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Nathan J Abraham, Katherine O McCabe, Christine B Wisecarver, Dawn L Williams, Rajesh K Rajpal; Clinical approach to patients with complex and high corneal astigmatism undergoing cataract surgery with Toric IOL insertion.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1317.
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© ARVO (1962-2015); The Authors (2016-present)
Toric intraocular lenses (IOL) have proven valuable in correcting low levels of astigmatism during cataract surgery. However, little consensus exists among ophthalmologists on how to surgically manage high levels of astigmatism, such as in keratoconus (KCN), a history of penetrating keratoplasty (PK), or post-refractive surgery corneal ectasia (ectasia). The purpose of this study is to analyze the visual outcomes and explore predictive pre-operative parameters leading to desirable outcomes in patients with KCN, PK, ectasia undergoing cataract surgery with Toric IOLs.
A retrospective chart review assessing pre- and post-operative outcomes of cataract surgery with Toric IOL implantation in patients with a history of high astigmatism from KCN, history of PK, or ectasia. Operative data reviewed at a single practice between 2005 – 2013. Corneal topography (Topo) interpretation performed by two in-office optometrist and first year ophthalmology resident. N values: total number of eyes = 39 (KCN = 16, Post-PK = 16, ectasia = 7). Pre-operative corneal Topo maps analyzed, including location of major astigmatic aberration (central 3mm, 3-5mm, and 5+mm zones). Pattern of central astigmatism noted (symmetric vs asymmetric). Paired and unpaired Student T-test used for statistical analysis.
Visual acuity was significantly improved in all three patient groups, each showing an improvement from pre-op, to post-op uncorrected, and post-op best corrected Log-MAR acuity [(KCN = 0.35/0.26/0.08, p<0.05), (PK = 0.52/0.39/0.16, p<0.05), (ectasia = 0.25/0.11/0.01, p<0.05)]. Central corneal astigmatism analysis demonstrated both patterns (symmetric and asymmetric) had significantly improved visual outcomes, with larger improvements noted with a symmetric central pattern in all three disease states (KCN, post-PK, and ectasia).
Cataract extraction with Toric IOL insertion represents a useful surgical strategy for correcting high levels of astigmatism in many patients with KCN, history of PK, and ectasia. Favorable and significant improvements in acuity up to 3 years post-operatively demonstrate a stable visual outcome. Analyzing central corneal astigmatic pattern is helpful in pre-operative cataract assessment in patients with complex and highly astigmatic corneal pathology.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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