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D. Domville-Barrera, J. M. Paulin-Huerta, E. Chavez-Mondragon, A. Ramirez-Miranda; Extreme Corneas, Extreme Measures: Toric Intraocular Lens Implant in Special Cases. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5449.
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To describe the outcome of toric IOL implantation patients with extreme high astigmatic corneas. A 37 years old patient with a 2 year-old optic penetrating keratoplasty (PK) after a micotic ulcer, inflammatory cataract and posterior synechiae which had a graft rejection episode 4 months prior to surgery, successfully treated with topical steroids. A 81 years old patient with a 25 year old hexagonal keratotomy (HK), he underwent to treat his hyperopya in both eyes. Two patients which had radiate keratotomy (RK) at leat 15 years old in both eyes. All the patients had cataract.
All the eyes with preoperative refraction, topographic and Scheimpflug images from 6 to 18 months follow up and of suture removal in the PK patient with at least 6 months stable astigmatism underwent phacoemulsification implanting toric IOL. We implanted an AcrySof Toric IOL Model SN60T5,SN60T7, SN60T8 and SN60T9 as needed (Table 1) . IOL calculation was performed using the IOLMaster and the online software.
UCVA improved dramatically (table 2). The postoperative refraction remained stable after 6 to 12 months of follow-up . No lens rotation was observed, neither a graft rejection episode in the PK patient. The patients were subjectively very satisfied, and fully re-integrated to their prior lifestyle.
Toric IOLs can be a great measure in well-selected cases with stable astigmatism after old refractive procedures and penetrating keratoplasty, extreme corneas as we call them.Extreme Cornea Toric IOL (Spherical and Toric Power)PK SN60T5 15.50D SE, Cyl 3.00 @ 60ºHK OD SN60T8 17.00D SE, Cyl 5.25 @ 99ºHK OS SN60T9 17.00D SE, Cyl 6.00 @ 60ºRK OD patient 1 SN60T9 24.50D SE, Cyl 6.00 @ 13ºRK OS patint 1 SN60T9 24.50D SE, Cyl 6.00 @ 172ºRK OD patient 2 SN60T5 22.50D SE, Cyl 3.00 @ 70ºRK OS patient 2 SN60T7 23.00D SE, Cyl 4.50 @ 85ºTable 1Extreme Cornea Pre UCVA Post UCVAPK 20/400 20/30HK OD 3/200 20/40HK OS 3/200 20/30RK OD patient 1 20/200 20/25RK OS patient 1 20/300 20/25RK OD patient 2 20/100 20/25RK OS patient 2 20/80 20/20Table 2
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