title: Correction of irregular and induced regular corneal astigmatism with toric IOL after posterior segment surgery: a case series.
abstract: BACKGROUND
  Toric intraocular lens (IOL) implantation can be an effective method for correcting corneal astigmatism in patients with vitreoretinal diseases and cataract. Our purpose is to report the outcome of toric IOL implantation in two cases - a patient with scleral-buckle-induced regular corneal astigmatism and a patient with keratoconus following pars plana vitrectomy. As far as we are aware, there are no reported cases of toric IOL implantation in a vitrectomized eye with keratoconus nor of toric IOL implantation in patients with scleral-buckle-induced regular corneal astigmatism.
  
  
  METHODS
  Two patients with myopia and high corneal astigmatism underwent cataract operation with toric IOL implantation after posterior segment surgery. Myopia and high astigmatism (>2.5 diopter) were caused by previous scleral buckling in one case and by keratoconus in the other case. Pre- and postoperative examinations during the follow-up of included uncorrected and spectacle corrected distance visual acuity (UCDVA/CDVA), automated kerato-refractometry (Topcon), Pentacam HR, IOL Master (Zeiss) axial length measurements and fundus optical coherence tomography (Zeiss). One year postoperatively, the UCDVA and CDVA were 20/25 and 20/20 in both cases, respectively. The absolute residual refractive astigmatism was 1.0 and 0.75 Diopters, respectively. The IOL rotation was within 3° in both eyes, therefore IOL repositioning was not necessary. Complications were not observed in our cases.
  
  
  CONCLUSIONS
  These cases demonstrate that toric IOL implantation is a predictable and safe method for the correction of high corneal astigmatism in complicated cases with different origins. Irregular corneal astigmatism in keratoconus or scleral-buckle-induced regular astigmatisms can be equally well corrected with the use of toric IOL during cataract surgery. Previous scleral buckling or pars plana vitrectomy seem to have no impact on the success of the toric IOL implantation, even in keratoconus. IOL rotational stability and refractive predictability in patients with a previous vitreoretinal surgery can be as good as in uncomplicated cases.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4012, Debrecen, Hungary.
authors.forename: Bence L
authors.initials: BL
authors.lastname: Kolozsvári
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4012, Debrecen, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Losonczy
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4012, Debrecen, Hungary.
authors.forename: Dorottya
authors.initials: D
authors.lastname: Pásztor
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4012, Debrecen, Hungary. mfodor@med.unideb.hu.
authors.forename: Mariann
authors.identifier: http://orcid.org/0000-0002-1089-3899
authors.initials: M
authors.lastname: Fodor
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D057972:Posterior Eye Segment / Q000601:surgery*; D016896:Treatment Outcome
keywords: Keratoconus; Scleral buckling; Toric IOL; Vitrectomy