Correction Of Astigmatism And Aphakia With A Toric Scleral 4-Point Fixated Iol

To introduce a novel surgical approach utilizing a toric scleral fixated IOL to address clinically significant astigmatism and aphakia in secondary IOL implantation in the absence of the capsular bag, aiming to improve visual outcomes and patient satisfaction.

Single-center, single surgeon, case series, Department of Ophthalmology, Medical University of Vienna.

Six eyes of six patients underwent implantation of a SOLEKO FIL 611 T toric hydrophilic, customized lens and were followed up for 6 months. The haptics were securely fixated in a 4-Point fixation fashion in the 0° axis using either a Prolene 6-0 intrascleral flanged technique or 8.0 Gore-tex suture placed 2.5 mm posterior to the limbus and 5mm apart. Astigmatism, tilt and decentration were measured with Tomey CASIA2 anterior OCT.

Preoperatively, the mean total corneal astigmatism (TCA) measured 3.75±0.89 diopters (range: 2.80 to 4.60). Following surgery, the mean total astigmatism power was reduced to 1.56±1.39 D (range: 0.25 to 3.50). Additionally, postoperatively, the IOL exhibited an average tilt of 5.80°±1.56°, with a mean decentration of 0.51mm ± 0.25. Before surgery, the best-corrected visual acuity (BCVA) ranged from 0.06 to 1.00, while postoperatively, the BCVA range was 0.32 to 1.00. After applying various formulae for IOL power calculation, the absolute prediction error with the SRKT formula ranged from 0.29 to 1.51 diopters, with the Holladay 1 formula ranging from 0.23 to 1.03 diopters, and the Hoffer Q formula ranging from 0.25 to 2.14 diopters.

In summary, the novel toric scleral sutured lens offers promising outcomes for comprehensive aphakia correction, in patients with compromised zonular support. Its efficacy extends to significant astigmatic correction, meeting the high expectations of patients for postoperative visual quality. Further research is needed to confirm its long-term efficacy and durability across diverse patient populations.