Visual Outcomes Following Implantation Of Small Aperture Intraocular Lens In Patients With Irregular Corneas

To evaluate visual performance of a small aperture extended depth of focus intraocular (IOL) in patients with irregular corneas from various underlying causes

A 1-year, two-surgeon, multicenter, nonrandomized, retrospective case series of consecutive eyes undergoing IC-8 (AcuFocus Inc, Irvine, CA) small aperture IOL insertion following cataract extraction for management of visually significant corneal irregularities.

A retrospective chart review of 58 patients (mean age of 44.8 + 10.3 years) with monocular implantation of IC-8 IOL (a hydrophobic acrylic non-toric IOL with an opaque mini ring measuring 3.23 mm in total diameter with a 1.36 mm central aperture) was undertaken. The most common aetiologies of corneal irregularities were previous corneal transplant (n= 18), ectasia (n=14), and prior refractive laser (n=8). Other aetiologies include corneal scars from previous herpetic infections, pterygium surgery, ocular trauma, and lipid keratopathy. All patients’ pre and post operative refraction, corneal topography monocular uncorrected distance and near visual acuity (UCDVA, UCNVA) were measured and analysed.

Pre-operative BCVA ranged from 20/16 to 20/640 (median VA=20/40, Q1=20/30, Q3=20/60) and this improved post-operatively to 20/16 to 20/80 (median=20/20, Q1=20/20, Q3=20/30). At 12 months, 45/58 (78%) of patients were 20/30 or better UCDVA in their IC-8 eye. 39/58 (67%) of the IC-8- eyes achieved N6 or better UCNVA. Interestingly, 41% of patients (n=24) with post-operative refraction showed residual astigmatic (>1D) following their surgery. Despite the presence of up to 2.50D pre-op corneal astigmatism, UCDVA of at least 6/9 or better was attained even in more than 75% of patients .

Implantation of a small aperture IOL provides patients with good simultaneous distance and near visual acuity, even in the presence of significant corneal astigmatism.