Case Reports

Use of a toric piggyback iol in a case of Terrien marginal corneal degeneration

Case Report Details

First Author: M.Bellino ITALY

Co Author(s):    M. Bellino                    

Abstract Details

Purpose:

to report the correction of high Astigmatism secondary to Terrien marginal corneal degeneration during Cataract Surgery with implantation of a sferic IOL in the bag (Camellens prim, soleko) and primary piggyback toric IOL implantation (Camellens Second , soleko).

Setting:

A 72-year-old women with Cataract and advanced Terrien marginal corneal degeneration, rare disease resulting in peripheral corneal thinning,usually manifests clinically with decreased visual acuity from increased corneal astigmatism. Although the exact etiology is unknown, hypotheses focus on possible degenerative and inflammatory origins.

Report of Case:

The 72-year-old women with Cataract and advanced Terrien marginal corneal degeneration, presented bilateral BCVA 6/30 (with cyl +6.5 axis 20 in the R.E., and cyl +7 axis 120 in the L.E.) which could not otherwise be improved. Topografy showed the considerable irregularity of the cornea with the elevated and irregular cylinder while the anterior Oct showed the reduction in thickness with the peripheral degenerative area. We asked ourselves which IOL to implant in such a case, to choose a toric IOL with the awareness that the progression of the corneal pathology could,in the future, have changed the refractive situation and the Astigmatism and also created aberrations difficult to correct, furthermore with the awareness that in the future, explanting an IOL from the bag is not always a happy choice, even for an expert surgeon. We therefore opted for a spherical implant in the bag (Camellens prim, soleko) and primary piggyback toric IOL implantation (Camellens Second , soleko).

Conclusion/Take Home Message:

We successfully report the use of a toric piggy back IOL in this case of advanced Terrien marginal degeneration in the left eye of this patient. This can give us the possibility to rotate the iol in the future if necessary or to explant the same without particular difficulties. In conclusion, in our opinion this technique appears effective for the correction of high Astigmatism like this and specially appears safe because it can be considered reversible in complex cases, as in case of unstable corneas.

Financial Disclosure:

None