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Keratoconus and refractive lens exchange with toric intraocular lenses

Poster Details

First Author: E.Hrdlickova CZECH REPUBLIC

Co Author(s):    M. Filipec   U. Tavandzi   F. Benda   A. Holubova   L. Filipova   Z. Hlinomazova     

Abstract Details


The aim of our study was to evaluate the refractive outcome of refractive lens exchange (RLE) with implantation of toric intraocular lenses (IOL) in eyes with keratoconus.


European Eye Clinic Lexum, Prague and Ostrava, Czech Republic


This retrospective study comprised 12 eyes of 9 patients diagnosed with keratoconus (grade I to IV) who underwent RLE with toric intraocular lenses. Seven eyes were implanted with AT TORBI 709M (Carl Zeiss Meditec) with a cylinder correction of 2.0 to 9.5 D, 3 eyes with AcrySof® toric lenses (SN60T8, SN60T9 and SN6AT8; Alcon Laboratories) with 2.0 to 4.5 D cylinder, and 2 eyes with enVista toric (Bausch&Lomb) with 1.25 and 2.0 D cylinder. Evaluated parameters were K-max, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), total and posterior astigmatism, and patient satisfaction.


Average patient age was 50±5 years (43 to 60 years). Mean follow-up was 15±15 months (6 to 48 months). All patients had keratoconus with irregular astigmatism without corneal scars. Mean K-max was 50.81±4.50 D (44.40 to 58.50 D). Mean UDVA improved from preoperative 1.09±0.31 logMAR to postoperative 0.21±0.20 logMAR, CDVA changed from 0.07±0.11 logMAR to postoperative 0.04±0.07 logMAR. Mean SE improved from -4.10±3.59 D to postoperative 0.39±1.05 D. Mean preoperative total astigmatism of -4.33±2.41 D changed to -0.81±0.78 D after surgery. Posterior astigmatism did not have significant influence on postoperative manifest astigmatism (p=0.893). All patients were satisfied with postoperative vision.


Our results confirm that the use of refractive lens exchange with toric IOL implantation may be a suitable option for correcting spherical and cylindrical refractive errors in keratoconic eyes in patients of presbyopic age, where laser refractive surgery or phakic intraocular lens surgery generally are not suitable. Furthermore, toric IOL implantation increased the overall potential of vision by improving corrected distance visual acuity.

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