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Refractive surgery of keratoconus = toric IOL in the bag + toric IOL in the sulcus

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Session Details

Session Title: Presented Poster Session: Intraocular Refractive Results

Venue: Poster Village: Pod 2

First Author: : P.Bulir CZECH REPUBLIC

Co Author(s): :                  

Abstract Details


This e-poster presents implantation refractive surgery technique for patients with stabilized keratoconus. Is based on combination technique of clear lens extraction with implantation of toric IOL in the bag as the 1st step of refractive surgery and implantation of toric IOL in the sulcus based on residual subjective refraction as 2nd step of surgery. Both surgeries were done under Verion navigation system control. Aim of this e-poster is to show technique which can bring more accuracy in final refraction in difficult and unpredictable situation such cases with keratoconus are.


Department of Ophthalmology , Hospital Liberec, Czech Republic


Poster is presenting refractive lens exchange of 55year old patient with bilateral keratoconus. We decided for two steps surgery. The first one was CLE with use of toric IOL in the bag. For calculation was used sim-K from keratotopograph, axial length was measured optically (Lenstar). Ultrasound phacoemulsification and implantation under Verion navigation system was used. 9 months after primary surgery was measured residual subjective refractive error and Sulcoflex Toric IOL was calculated based only on subjective refractive error. The second surgery based on in the sulcus implantation of toric Sulcoflex IOL was done with the Verion navigation system too.


The first surgery (phaco + toric in the bag) despite aiming refraction to emetropia end up with UCVA: 0,3 and +4,0 com -3/112 residual refraction. The second step of surgery (toric sulcoflex implantation) end up with UCVA: 0.9 Refraction is stable more than 1 year from second surgery, there is no sign of iris irritation, IOL displacement or rotation.


Predictability of refractive results by patients with irregular cornea and keratoconus is not satisfactory. In order to increase the chance to achieve postop emetropia by those patients author believes that two steps surgery based on combination of toric IOL in the bag and toric IOL (Sulcoflex) in the sulcus based on subjective residual refraction is the way how get as close as possible to desired refraction. The use of positioning digital system (Verion) for precise positioning of both toric lenses will only increase the probability of success.

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