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Implantation of toric intraocular lenses with extreme cylinder values to compensate for post-keratoplasty corneal astigmatism

Session Details

Session Title: Toric IOL Outcomes

Session Date/Time: Monday 07/10/2013 | 16:30-18:30

Paper Time: 18:15

Venue: Auditorium (First Floor)

First Author: : U.Vossmerbaeumer GERMANY

Co Author(s): :    A. Mayer   J. Eha           

Abstract Details


To evaluate feasibility and surgical results after phacoemulsification cataract surgery with implantation of customized extreme-toric intraocular lenses (IOL) in eyes with very high corneal astigmatism. Extreme corneal astigmatism over 10 diopters e.g. from penetrating keratoplasty precludes patients from using their visual potential despite a clear graft. However, the degree of astigmatism often exceeds the normal range of IOL available. We describe a series of patients where high astigmatism was successfully corrected using custom-made extreme cylinder IOL.


Retrospective, noncomparative case series of a university eye hospital


8 eyes of 7 phakic patients (mean age 64 years, range 56-78) with moderate to advanced cataract were included. All eyes had received penetrating keratoplasty 4-25 years earlier due to keratoconus. All underwent phacoemulsification cataract surgery with customized pseudophakic toric IOL implantation (LU313T, Oculentis). Keratometry and corneal topography, manifest refraction, uncorrected distance visual acuity (UCVA/D), best corrected distance visual acuity (BCVA/D) patient satisfaction and postoperative clinical course were recorded.


Mean preoperative corneal astigmatism was 11.5 dpt cyl (7.52-16.06), preOP UCVA was 0.05. Nucleocortical cataract was diagnosed and phacoemulsification perfomed. Custom made toric monofocal IOL (Oculentis L 314T) were implanted and results quantified. Mean cylinder of the implanted IOL was 15.42 dpt (11.7-20.0). Postoperative mean cylinder error was 1.98 dpt cyl, UCVA 0.5 (0.32-1.0), BSCVA 0.63 (0.5-1.0). Corneal astigmatism was not altered by the phaco incisions. Patient satisfaction reached 95%.


Our series demonstrates that toric IOL with cylinder beyond the regular commercially available range of 12 dpt cyl may be an effective means to compensate for even extreme degrees of post-keratoplasty corneal astigmatism. These implants can enable patients to make best possible use of their visual potential and improve spectacle independence. Further research in larger cohorts is worthwhile.

Financial Interest:


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