Toric Intraocular Lens Implantation for Correction of Astigmatism in Cataract Patients with Corneal Ectasia
A 72-year-old woman presented to our outpatient clinic with decreased visual acuity in both eyes. Slit-lamp examination showed bilateral nuclear cataract. The BCVA was 4/10 in both eyes with +1.00 −4.25 × 90° and +1.00 −5.00 × 91° in the right and left eye, respectively. Automated refractometry showed +1.50 −5.25 × 106° with K1 40.25 at 92° and K2 54.75 at 2° in the right eye and −8.0 × 98° with K1 41.75 at 106° and K2 49.50 at 16° in the left eye. Orbscan confirmed PMD in both eyes (fig. ), which had been known and stable for the last 3 years. K values for the steep and flat axis were 39.28 D at 93° and 54.7 D at 3°, respectively, in the right eye, and 39.7 D at 106° and 48.3 D at 16°, respectively, in the left eye. Lens power calculation was performed as described for case 1. A standard phacoemulsification with toric IOL was performed in both eyes. In the right eye, a toric IOL (AcrySof SN60T9) with a spherical power of 9.5 D and a cylinder power of 6.00 D at the IOL plane was implanted at an axis of 3°. In the left eye, a toric IOL (AcrySof SN60T9) with a spherical power of 16.5 D and a cylinder power of 6.0 D at the IOL plane was implanted at 14°. Postoperatively, the BCVA was 7/10 with −2.50 × 80° in the right eye and 8/10 with −1.50 × 100° in the left eye, which remained stable at the 24- and 28-month follow-up for the right and left eye, respectively. Corneal topography remained almost stable, with K values for the steep and flat axis of 53.3 D at 180° and 38.5 D at 90°, respectively, in the right eye, and 48.6 D at 15° and 39.9 D at 105°, respectively, in the left eye. The toric IOL alignment axis, as determined by slit-lamp biomicroscopy, was at 5° in the right eye and at 15° in the left eye (fig. ). The patient was satisfied with the postoperative visual outcomes at the end of the follow-up.