Posters

Transitional conic toric surface intraocular lenses in the management of high and slightly irregular astigmatism after corneal transplant: 2 case reports

Poster Details

First Author: C.Azpitarte Sanchez-Muros SPAIN

Co Author(s):    N. Alejandre Alba                    

Abstract Details

Purpose:

To present 2 case reports of patients with high and slightly irregular astigmatism corrected with implanted transitional conic toric surface intraocular lenses after a penetrating keratoplasty (PK) and a deep anterior lamellar keratoplasty (DALK).

Setting:

Ophthalmology Department, Universitary Hospital Fundacion Jimenez Diaz Hospital, Madrid, Spain.

Methods:

High residual astigmatism occurs in around 30% of patients after full stroma corneal transplants (CT) becoming an important cause of suboptimum vision in these patients. Glasses often do not provide enough quality of vision and contact lenses are difficult to fit in many cases. Also, cataract formation is common in these patients, due to the use of steroids or because of inflammatory diseases. Traditionally, patients after CT and irregular astigmatism were not candidates for toric IOL implantation but encouraging results have been reported by several authors.

Results:

79-years-old patient underwent DALK. UVA (uncorrected visual acuity)= 0.2, CVA (corrected visual acuity)= 0.4. Topographic astigmatism= 10D, keratometric astigmatism= 6D. Implantation of transitional conic toric surface IOL (Precizon toric) was calculated for a target of 6D corneal astigmatism. IOL rotation 3 months after surgery was 1⁰. 1-year-follow-up UDVA= 0.6 and CDVA= 0.8 (with +1.5 -4 115º). 49-years-old keratoconus patient underwent PK. UVA= 0.1, CVA= 0.5. Topographic astigmatism= 8D, keratometric astigmatism= 5D. Transitional conic toric surface IOL (Precizon toric) was calculated for a target of 5D of corneal astigmatism. IOL rotation 3 months after surgery was 3⁰. 1-year follow-up UDVA= 1.0.

Conclusions:

Transitional conic toric surface IOLs can be a very helpful tool in the management of high and slightly irregular astigmatism after full stroma corneal transplants as these two cases show. None of them had a significant rotation of the IOL but in some cases a capsular tension ring should be considered since in complicated eyes or deep anterior chambers. Refractive target should be cautious and performed comparing different devices. Bigger and randomized studies are needed to improve the use of toric IOLs in irregular corneas. In the future ray tracing calculation and customized quality of vision targets may improve outcomes.

Financial Disclosure:

None