Case series
Cataract Surgery with Toric Intraocular Lens for Correction of High Corneal Astigmatism

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Abstract

Objective

To analyze the outcomes of cataract surgery with high-power toric intraocular lens (IOL) implantation in patients with high corneal astigmatism.

Design

Retrospective case series.

Participants

Twelve eyes of 9 patients.

Methods

Patients with idiopathic, pathologic, or postsurgical corneal astigmatism and a visually significant cataract were included in the study. Cataract extraction with implantation of a custom-made high-power toric IOL was performed on all patients. Outcomes included uncorrected and best corrected distance visual acuity (UDVA and BCDVA), manifest refraction, and mean and steepest keratometry. Analysis of astigmatic vectors was also performed.

Results

The mean follow-up time was 3.75 months. At the last follow-up visit, there was a significant improvement of UDVA (1 ± 0.64 vs 0.39 ± 0.21 logMAR; p < 0.05), cylindrical refraction (–4.72 ± 1.13 vs –1.81 ± 1.10 D; p < 0.01), and refractive spherical equivalent (–4.56 ± 5.58 vs –0.36 ± 1.19 D; p < 0.05). The BCDVA improvement did not reach statistical significance. Astigmatism on the target axis was reduced by an average of 5 D (p < 0.01).

Conclusions

Cataract surgery with implantation of a high-power toric IOL was safe and effective in correcting high values of corneal astigmatism.

Résumé

Objet

Analyse des résultats de la chirurgie de la cataracte avec des puissantes lentilles intraoculaires (LIO) toriques chez des patients ayant un astigmatisme cornéen.

Nature

Rétrospective d'une série de cas.

Participants

Douze yeux de 9 patients.

Méthodes

Les patients ayant un astigmatisme cornéen idiopathique, pathologique ou post chirurgical, et une importante cataracte visuelle ont fait l'objet de l'étude. L'extraction de la cataracte avec implantation d'une puissante LIO faite sur mesure a été exécutée chez tous les patients. Les résultats ont compris l'acuité visuelle à distance non corrigée et la mieux corrigée (AVDNC et AVDMC), la réfraction manifeste et la kératométrie moyenne et la plus rapide. L'analyse des composantes astigmatiques a aussi été effectuée.

Résultats

La durée moyenne du suivi a été de 3,75 mois. À la dernière visite de suivi, l'AVDNC s'était améliorée considérablement (1 ± 0,64 vs 0,39 ± 0,21 logMAR; p < 0,05), réfraction cylindrique (-4,72 ± 1,13 vs -1,81 ± 1,10 D; p < 0,01) et équivalant sphérique réfractif (-4,56 ± 5,58 vs -0,36 ± 1,19 D; p < 0,05). L'amélioration de l'AVDMC n'avait pas atteint d'importance statistique. Sur l'angle cible, l'astigmatisme était en moyenne réduit de 5 D (p < 0,01).

Conclusions

La chirurgie de la cataracte avec implantation d'une puissante LIO torique était sécuritaire et efficace pour corriger les valeurs élevées de l'astigmatisme cornéen.

Section snippets

Methods

Twelve eyes of 9 patients were included in this retrospective case series (5 male, 4 female; mean age, 57.8 ± 10.3 years, range, 39–68 years). All eyes had a visually significant cataract and corneal astigmatism ≥3 D. The high astigmatic refraction was idiopathic in 2 patients (3 eyes), due to keratoconus in 2 patients (4 eyes), consequent to penetrating keratoplasty (PK) in 4 patients (4 eyes), and radial keratotomy (RK) in 1 patient. Patients with irregular astigmatism at corneal topography

Results

The mean follow-up period was 3.75 months (range, 1–12 months). Preoperatively, the eyes included in the study had a mean refractive astigmatism of –4.72 ± 1.13 D (range, 3–6.25 D).

After cataract extraction and implantation of the toric IOL, a significant improvement, as expected, was achieved in the mean UDVA (p < 0.05; Table 1). A trend toward improvement that did not reach statistical significance was also recorded in the mean BCDVA (p > 0.05; Table 1). Nine of 12 eyes (75%) had a BCDVA of

Discussion

In our small case series, cataract surgery with a high-power toric IOL was shown to be both safe and effective in correcting high values of corneal astigmatism in the presence of a visually significant cataract.

The role of toric IOLs in correcting low levels of astigmatism has been well established.15 A multicentric Canadian series reported 70% of spectacle independence, 0.4 D of residual astigmatic refraction, and high satisfaction rates in patients with astigmatism between 1 and 2.5 D.3 In

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