developing refractive errors is comparable. Nonsurgical interventions such as spectacles and lenses fail to provide desirable vision in cases with high astigmatism and corneal irregularity. When these limitations are encountered, surgical interventions including incisional keratotomy, wedge resection, laser refractive surgeries, intracorneal segments, and intraocular lens implantation are employed. However, occasionally, none of these approaches deliver the desired effects, leading to the need for a repeat keratoplasty.
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Affiliation(s)
- Niloufar Bineshfar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA
| | - Azin Tahvildari
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Correction of postkeratoplastic ametropia in patients with cataract. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov109153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Penetrating keratoplasty leads, on the one hand, in 100% of cases, to the formation of induced astigmatism of variable degree, on the other hand, to a decrease in the density of endothelial cells of the corneal graft, which can reach from 19.1 to 38.3%. Thus, today the task of safe cataract extraction with minimal loss of density of endothelial cells and maximal correction of corneal astigmatism by the aid of an implantation of a toric intraocular lens is paramount.
AIM: The aim of the study is to conduct a clinical and functional analysis of cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty.
MATERIALS AND METHODS: We performed phacoemulsification with implantation of a toric intraocular lens in 25 eyes (25 patients) having a history of penetrating keratoplasty. The 1st degree of the lens nucleus density (according to Buratto classification) was noted in 4 eyes, the 2nd degree in 17 eyes, the 3rd degree in 4 eyes. According to keratotopography, all patients had a symmetrical type of postkeratoplastic astigmatism. The average follow-up period was 1 year.
RESULTS: Intra- and postoperative complications were noted. One month after surgery, uncorrected visual acuity increased from an average of 1.3 1.6 to 0.3 0.9 LogMAR, best corrected visual acuity increased from 1.0 1.18 to 0.1 0.9 LogMAR, refractive astigmatism decreased from 7.5 2.43 to 1.43 0.38 D, and did not change during 1 year of follow-up. The density of endothelial cells decreased by 9% 1 year after surgery.
CONCLUSIONS: Cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty allows achieving high refractive results. Preoperative analysis of endothelial cell density, careful approach to the intraocular lens calculation, and standard protocol of phacoemulsification make this operation predictable and safe.
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Devebacak A, Degirmenci C, Barut Selver O, Palamar M, Egrilmez S. Correction of high astigmatism with toric intraocular lens in eyes with corneal transplant. Eur J Ophthalmol 2022; 33:11206721221123885. [PMID: 36046940 DOI: 10.1177/11206721221123885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the results of toric intraocular lens (IOL) implantation during cataract surgery in eyes with high regular astigmatism associated with prior penetrating keratoplasty (PK). METHODS A retrospective data analysis of patients with prior PK, who underwent uncomplicated cataract surgery with hydrophobic toric single piece IOL (EyeCryl Toric®, Biotech Vision Care, Luzern, Switzerland). RESULTS A total of 18 eyes of 18 patients were included in the study. The mean age was 53.4 ± 12.4 (25-70) years. The mean follow-up period was 15.5 (4-24) months. The mean best corrected visual acuity (BCVA) significantly increased from 1.36 ± 1.0 logMAR to 0.31 ± 0.17 logMAR (p < .001) pre- and post-operative 4 weeks, respectively. There was no significant change in mean BCVA during follow-up; mean BCVA was 0.32 ± 0.17 logMAR at the last visit. The mean pre-operative topographic astigmatism was 6.52 ± 1.80 diopters (D). The mean manifest refraction astigmatism was decreased from 6.55 ± 1.62 D to 2.80 ± 1.43 D (p˂0.001). The mean Surgically induced astigmatism (SIA) was 3.74 ± 0.77 D according to vector analysis. There was no patient with graft rejection or failure, the mean endothelial cell loss rate was 12.75 ± 3.76% (7-17%). There was no patient requiring IOL reposition. CONCLUSIONS Toric IOL implantation during cataract surgery provides an option to correct astigmatism in post-PK eyes with high regular astigmatism. When appropriate patients are selected it is a safe method to achieve significant improvements in visual acuity and astigmatism.
