Xtrafocus Pinhole Lens Implantation In Two Different Cases Of High Astigmatism

To describe the results obtained after implantation of a pinhole Xtrafocus intraocular lens in two patients with high astigmatism, one due to keratoconus and the other due to traumatic corneal leukoma

Germanes Hospitalàries del Sagrat Cor de Jesus “Hospital Sant Rafael”, Barcelona

Two patients with cataract and high astigmatism were proposed for surgery.

The first case involved a 79-year-old patient with cataract and keratoconus; his previous visual acuity (VA) was Hand Movement (HM), reaching 0.05 with pinhole (PH).

Cataract surgery was performed with a toric lens implant and an Xtrafocus piggy-back lens implantation in sulcus in a second stage.

The second case was an 82-year-old patient with irregular astigmatism secondary to traumatic corneal leukoma, with a VA of Counting Fingers (CF), reaching 0.16 with PH. VA improved to 0.05 (PH 0.25) after cataract surgery, so Xtrafocus piggy-back lens implantation was purposed.

In both cases, Xtrafocus pinhole piggy-back lens implantation was purposed in order to achieve best predicted postoperative VA based upon preoperative PH vision.

Xtrafocus lens implantation was purposed also in order to avoid more complex surgeries in those elderly patients.

In the first case -the keratoconus one- VA reached 0.05, the maximum predicted preoperatively, but in the second one -traumatic corneal leucoma- after an uneventful surgery, VA remained at 0.05 (without reaching expected 0.25).

Small aperture optics work by a pinhole effect blocking peripheral light rays, with the theoretical beneficial effect of reducing aberrations caused by irregular corneas.

Patients with irregular or ectasic corneas may benefit of their aberration-reducing capability.

In one of our two cases, VA improved as supposed, with patient referring better quality of vision; in the other hand, our second case did not improved as it was expected by previous evaluation.

So in those cases in which achieving a great VA improvement is not expected, and specially if we agree with the patient to avoid more aggressive surgerys such as keratoplasty, to implant a pinhole lens may be an easy way to give patients a better quality of vision with low risk.