Visual Outcome Of Trifocal Toric Intraocular Lens In Prior Radial Keratotomy Eyes: A Case Report

To assess the visual outcome following implantation of Trifocal Toric intraocular lens (IOLs) implantation in prior radial keratotomy (RK) eyes.

The patient was examined, evaluated and operated on for both eyes at Aastha Eye and Children Hospital, Anand, Gujarat, India between 5th May 2023 to 18th June 2023

A 53-year-old male patient presented with nuclear sclerotic grade II cataracts in both eyes and a history of 8-cut radial keratotomy (RK) in both eyes 25 years ago. Corneal astigmatism was measured as 1.73D in the right eye (OD) and 1.93D in the left eye (OS). The patient desired spectacle freedom for all distances.

Preoperative assessment included optical biometry, corneal topography, pachymetry, tonometry and OCT to gather comprehensive data.
IOL power calculation was performed incorporating flat keratometry (K) values, minimum cylinder, and other relevant values from optical biometry, topographic average central power value, Atlas ring values at 1, 2, 3, and 4mm, lens thickness, and WTW values into the ASCRS prior RK IOL calculator to obtain IOL power. The K value of the optical biometry data, the axis of topography and the IOL power from the ASCRS prior RK IOL calculator were then inputted into the Barrett toric calculator to get the final Trifocal toric IOL power.
Phacoemulsification cataract surgery with IOL  implantation was performed in both eyes.
1-week follow-up after second eye(OS) surgery: Binocular uncorrected visual acuity (BUCVA) at 3 meters was 0.0 logmar, binocular uncorrected intermediate visual acuity (BUIVA) was -0.1 logmar at 66cm, and binocular uncorrected near visual acuity (UNVA) was -0.1 logmar at 33cm.
6-month follow-up: BUCVA at 3 meters was 0.0(-2) logmar, BUIVA was -0.1 logmar at 66 cm, and BUNVA was -0.1 logmar at 33 cm.

When comparing values from different equipment, we prioritized flat keratometry (K) values of optical biometry to obtain the IOL  power ASCRS prior RK IOL calculator.
For toric IOLs in prior RK cases, we relied on the Barrett toric calculator, inputting the flat K value from optical biometry, the axis of topography, and the IOL power obtained from the ASCRS prior RK calculator.
There are no studies or case reports discussing Trifocal toric IOL placement in patients with prior RK. Our experience with this meticulous IOL calculation method in prior RK eyes has consistently yielded excellent visual outcomes, characterized by spectacle freedom for all distances and high patient satisfaction, particularly with Trifocal toric IOLs.