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A. Navas, A. Haber, R. Suarez; Toric Intraocular Lens in a Patient With Keratoconus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4325.
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To describe the outcome of a toric intraocular lens implantation in a patient with forme fruste keratoconus.
A 55 year-old male came to us requesting a refractive surgery. He had a well controlled arterial hypertension and no previous history of another diseases. On ophthalmic examination his uncorrected visual acuity was 20/700 and 20/800 respectively. The refraction was -7.50=sphere and -6.50=-3.00x175° respectively, achieving a best corrected visual acuity of 20/25 and 20/30. He referred a stable refraction of at least ten years. The examination of both eyes was within normal limits. We found a topographic (Orbscan II, Baush and Lomb, Orbtek Inc, Salt Lake City, UT) and Sheimpflug images (Pentacam, Oculus, Wetzlar, Germany) compatible with forme fruste keratoconus in both eyes. We decided to perform phacoemulsification using a toric intraocular lens in his left eye (Acrysof Toric IOL Model SN60T5, Alcon Laboratories Inc., Forth Worth, Texas). The intraocular lens calculation was perform using IOL Master (Carl Zeiss, Meditec, Germany) and the Acrysof Toric Calculator Online Software. We also performed phacoemulsification on his right eye using an aspheric intraocular lens (Acrysof IQ Model SN60WF, Alcon Laboratories Inc., Forth Worth, Texas).
Phacoemulsification was performed uneventfully in both eyes. Two months after phacoemulsification the uncorrected visual acuity of the left eye was 20/25 with a refraction of -0.25=-0.50x140°. No lens rotation was observed. Two weeks after phacoemulsification the uncorrected visual acuity of the right eye was 20/20 with a refraction of plano=-0.50x150°. The patient was subjectively very satisfied with both eyes.
Despite the fact that toric intraocular lenses are used in patients with regular astigmatism, we decided to use it in this case because the patient had a stable refraction and a nonprogressive forme fruste keratoconus. Although the average lens rotation is less than 4° from the lens’ initial placement, we need to further follow up to evaluate the possibility of rotation. To our knowledge this is the first case of an Acrysof toric lens implant in a patient with keratoconus.
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