Posters

Correction of astigmatism in a patient with cataract and keratocone implanting toric iol

Poster Details

First Author: G.Garotti BRAZIL

Co Author(s):    L. Alberto Rosa Barbalho   A. Cardoso Toldo   B. Luiz Manni   É. Hideki Uchida   M. Hitoshi Otsuka        

Abstract Details

Purpose:

Keratoconus is an idiopathic, bilateral and asymmetric corneal ectasia, which becomes apparent in the second decade of life, progressing to the third or fourth decade of life. The clinical pictur is characterized by a low progressive visual acuity (AVB) due to the induction of irregular astigmatism, an aspect that when added to the visual loss related to the formation of the cataract, represents a surgical challenge, and there must be a personalized planning. The work, aims to report the planning and approach in performing a facectomy with toric intraocular lens (IOL) implantation to correct astigmatism in a patient with keratoconus.

Setting:

IDS patient, 66 years old, female, white, complaining of progressive LAV in both eyes (BE), more important in the right eye (RE) than in the left eye (LE), since puberty, but that has increased in the last two years, He has a diagnosis of keratoconus, as well as his parents.

Methods:

Corneal specular microscopy RE 2568 / LE 2409. Pachymetry RE 420 / LE 432. . Corneal topography performed preoperatively with pentacam showing the following results: RE - curved corneal meridian 51.91D (6.64mm) 1570 and flatter 48.91D (7.39mm) 670. LE - curved corneal meridian 49.99D (6.77mm) 370 and flatter 47.48D (7.39mm) 1270. Astigmatism resulting from 3.00 in RE and 2.51 in LE.

Results:

The ophthalmological examination has visual acuity (VA) with better correction in RE 20 / 100p (-8.25 -2.00 x 130°) and in LE 20 / 40p (-10.75 -1.75 x 40°). In RE biomicroscopy, it presents normality in the anterior segment associated with media opacity consistent with cataracts, having nuclear classification 3+ associated with anterior cortical 2+ according to LOCS III (Lens Opacities Classification System), and, in LE, with a biomicroscopic aspect. similar, but with nuclear rating 2+. The approach adopted was to perform a facectomy in both eyes (BE) with a toric IOL implantation, first addressing RE and then LE. The IOL model chosen was PANOPTIX TORIC TFNT60 7,00D for RE and PANOPTIX TORIC TFNT60 10,50D for LE based on calculations performed by VERIONTM that pointed as perspective the following residuals: RE: -0,10 -0,79D x 690; LE: +0.02 -0.64D x 1280. Final VA with correction was 20/20 (+0.50) in RE and LE 20/20 (+0.25), with the addition of +2.75 in BE (J1).

Conclusions:

In cases of low progressive visual acuity (AVB) related to the formation of the cataract added to induction of irregular astigmatism,caused by keratoconus ,the planning and approach in performing a facectomy with toric intraocular lens (IOL) implantation to correct astigmatism represents a surgical challenge, and there must be a personalized planning together with reliable formulas for accurate calculation and choice of desirable intraocular lens to obtain the best possible results, like that case in focus

Financial Disclosure:

None