Posters

14 diopter astigmatism toric intraocular lens for management of a patient with pellucid marginal degeneration and floppy iris syndrome

Poster Details

First Author: P.Marti Rodrigo SPAIN

Co Author(s):    E. Segovia Maldonado   J. Armentia Perez de Mendiola   A. Herranz Cabarcos              

Abstract Details

Purpose:

To describe the use of a high astigmatism intraocular toric lens and the refractive result in an advanced pellucid marginal degeneration (PMD)

Setting:

A 69 year old patient with a long-term lost of sight in his right eye (RE) presented at the Hospital de l’Esperança (Parc de Salut Mar) for bilateral cataract surgery. Patient had diabetes mellitus and prostatic hyperplasia treated with tamsulosin

Methods:

Patient presented unilateral PMD in RE with preoperative subjective refraction of uncorrected visual acuity (UCVA) 20/400, 80º -10,00 +5,50  20/40 best corrected visual acuity (BCVA). Slit lamp examination showed inferior peripheral band of thinning. Mild symmetric cataract was seen. Scotopic pupils measurements were 5.0 millimeters. Topography showed crab-claw pattern with 10 diopter (D) irregular astigmatism with thinnest point 427 micrometers. Patient underwent cataract surgery firstly for his left eye. IFIS was noticed.  Considering IFIS condition and the mesopic pupil measurement, toric lens for the right eye was then considered.

Results:

Left eye UCVA was 20/20 one week after surgery. Pentacam tomography was used for toric lens calculation. 160º 14D astigmatism 20,5D customized toric lens (Ultima Smart Toric) was used. After uneventful cataract surgery besides IFIS on RE, patient achieved UCVA 20/30, BCVA 20/25 (110º -4,00 +2,00). About 5 degrees of rotation were seen on the postoperative, but patient was happy enough with his UCVA to refuse further surgery.

Conclusions:

It is uncommon the presentation of an undiagnosed PMD at this age. The IFIS condition along with small scotopic measurement made us consider the option of intraocular toric lens for astigmatism correction with a satisfactory visual rehabilitation. Undercorrection of 4 diopter astigmatism was achieved although a surprising UCVA was achieved. High optical aberrations are expected in this kind of cases, but patient’s satisfaction was enough. Other surgical solutions are more complex and it’s difficult to achieve such visual rehabilitation.

Financial Disclosure:

None