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Affiliation(s)
- Ali Devebacak
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | | | | | - Melis Palamar
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, 60521Ege University, Izmir, Turkey
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Toric intraocular lens for astigmatism correction following keratoplasty in phakic and pseudophakic eyes. J Cataract Refract Surg 2022; 48:1078-1087. [PMID: 35137695 DOI: 10.1097/j.jcrs.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
Abstract
ABSTRACT Residual astigmatism and anisometropia significantly impact patients' vision and quality of life even in clear grafts after corneal transplant. We reviewed and summarized the role of toric intraocular lens (IOL) in phakic and pseudophakic eyes after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) in correcting residual astigmatism. We included 342 eyes from 20 studies with iris-clipped toric IOL, ciliary sulcus toric implantable collamer lens, piggyback sulcus toric IOL, or posterior chamber toric IOL implantations for phakic, pseudophakic, or eyes undergoing cataract surgery after keratoplasty. Visual, refractive, and predictability outcomes were encouraging. Secondary re-alignment rate and complications were low. Endothelial cell loss secondary to phakic toric IOL might be a concern over the long-term, particularly in iris-clipped IOL in PKP eyes. Toric IOL represent a viable option in the treatment of residual astigmatism in post-keratoplasty eyes, resulting in improved visual acuity and reduced anisometropia.
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Deshmukh R, Nair S, Vaddavalli PK, Agrawal T, Rapuano CJ, Beltz J, Vajpayee RB. Post-penetrating keratoplasty astigmatism. Surv Ophthalmol 2021; 67:1200-1228. [PMID: 34808143 DOI: 10.1016/j.survophthal.2021.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.
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Affiliation(s)
| | - Sridevi Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Tushar Agrawal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | - Rasik B Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Vision Eye Institute, Melbourne, Australia; University of Melbourne, Australia
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Ra H, Hwang HS, Kim HS, Kim MS, Kim EC. Toric intraocular lens implantation in cataract patients with corneal opacity. BMC Ophthalmol 2020; 20:98. [PMID: 32169054 PMCID: PMC7068861 DOI: 10.1186/s12886-020-01352-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background To evaluate the effect of toric intraocular lens implantation in cataract patient with corneal opacity and high astigmatism. Methods Thirty-one eyes of 31 patients who underwent cataract surgery with toric intraocular lens implantation were included. All patients had corneal opacity with astigmatism. Preoperative total corneal astigmatism was determined considering posterior astigmatism using a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany). At 2 months after toric intraocular lens implantation, we evaluated residual astigmatism, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Results Postoperative UCVA and BCVA (0.30 ± 0.17, 0.22 ± 0.16LogMAR) were statistically improved compared to preoperative UCVA and BCVA (1.2 ± 0.34, 1.1 ± 0.30LogMAR, respectively) (P < 0.01). Postoperative residual refractive astigmatism (1.2 ± 0.35D) was statistically reduced compared to preoperative refractive astigmatism (2.4 ± 0.65D) (P < 0.05). Preoperative and postoperative total corneal astigmatism values were not statistically different. All eyes achieved postoperative visual acuity as good as or better than preoperative one. The size of corneal opacity covering pupil had significant negative correlation with postoperative UCVA and BCVA (logMAR) (R = 0.91 P < 0.05 and R = 0.92 P < 0.05, respectively). Conclusion Toric intraocular lens implantation can improve UCVA, BCVA, and refractive astigmatism in cataract patient with corneal opacity. The size of corneal opacity covering pupil is the major prognostic factor for postoperative visual improvement. Therefore, toric intraocular lens implantation should be considered for cataract patients who have corneal opacity with high astigmatism.
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Affiliation(s)
- Ho Ra
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, South Korea.,Department of Ophthalmology, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon, Gyeonggi-do, 14647, South Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Hyun Seung Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Man Soo Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Eun Chul Kim
- Department of Ophthalmology, College of Medicine, Catholic University of Korea, Seoul, South Korea. .,Department of Ophthalmology, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon, Gyeonggi-do, 14647, South Korea.
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Stepwise Combination of Femtosecond Astigmatic Keratotomy With Phacoemulsification and Toric Intraocular Lens Implantation in Treatment of Very High Postkeratoplasty Astigmatism. Cornea 2019; 39:71-76. [PMID: 31490273 DOI: 10.1097/ico.0000000000002131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the outcomes of stepwise combined femtosecond astigmatic keratotomy (FSAK) and phacoemulsification with toric intraocular lens (IOL) implantation in the treatment of very high astigmatism after either penetrating keratoplasty or deep anterior lamellar keratoplasty. METHODS This is a retrospective, interventional case series including 8 eyes of 6 patients with very high astigmatism [≥8.00 diopter (D)] after either penetrating keratoplasty or deep anterior lamellar keratoplasty who underwent FSAK, followed by phacoemulsification and toric IOL implantation. Outcome measures were corneal and manifest astigmatism and uncorrected and best spectacle-corrected visual acuity (UCVA, BSCVA). RESULTS The average age was 58.9 ± 5.1 years. The average follow-up time was 40.9 ± 43.8 months. Outcome measure changes after both FSAK and toric IOL implantation were: corneal astigmatism improved from 13.56 ± 4.81 D to 4.48 ± 2.83 D (P < 0.001), manifest astigmatism improved from 9.15 ± 3.86 to 1.46 ± 0.88 D (P = 0.011), UCVA improved from 1.69 ± 0.45 LogMAR (Snellen equivalent ∼20/980) to 0.23 ± 0.11 LogMAR (Snellen equivalent ∼20/33, P < 0.001), and BSCVA improved from 1.01 ± 0.71 LogMAR (Snellen equivalent ∼20/200) to 0.19 ± 0.11 LogMAR (Snellen equivalent ∼20/30, P = 0.015). BSCVA and UCVA at the last follow-up were 20/40 or better in all patients. All procedures were uneventful. Two eyes underwent photorefractive keratectomy after FSAK to regularize and further reduce astigmatism before toric IOL implantation. One patient underwent temporary compression suturing because of FSAK overcorrection. CONCLUSIONS Combined stepwise use of FSAK and phacoemulsification with toric IOL implantation was an effective and apparently safe approach in patients with very high postkeratoplasty astigmatism. Additional treatment using photorefractive keratectomy may be beneficial in some cases.
