1. 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

2. 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

3. 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
x171 = 20/40 OD
Dx: suture abscess/corneal ulcer OD
Exposed suture removed (running suture), treated with Zymar/Pred Forte, resolution of abscess

4. 2 ½ Years Post-PKP OD c/o Failed Driving Test
x157 = 20/30+ OD x103= 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

5. 2.6 D WTR corneal astigmatism on Orbscan (steep at 005o)
2.68 D WTR corneal astigmatism on IOLMaster (steep at 006o)

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

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

8. 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.