Piggyback sulcus toric or non-toric lens implantation to reduce refractive error and astigmatism after penetrating keratoplasty in pseudophakic eyes

Session Details

Session Title: Presented Poster Session: Refractive

Venue: Poster Village: Pod 3

First Author: : A.Turnbull UK

Co Author(s): :    E. Karmiris   A. Konstantopoulos   P. Hossain   D. Anderson              

Abstract Details

Purpose:

To report the efficacy of supplementary piggy-back sulcus implantation of a toric or non-toric intraocular lens (IOL) (Sulcoflex™, Rayner Intraocular Lenses Ltd.) in reducing ametropia and astigmatism in pseudophakic eyes after penetrating keratoplasty (PKP).

Setting:

Corneal and External Eye Disease Service, University Hospital Southampton, Southampton, UK.

Methods:

Retrospective analysis of 10 eyes of 10 post-PKP pseudophakic patients who underwent secondary piggyback sulcus IOL implantation to correct residual refractive error. Toric Sulcoflex 653T IOLs were implanted in nine eyes, and a non-toric Sulcoflex 653L IOL was implanted in one. Manifest refraction spherical equivalent (MRSE), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured pre and postoperatively.

Results:

UCVA and BCVA improved in 90% (mean 15 logMAR letters) and 60% (mean 11 letters) eyes respectively. Mean MRSE improved from -3.00DS (-14.00DS to +1.25DS, S.D. 4.53) to -2.18DS (-5.25 to -0.125, S.D. 2.06). Mean cylinder improved from -6.35DC (-16.00DC to -2.00DC, S.D. 3.69) to -4.93DC (-11.50DC to -2.50DC, S.D. 2.74). Procedure-related complications included hyphaema with raised intraocular pressure (n=1) and a suspected graft rejection episode (n=1), both of which resolved with conservative management and without sequelae. No patient suffered a permanent loss of best measured acuity. No lenses required explantation.

Conclusions:

In this series of eyes with complex ophthalmic comorbidity, standard deviation of MRSE and cylinder reduced and most patients gained visual acuity. Observed residual refractive error is likely to reflect uncorrected irregular astigmatism, difficulties with preoperative toric measurement and less predictable surgically induced astigmatism in abnormal post-PKP corneas. Sulcus IOLs are a good option for correcting residual pseudophakic ametropia and astigmatism post-keratoplasty, but should be reserved for cases with stable, regular corneal topography.

Financial Disclosure:

None