Tehrani M., Dick H. B., Schwenn O.

Augenklinik, Johannes-Gutenberg-Universität, Mainz

After penetrating keratoplasty residual astigmatism and anisometropia account for many patients and decrease visual outcome. Up to 20% of eyes have astigmatism, that cannot be corrected with spectacles or contact lenses. Those patients can be treated surgically with radial keratotomy, photorefractive keratectomy (PRK) or Laser in situ keratomileusis (LASIK). These surgical procedures have in common the irreversibility and the manipulation of the cornea which increases the risk of corneal damage or rejection. An alternative method for correcting higher astigmatism without involving the cornea is the implantation of an individually designed toric intraocular lens (IOL) according to keratometry and biometry with a cylindrical power up to 12 D, even in pseudophakic eyes. A 66-year-old patient presented after penetrating keratoplasty and implantation of an IOL 4 years ago with a visual acuity of 20/160. The keratoplasty left him a high residual astigmatism of -10D x 51°. After biometry an individually manufactured toric PMMA-IOL of +12D cylindrical and -9.5D spherical power was implanted via a sclerocorneal tunnel incision additionally to the existing IOL. Postoperatively a well centered and stable positioned IOL was found. One year after the imlantation of the toric IOL the position was still unchanged and a optimal graft clarity was observed. Sperical equivalent refraction was +1,25-3,0x121°, with an uncorrected visual acuity of 20/60, corrected of 20/40.
Conclusion: Implantation of an individually designed toric IOL allows an effective and safe correction of high astigmatism after penetrating keratoplasty and pseudophakia. It is the reversibility that is the advantage of this method. This alternative option may decrease the incidence of allograft rejection.

Copyright © Deutsche Ophthalmologische Gesellschaft, 2001. All rights reserved.

Last updated: 

Webdesign: SPALLEK.COM