Customized Solution in an Odd Eye: the Two IOL Concept
Tehrani M., Christmann S., Dick H. B.
University Eye Hospital, Medical School, University of Mainz
Purpose: The authors describe the first case report of an implantation of an intraocular lens with a torus of 30 diopters in an eye after penetrating keratoplasty.
Method: A 62-year-old female presented with cataract and a best-corrected visual acuity of 20/400. A penetrating keratoplasty was performed in 1975 because of a decompensated keratoconus. With a clear, but inferiorly decentred corneal graft, visual acuity was limited because of a keratoplasty related highcorneal astigmatism of 22.5 D /156°, which could not be sucessfully treated with spectacles or contact lenses. A toric intraocular lens with 30 D cylindrical power (individually manufactured) was implanted via a sclerocorneal tunnel incision into the capsular bag. Further, a spherical IOL of -12 D sphere was implanted into the ciliary sulcus.
Results: Postoperatively optimal graft clarity with well-centred and stable positioned IOLs was found. The total astigmatism was decreased postoperatively to -5 diopters, with a slight axis rotation of 5°. Six months after implantation, the IOLs were still well centred with an uncorrected visual acuity of 20/60.
Conclusions: The implantation of an individually manufactured toric intraocular lens in cataractous eyes with a keratoplasty-associated high astigmatism is an alternative method, with minor manipulations on the corneal graft, when compared to keratorefractive techniques.
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