Abstract
BackgroundToric intraocular lens (IOL) implantation can be an effective method for correcting corneal astigmatism in patients with vitreoretinal diseases and cataract. Our purpose is to report the outcome of toric IOL implantation in two cases - a patient with scleral-buckle-induced regular corneal astigmatism and a patient with keratoconus following pars plana vitrectomy. As far as we are aware, there are no reported cases of toric IOL implantation in a vitrectomized eye with keratoconus nor of toric IOL implantation in patients with scleral-buckle-induced regular corneal astigmatism.Case presentationTwo patients with myopia and high corneal astigmatism underwent cataract operation with toric IOL implantation after posterior segment surgery. Myopia and high astigmatism (>2.5 diopter) were caused by previous scleral buckling in one case and by keratoconus in the other case. Pre- and postoperative examinations during the follow-up of included uncorrected and spectacle corrected distance visual acuity (UCDVA/CDVA), automated kerato-refractometry (Topcon), Pentacam HR, IOL Master (Zeiss) axial length measurements and fundus optical coherence tomography (Zeiss). One year postoperatively, the UCDVA and CDVA were 20/25 and 20/20 in both cases, respectively. The absolute residual refractive astigmatism was 1.0 and 0.75 Diopters, respectively. The IOL rotation was within 3° in both eyes, therefore IOL repositioning was not necessary. Complications were not observed in our cases.ConclusionThese cases demonstrate that toric IOL implantation is a predictable and safe method for the correction of high corneal astigmatism in complicated cases with different origins. Irregular corneal astigmatism in keratoconus or scleral-buckle-induced regular astigmatisms can be equally well corrected with the use of toric IOL during cataract surgery. Previous scleral buckling or pars plana vitrectomy seem to have no impact on the success of the toric IOL implantation, even in keratoconus. IOL rotational stability and refractive predictability in patients with a previous vitreoretinal surgery can be as good as in uncomplicated cases.
Highlights
Toric intraocular lens (IOL) implantation can be an effective method for correcting corneal astigmatism in patients with vitreoretinal diseases and cataract
These cases demonstrate that toric IOL implantation is a predictable and safe method for the correction of high corneal astigmatism in complicated cases with different origins
Irregular corneal astigmatism in keratoconus or scleral-buckle-induced regular astigmatisms can be well corrected with the use of toric IOL during cataract surgery
Summary
There are many surgical options for treating preexisting or induced corneal astigmatism including excimer laser refractive procedures, limbal or corneal relaxing incisions and phakic IOLs. Further studies are needed to compare whether toric IOL implantation or corneal refractive surgery gives predictable results for anisometropia and astigmatism correction after scleral buckling surgery These cases demonstrate that toric IOL implantation may be safe and effective for the correction of refractive errors induced by retinal detachment repair or after vitrectomy in patients with corneal ectasia. Due to the limited number of cases and absence of previous reports, it is hard to precisely demonstrate the efficacy of toric IOL in vitrectomized, keratoconic eyes, as well as in eyes with induced astigmatism caused by scleral buckling implants. This study shows that AcrySof toric IOL has good rotational stability, achieving optimal refractive and visual outcomes, even in vitrectomized keratoconic eyes This is the case in eyes with induced astigmatism caused by scleral buckling implants, which has not been reported before.
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