Correction of Astigmatism with Toric IOL After Previous RK

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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
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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
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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 Jul33(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 Aug31(8)1561-8.
• Joyal H, Gregoire J, Faucher A. Photorefractive
  keratectomy to correct hyperopic shift after
  radial keratotomy. JCRS 2003 Aug29(8)1502-6.
• Shah CR, Gimbel HV. Role of the Implantable
  Corrective Lens (ICL) in applications in
  secondary refractive surgery. ASCRS May 2007.

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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-Aug14(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
  Jun102(6)947-50
• Koppen C, Gobin L, Tassignon MJ. Intacs to
  stabilize diurnal variation in refraction after
  radial keratotomy. J Cataract Refract Surg. 2007
  Dec33(12)2138-41

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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
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Correction of Astigmatism with Toric IOL After
Previous RK
Methods
Case Report documents patients 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.
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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)

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Correction of Astigmatism with Toric IOL After
Previous RK
Cataract Cortical 1 Nuclear Color/Opal 3
PSC3 ASC2
Haigis
Holladay II
similar
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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

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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

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Correction of Astigmatism with Toric IOL After
Previous RK

• 6 months OS
• UCVA 20/30
• 0.50-0.50x75 20/25
• PCO 2
• NdYAG Posterior Capsulotomy performed
• Post YAG
• UCVA 25
• 0.50-0.50x71 20/20
• Clear Capsulotomy
• TIOL oriented at 110
• Patient very happy

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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.