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Customized Toric Intraocular Lens Implantation in Eyes with Cataract and Corneal Astigmatism after Deep Anterior Lamellar Keratoplasty: A Prospective Study. J Ophthalmol 2018; 2018:1649576. [PMID: 30057802 PMCID: PMC6051070 DOI: 10.1155/2018/1649576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effectiveness of toric intraocular lenses (IOLs) for treating corneal astigmatism in patients with cataract and previous deep anterior lamellar keratoplasty (DALK). Setting San Giovanni-Addolorata Hospital, Rome, Italy. Design Prospective interventional case series. Methods Patients undergoing cataract surgery after DALK for keratoconus were enrolled. Total corneal astigmatism (TCA) was assessed by a rotating Scheimpflug camera combined with Placido-disk corneal topography (Sirius; CSO, Firenze, Italy). A customized toric IOL (FIL 611 T, Soleko, Rome, Italy) was implanted in all eyes. One year postoperatively, refraction was measured, the IOL position was recorded, and vectorial and nonvectorial analyses were performed to evaluate the correction of astigmatism. Results Ten eyes of 10 patients were analyzed. The mean preoperative TCA magnitude was 4.92 ± 1.99 diopters (D), and the mean cylinder of the IOL was 6.18 ± 2.44. After surgery, the difference between the planned axis of orientation of the IOL and the observed axis was ≤10° in all eyes. The mean surgically induced corneal astigmatism was 0.35 D at 20°. The mean postoperative refractive astigmatism power was 1.13 ± 0.94 D; with respect to preoperative TCA, the reduction was statistically significant (p < 0.0001). The mean change in astigmatism power was 3.80 ± 1.60 D, corresponding to a correction of 77% of preoperative TCA power. Nine eyes out of 10 had a postoperative refractive astigmatism power ≤ 2D. Conclusions Toric IOLs can effectively correct corneal astigmatism in eyes with previous DALK. The predictability of cylinder correction is partially lowered by the variability of the surgically induced changes of TCA. This trial is registered with NCT03398109.
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Nuzzi R, Monteu F. Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation. Case Rep Ophthalmol 2017; 8:385-388. [PMID: 28868034 PMCID: PMC5567111 DOI: 10.1159/000478518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
After penetrating keratoplasty (PK), high astigmatism is often induced, being frequently about 4–6 dpt. According to the entity and typology of astigmatism, different methods of correction can be used. Selective suture removal, relaxing incisions, wedge resections, compression sutures, photorefractive keratectomy, and laser-assisted in situ keratomileusis can reduce corneal astigmatism and ametropia, but meanwhile they can cause a reduction in the corneal integrity and cause an over- or undercorrection. In case of moderate-to-high regular astigmatisms, the authors propose a toric multifocal intraocular lens (IOL) implantation to preserve the corneal integrity (especially in PK after herpetic corneal leukoma keratitis). We evaluated a 45-year-old patient who at the age of 30 was subjected to PK in his left eye due to corneal leukoma herpetic keratitis, which led to high astigmatism (7.50 dpt cyl. 5°). The patient was subjected to phacoemulsification and customized toric multifocal IOL implantation in his left eye. The correction of PK-induced residual astigmatism with a toric IOL implantation is an excellent choice but has to be evaluated in relation to patient age, corneal integrity, longevity graft, and surgical risk. It seems to be a well-tolerated therapeutic choice and with good results.
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Affiliation(s)
- Raffaele Nuzzi
- M.D. Eye Clinic Section, University of Turin, Ophthalmic Hospital, Turin, Italy
| | - Francesca Monteu
- M.D. Eye Clinic Section, University of Turin, Ophthalmic Hospital, Turin, Italy
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