[Cataract surgery with implantation of toric silicone lenses for severe astigmatism after keratoplasty].
BACKGROUND
The treatment of high astigmatism after keratoplasty is often not possible with glasses or refractive corneal surgery, particularly in patients with anisometropia and contact lens incompatibility.


METHODS
In 3 patients with cataract and high astigmatism after penetrating keratoplasty, phacoemulsification was performed via a 4 mm sclerocorneal tunnel incision. A toric silicone lens with Z-haptic was implanted in the bag (Type MS 6116 TU, Dr. Schmidt). All patients had high anisometropia and contact lens incompatibility. The follow-up was ten weeks, uncorrected and corrected visual acuity, corneal and total astigmatism were evaluated.


RESULTS
A 68-year-old female presented with corneal astigmatism of 10 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 22.5 + 11.0 dpt.) uncorrected visual acuity increased from 1/50 to 20/40, corrected visual acuity increased from 20/30 to 20/25. A 78-year-old male presented with irregular corneal astigmatism of 6.5 dpt. Keratoplasty was performed 25 years previously. Due to high myopia (corneal radii 5.3/5.9 mm), implantation of a toric lens (- 3.0 + 7.0 dpt.) in the bag was combined with implantation of a spheric lens (- 6.0 dpt., Type MS 614, Dr. Schmidt) in the sulcus. Uncorrected visual acuity increased from light perception to 1/20, corrected visual acuity increased to 1/10. An 84-year-old female presented with irregular corneal astigmatism of 8.6 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 16.0 + 11.0 dpt.) uncorrected visual acuity increased to 20/50, corrected visual acuity increased from 20/100 to 20/25. During the follow-up all implanted lenses were well-centered and no significant IOL rotation was observed.


CONCLUSIONS
Implantation of foldable toric silicone lenses during cataract surgery may improve considerably the uncorrected visual acuity by reducing the total astigmatism in patients with high astigmatism after keratoplasty. Preoperatively, a reliable keratometry is important.
Buchwald
H-J
HJ
Universitäts-Augenklinik Ulm, Ulm. Uni.Augenklinik@medizin.uni-ulm.de
Lang
G K
GK
D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002387:Cataract Extraction / Q000379:methods*; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000295:instrumentation / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D012720:Severity of Illness Index; D012828:Silicones; D016896:Treatment Outcome
D012828:Silicones