Artisan toric lens implantation for correction of postkeratoplasty astigmatism

Abstract

Purpose To determine the efficacy of Artisan toric iris-fixated lens implantation after penetrating keratoplasty to correct high ametropia and astigmatism. Design Prospective, noncomparative case series. Participants Artisan toric lens implantation was performed in 16 eyes of 16 patients who were contact lens intolerant or were unable to wear glasses because of anisometropia, high astigmatism, or both. Intervention Sixteen eyes of 16 patients received Artisan toric lenses for postkeratoplasty astigmatism, anisometropia, or both. Main outcome measures Manifest refraction, uncorrected and spectacle-corrected visual acuity, and corneal topography were performed before surgery and 1, 3, 6, 12, and 18 months after surgery. Efficacy, percent reduction of refractive astigmatism, topographical astigmatism, anisometropia of defocus, and the astigmatism correction index were determined. A patient satisfaction questionnaire and specular microscopy results were assessed. Results The mean ± standard deviation of the preoperative refractive cylinder was −6.66±1.93 diopters (D; range, −4.0 to −10.0 D), which was reduced to −2.08±1.33 D, −2.14±1.76 D, −1.98±1.65 D, −1.84±0.77 D, and −1.42±0.78 D at 1 month, 3 months, 6 months, 12 months, and the final follow-up examination (8.4±4.9 months), respectively. Spherical equivalent was reduced from −4.90±5.50 D before surgery to −0.96±0.86 D at the final follow-up. The uncorrected and best-corrected visual acuities were ≥20/40 in 42% and 100% of eyes, respectively. There was no loss of best-corrected visual acuity and a gain of at least 2 lines in 50% of eyes. The percent reduction in refractive astigmatism, topographical astigmatism, and anisometropia of defocus were 78.0±11.5%, 20.3±34.9%, and 77.0±12.0%, respectively. The astigmatism correction index was 102.8±18.6%. Satisfaction increased from 3.2 to 8.3 after implantation. The endothelial cell loss was 7.6±18.9% at 3 months and 16.6±20.4% at the last follow-up. In 1 patient, a reversible graft rejection occurred. Conclusions Artisan toric lens implantation after penetrating keratoplasty was effective for reduction of refractive astigmatism and ametropia. All patients were suitable for spectacle correction after implantation. A longer follow-up and a larger number of patients are needed to assess the safety and the effect of the lens on the corneal graft endothelium.