Transcript Correction of Astigmatism with Toric IOL After Previous RK

Correction of
Astigmatism with
Toric IOL After
Previous RK
By
Chirag R. Shah MD;
H. V. Gimbel MD, MPH; A. Dardzhikova
MD
Authors have no financial interest
ASCRS 2008
Correction of Astigmatism with Toric
IOL After Previous RK
Background

Post RK persistent hyperopic shift with or without increase in
astigmatism is well documented in the literature
– Prospective Evaluation of Radial Keratotomy (PERK): After a
decade of patient follow-up, the study reported that RK
remained a reasonably safe and effective technique
– However, the study found that more than 40 percent of RK
eyes continued to have a gradual shift toward farsightedness
– Between 6 months and 10 years, the refractive error of 43% of
eyes changed in the hyperopic direction by 1.00 D or more
– A shift of the refractive error in the hyperopic direction
continued during the entire 10 years after surgery
Waring GO 3rd, Lynn MJ, McDonnell PJ: Results of the prospective evaluation of radial keratotomy
(PERK) study 10 years after surgery. Arch Ophthalmology 1994 Oct; 112(10): 1298-308
Correction of Astigmatism with Toric
IOL After Previous RK
Various procedures are used to manage post-op RK
hyperopic shift with astigmatism
• Femtosecond LASIK
• Traditional LASIK
• PRK
• ICL
•Munoz G, Albarran-Diego C, Sakla HF, Javaloy J. Femtosecond laser in situ keratomileusis
for consecutive hyperopia after radial keratotomy. JCRS. 2007 Jul;33(7):1183-9.
•Oral D, Awwad ST, Seward MS, Bowman RW, McCulley JP, Cavanagh HD. Hyperopic laser
in situ keratomileusis in eyes with previous radial keratotomy. JCRS. 2005 Aug;31(8):1561-8.
•Joyal H, Gregoire J, Faucher A. Photorefractive keratectomy to correct hyperopic shift after radial keratotomy.
JCRS 2003 Aug;29(8):1502-6.
•Shah CR, Gimbel HV. Role of the Implantable Corrective Lens (ICL) in applications in secondary refractive
surgery. ASCRS May 2007.
Correction of Astigmatism with Toric
IOL After Previous RK
Various procedures are used to manage post-op RK
hyperopic shift with astigmatism
•Suturing Techniques
•PK
•Corneal Segments
•Damiano RE, Forstot SL, Frank CJ, Kasen WB. Purse-string sutures for hyperopia following radial
keratotomy. J Refract Surg. 1998 Jul-Aug;14(4):408-13
•Parmley V, Ng J, Gee B, Rotkis W, Mader T. Penetrating keratoplasty after radial keratotomy. A
report of six patients. Ophthalmology. 1995 Jun;102(6):947-50
•Koppen C, Gobin L, Tassignon MJ. Intacs to stabilize diurnal variation in refraction after radial
keratotomy. J Cataract Refract Surg. 2007 Dec;33(12):2138-41
Correction of Astigmatism with Toric
IOL After Previous RK
Purpose
To report the astigmatism and myopic correction after
cataract surgery using the Alcon Toric IOL (TIOL) in an
eye with previous RK
Correction of Astigmatism with Toric
IOL After Previous RK
Methods
Case Report documents
patient’s ophthalmic history of
RK and RK enhancement
surgery. Derived and measured
keratometry was used for
various IOL power calculation
formulas. TIOL calculation,
incision used, and targeted
correction are discussed.
Correction of Astigmatism with Toric
IOL After Previous RK
Case Results:

58 yr old female

Pre RK:
– -6.0 -0.5 x 45 20/15
–
44.00 (8) 45.25 (97)

RK 1988-- 8 incisions

Pre RK enhancement:
– -1.75 - 0.75 x 50 20/15

RK enhancement 1989
– 8 more incisions

Pre Cataract + TIOL:
– -1.0 -1.5 x 36 20/30
 38.14(7)39.57(97)
Correction of Astigmatism with Toric
IOL After Previous RK
Cataract:
Cortical 1+
Nuclear Color/Opal 3+
PSC3+
ASC2+
Haigis +
Holladay II
similar
Correction of Astigmatism with Toric
IOL After Previous RK

Cataract Sx 12 July 07
– Pre-op astigmatism: - 1.43 x 97
– Temporal Conjunctival Advancing
Scleral Tunnel (CAST) incision

Alcon Acrysof Toric IOL
– Spherical power 21.0 D
– Cylinder power at IOL plane:
– 2.25 D
– Cylinder power at corneal plane:
1.55 D
– Surgery induced astigmatism:
0.25 x 97
– Anticipated residual astigmatism:
0.13 x 97
Correction of Astigmatism with Toric
IOL After Previous RK

1 day p/o
– UCVA 20/150
– + 4.75 -0.5 x 29 20/20-2
– 1+ corneal edema
– IOL centered- oriented at 105°

2 weeks p/o
– UCVA 20/25
– + 0.5 sph 20/20
– IOL centered- oriented at 105°

8 weeks p/o
– UCVA 20/30
– - 0.75 sph 20/20
– IOL centered-oriented at 105°
– PC fibrosis 1+
Correction of Astigmatism with Toric
IOL After Previous RK


6 months OS
– UCVA 20/30
– +0.50-0.50x75 20/25
– PCO 2+
– Nd:YAG Posterior
Capsulotomy performed
Post YAG
– UCVA 25
– +0.50-0.50x71 20/20
– Clear Capsulotomy
– TIOL oriented at 110°
– Patient very happy
Correction of Astigmatism with Toric
IOL After Previous RK
Conclusion
The TIOL is a safe and effective alternative to bioptic
procedures, or limbal relaxing incisions, or AK, in cataract
eyes especially when the latter cannot be performed as in this
case of previous RK.