Refractive Outcomes Of Bilateral Non Sequential Toric Iol Implantation In A Patient With Corneal Ectasia After Radial And Arcuate Keratotomies

To report the visual and refractive outcome of binocular toric intraocular lens (IOL) implantation for refractive correction in a patient affected by stable binocular corneal ectasia developed after radial and arcuate keratotomy incisions.

Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy

A 50-year-old female patient with bilateral corneal ectasia developed following arcuate and radial keratotomy performed at young age, was referred to us for cataract surgery. The patient had stable inferior corneal ectasia, with a refractive error unchanged over the years, therefore we decided to perform standard cataract surgery with toric IOL implantation in both eyes. Preoperative best corrected visual acuity (BCVA) was 0.4logMAR in right eye (RE) and 1.0logMAR in left eye (LE).
Preoperative exams included autorefractor/keratometer, corneal topography,  endothelial cell count and optical biometry. Preoperative refractive error was -6.50sf -3.50cyl(ax90) in RE and -4.25sf -8.75cyl(ax 90) in LE. For the IOL power choice we considered Barrett universal II formula, Barrett True K formula and Alcon® Toric IOL calculator.
Considering the inferior corneal ectasia, IOL power was calculated using  simulated keratometry values at 3 mm (SimK) (RE -2.70cyl(ax90), LE -4.50cyl(ax100))
Postoperative uncorrected visual acuity was 0.0logMAR in both eye at 1 year of follow-up.

In patients affected by cataract and corneal ectasia, surgeons may consider implanting toric IOLs. As our case suggests, in patients with corneal ectasia due to radial and arcuate keratotomy who are to undergo cataract surgery, it is important to know the refractive history in order to confirm the stability of the refractive defect.
In our case, the implantation of a toric IOL ensured a good recovery of visual acuity with an acceptable refractive error.