Utilizing Wavefront Aberrometry And Corneal Tomography For Toric Iol: Improving Visual Outcomes In A Post-Penetrating Keratoplasty Patient With High Corneal Astigmatism

To demonstrate the use of Wavefront aberrometry and corneal tomography in the calculation of toric IOL in a post-penetrating keratoplasty case.

Eye and Vision Institute, The Medical City, Pasig City, Philippines

A 26 year-old male, underwent uneventful post-penetrating keratoplasty of the left eye for corneal leukoma secondary to trauma. All corneal sutures were removed the year after. Two years later, he consulted for gradual blurring of vision of the left eye (UCVA 20/200, BCVA 20/70+2). Slit lamp examination revealed a clear corneal graft along with a grade 3 nuclear cataract.

The Pentacam AXL Wave (OCULUS Optikgeräte GmbH, Germany) and iTrace aberrometer (Tracey Technologies, USA) were utilized for corneal surface evaluation and IOL calculation.

Pentacam AXL Wave showed high corneal astigmatism (7.4D) with a regular, minimally asymmetric oblique bowtie pattern. iTrace aberrometry also showed similar results. The Total Corneal Refractive Power (TCRP) was obtained for toric IOL calculation using Barrett Toric Calculator. Adjustments were done for post-corneal transplant eyes. A power of +16.0D sph, -6.00D cyl (T9) was selected.

Patient underwent uneventful phacoemulsification with a monofocal aspheric IOL (Acrysof IQ Toric, Alcon). Visual acuity was notably improved (UCVA 20/40+1, BCVA 20/25+2) with a low residual compound myopic astigmatism on manifest refraction. 

Pentacam AXL Wave and iTrace aberrometry showed low internal and total eye aberrations on Visual Performance Displays.

Wavefront aberrometry along with corneal tomography are essential tools for accurately calculating toric IOLs in post-penetrating keratoplasty patients with high residual astigmatism. The presence of regular astigmatism is also a good indicator for successful toric intraocular implantation outcomes in this subset of patients.