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. Correction of Astigmatism with Toric IOL After Previous RK.

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Correction of Astigmatism with Toric IOL After Previous RK

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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 rk1

Correction of Astigmatism with Toric IOL After Previous RK

  • 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

Background

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 rk2

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 rk3

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 rk4

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 rk5

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 rk6

Correction of Astigmatism with Toric IOL After Previous RK

  • 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)

Case Results:


Correction of astigmatism with toric iol after previous rk7

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 rk8

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 rk9

Correction of Astigmatism with Toric IOL After Previous RK

  • 1dayp/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 rk10

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 rk11

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.


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