Methods: After a routine phacoemulsification we implanted an individually manufactured toric IOL (MP 600 TU, Dr. Schmidt) via sclerocorneal tunnel incision in three postkeratoplasty eyes with high, topographically regular astigmatism. The preoperative astigmatisms were 5.0, 6.0 and 7.5 cyl D. The spherical equivalent of the two high myopic eyes was -15.0 resp. -14.75 D, of the hyperopic eye +6.5 D. A complete standard ocular examination was performed including corneal topography, evaluation of anterior chamber depth, ultrasonic biomicroscopy and perimetry. Minimum follow-up is 6 months.

Results: Implantation and intraoperative alignment of the toric IOL were uneventful. The astigmatisms 6 months postoperatively were reduced to 2.0, 1.75 and 4.0 cyl D. The spherical equivalent was -4.25, -2.0 resp. +5.0 D. At the 6 months examination we observed IOL rotation of 20 degrees in one patient. There was no capsular bag shrinking.

Discussion: Toric IOL technology allows enhancement of IOL surgery with improved refractive outcome. An essential problem after penetrating keratoplasty is the exact biometry, especially in cases of combined high spherical and cylindrical errors. A greater number of cases with longer follow-up is required to answer questions about long-term IOL-axis stability. A prospective study was initiated.