Jonathan M. Davidorf, MD Los Angeles, CA ASCRS Annual Meeting

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Presentation transcript:

Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism Jonathan M. Davidorf, MD Los Angeles, CA ASCRS Annual Meeting San Francisco, CA April, 2009 I have no financial interest in the products, devices, or techniques discussed in this presentation

Case Report: Initial Presentation October, 2005, a 64 y.o. female presents with Fuch’s Corneal Endothelial Dystrophy, BSCVA 20/50- OD, 20/40+ OS c/o difficulty driving/glare 3+ guttata OU, trace nuclear sclerosis OD, otherwise normal exam Penetrating keratoplasty (PKP) performed OD (shortly prior to the first DSEK at our clinic); 12 interrupted, 12 bite running; 8.0 mm host, 8.5 mm donor

Follow-up 4M postop BSCVA OD: -4.25+2.00x178 = 20/25- 2 sutures removed in horizontal meridian Patient lost to follow-up Returns 1 year later (15 M s/p PKP OD) c/o irritation, blurred vision OD -3.75+2.75x171 = 20/40 OD Dx: suture abscess/corneal ulcer OD Exposed suture removed (running suture), treated with Zymar/Pred Forte, resolution of abscess

2 ½ Years Post-PKP OD c/o Failed Driving Test -6.00+5.75x157 = 20/30+ OD -4.50+1.25x103= 20/40- OS Slit-lamp: OD: 1+ anterior subcapsular and 2+ posterior subcapsular cataract OD, clear graft, no horizontal sutures OS: 4+ guttata, 1-2+ nuclear sclerosis

2.6 D WTR corneal astigmatism on Orbscan (steep at 005o) 2.68 D WTR corneal astigmatism on IOLMaster (steep at 006o)

Cataract Surgery with 16D AcrySof Toric (T5) IOL at 180o 20/30 UCVA on POD 1 (toric IOL at approximately 175o)

Postoperative Course 1 week s/p cataract/toric IOL OD: 20/30+ UCVA -1.50+1.00x026 = 20/20 Stable at last follow-up, 1 month following cataract surgery

Conclusions The AcrySof toric IOL can correct post-PKP regular astigmatism during cataract surgery. Efficacy and refractive stability likely predicated on stability of corneal curvature Further studies are needed to evaluate the safety, predictability, and stability of the technique.