title: Custom-designed toric phakic intraocular lenses to correct high corneal astigmatism.
abstract: To analyze the results of a custom-designed posterior chamber toric phakic intraocular lens (PIOL).
  
  
  
  A 40-year-old woman with high astigmatism and thin corneas underwent bilateral PIOL implantation with the toric Implantable Collamer Lens (ICL) custom-designed and manufactured by STAAR Surgical. The appropriate toric ICL power was calculated to be -8.00 +8.00 x 96 degrees for the right eye and -8.50 +7.50 x 86 degrees for the left eye. Optical zone was 5.5 mm and 6.875 mm at the corneal plane.
  
  
  
  At 3 and 6 months postoperatively, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA) of both eyes had improved to 20/20 and 20/16, respectively. At 19 months, UCVA was 20/20 and 20/16 in the right and left eyes, respectively, and BSCVA had improved to 20/16 and 20/10, respectively. The subjective refraction was stable, with a change of -0.37 +/- 0.17 D from preoperative to 19 months postoperatively. Throughout the postoperative period, iridotomies remained patent and the corneas were clear.
  
  
  
  Bilateral implantation of the custom-designed toric ICL successfully corrected the patient's high astigmatism. Preoperative subjective refractive cylinder of -5.25 x 6 degrees in the right eye and -5 x 176 degrees in the left eye changed to -0.5 x 77 degrees and -0.5 x 115 degrees, respectively, after toric IOL implantation. There was almost no change in corneal astigmatism. This customized approach led to UCVA of 20/20 in the right eye and 20/16 in the left eye, and BSCVA of 20/16 in the right eye and 20/10 in the left eye. This is the first report of a toric PIOL being specifically manufactured to meet the refractive cylinder requirements of a specific patient.
authors.affiliation: Antwerp Eye Center, Antwerp, Belgium. e.mertens@zien.be
authors.forename: Erik L
authors.initials: EL
authors.lastname: Mertens
authors.forename: Donald R
authors.initials: DR
authors.lastname: Sanders
authors.forename: Pauline N
authors.initials: PN
authors.lastname: Vitale
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D054120:Phakic Intraocular Lenses; D011474:Prosthesis Design; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology