Clear lens exchange with customized toric IOL implantation in eyes with stable corneal topography and stable cylinder axis might be a good option to correct severe induced refractive error after previously performed penetrating keratoplasty.
In this video, Dimitrii Dementiev, MD, performs lens exchange with implantation of a new customized toric IOL (FIL611 T, Soleko IOL) to correct high myopic astigmatism and myopia in a patient after PK.
The patient, a 38-year-old woman, had the right eye operated 20 years ago, at the age of 18 years, by PK for grade 4 keratoconus. At a visit in 2015, in the right eye, uncorrected visual acuity was 20/200, and best corrected visual acuity was 20/22 with cylinder –7.0 D axis 100°. The corneal graft was transparent, corneal topography was stable, endothelial cell count was 1,870 cells/mm2, and the lens was clear. In the left eye, UCVA was 20/60, and BCVA was 20/50 with +1.5 D sphere and –2.0 D axis 105° cylinder. No spectacle correction could be used because of anisometropia. For 20 years, the left eye with the worse visual acuity had remained the dominant eye.
“In November 2015, I exchanged the clear lens of the right eye with a customized toric hydrophilic IOL (FIL611 T) with an optical power of +14.5 D sphere and +7.0 D axis 13° cylinder,” Dementiev said.
In this lens, the cylinder axis is set during construction, based on what is named the “real axis technology.” The IOL must be positioned with the reference marks on the 0° to 180° axis. No additional rotation is needed in the capsular bag, he said.
“The first-day results were impressive, and the patient was very happy. Visual acuity improved to 20/20 up to 20/16 without correction, and refraction improved to –0.25 D sphere. No cylinder correction was needed. No change in refraction, no IOP rise, no excessive loss of endothelial cells, and no IOL dislocation or rotation were observed in the postoperative period of 3 months,” Dementiev said.
According to Dementiev’s results, this toric IOL provides higher predictability and stability in the capsular bag compared with other customized models, basically because no rotation is needed during lens positioning. The real axis technology for customized cylinder minimizes IOL manipulation and capsular bag stretching, making it easier for the surgeon to place the lens in the 0° to 180° axis.
“All this helps us to reach the target refraction and to maintain it stable, avoiding IOL rotation, which is crucial in toric IOL surgery,” Dementiev said.
The recommended incision size is 2.2 mm. The range of IOL power is between –10 D and +35 D sphere in 0.25 D increments. Cylinder range is from +1 D to +16 D, also in 0.25 D increments.
“In our opinion, this IOL can be successfully used for correcting irregular astigmatism in patients with stable keratoconus and after previously performed refractive and keratoplasty procedures, such as radial keratotomy, LASIK, PRK and PKP,” Dementiev said. – by Michela Cimberle
For more information:
Dimitrii Dementiev, MD, can be reached at the International Center for Ophthalmology, Davidkovskaja Street 3/2, Moscow, Russia; email: firstname.lastname@example.org.
Disclosure: Dementiev reports no relevant financial disclosures.