Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism - PowerPoint PPT Presentation

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Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism

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Dx: suture abscess/corneal ulcer OD. Exposed suture removed (running suture), treated with Zymar/Pred Forte, resolution of abscess ... – PowerPoint PPT presentation

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Title: Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism


1
Acrysof Toric IOL Implantation to Correct
Post-Penetrating Keratoplasty Astigmatism
  • Jonathan M. Davidorf, MD
  • Los Angeles, CA
  • ASCRS Annual Meeting
  • San Francisco, CA
  • April, 2009
  • I have no financial interest in the products,
    devices, or techniques discussed in this
    presentation

2
Case ReportInitial Presentation
  • October, 2005, a 64 y.o. female presents with
    Fuchs Corneal Endothelial Dystrophy, BSCVA
    20/50- OD, 20/40 OS c/o difficulty driving/glare
  • 3 guttata OU, trace nuclear sclerosis OD,
    otherwise normal exam
  • Penetrating keratoplasty (PKP) performed OD
    (shortly prior to the first DSEK at our clinic)
  • 12 interrupted, 12 bite running 8.0 mm host, 8.5
    mm donor

3
Follow-up
  • 4M postop BSCVA OD-4.252.00x178 20/25-
  • 2 sutures removed in horizontal meridian
  • Patient lost to follow-up
  • Returns 1 year later (15 M s/p PKP OD) c/o
    irritation, blurred vision OD
  • -3.752.75x171 20/40 OD
  • Dx suture abscess/corneal ulcer OD
  • Exposed suture removed (running suture), treated
    with Zymar/Pred Forte, resolution of abscess

4
2 ½ Years Post-PKP OD c/o Failed Driving Test
  • -6.005.75x157 20/30 OD-4.501.25x103 20/40-
    OS
  • Slit-lamp OD 1 anterior subcapsular and 2
    posterior subcapsular cataract OD, clear graft,
    no horizontal suturesOS 4 guttata, 1-2
    nuclear sclerosis

5
  • 2.6 D WTR corneal astigmatism on Orbscan (steep
    at 005o)
  • 2.68 D WTR corneal astigmatism on IOLMaster
    (steep at 006o)

6
Cataract Surgery with 16D AcrySof Toric (T5) IOL
at 180o
  • 20/30 UCVA on POD 1 (toric IOL at approximately
    175o)

7
Postoperative Course
  • 1 week s/p cataract/toric IOL OD20/30
    UCVA-1.501.00x026 20/20
  • Stable at last follow-up, 1 month following
    cataract surgery

8
Conclusions
  • The AcrySof toric IOL can correct post-PKP
    regular astigmatism during cataract surgery.
  • Efficacy and refractive stability likely
    predicated on stability of corneal curvature
  • Further studies are needed to evaluate the
    safety, predictability, and stability of the
    technique.
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