Elsevier

Ophthalmology

Volume 111, Issue 6, June 2004, Pages 1086-1094
Ophthalmology

Original article
Artisan toric lens implantation for correction of postkeratoplasty astigmatism

Presented in part at: American Society of Cataract and Refractive Surgeons annual meeting, June, 2002, Philadelphia, Pennsylvania; and European Society of Cataract and Refractive Surgeons annual meeting, September, 2002, Nice, France.
https://doi.org/10.1016/j.ophtha.2003.09.045Get rights and content

Abstract

Purpose

To determine the efficacy of Artisan toric iris-fixated lens implantation after penetrating keratoplasty to correct high ametropia and astigmatism.

Design

Prospective, noncomparative case series.

Participants

Artisan toric lens implantation was performed in 16 eyes of 16 patients who were contact lens intolerant or were unable to wear glasses because of anisometropia, high astigmatism, or both.

Intervention

Sixteen eyes of 16 patients received Artisan toric lenses for postkeratoplasty astigmatism, anisometropia, or both.

Main outcome measures

Manifest refraction, uncorrected and spectacle-corrected visual acuity, and corneal topography were performed before surgery and 1, 3, 6, 12, and 18 months after surgery. Efficacy, percent reduction of refractive astigmatism, topographical astigmatism, anisometropia of defocus, and the astigmatism correction index were determined. A patient satisfaction questionnaire and specular microscopy results were assessed.

Results

The mean ± standard deviation of the preoperative refractive cylinder was −6.66±1.93 diopters (D; range, −4.0 to −10.0 D), which was reduced to −2.08±1.33 D, −2.14±1.76 D, −1.98±1.65 D, −1.84±0.77 D, and −1.42±0.78 D at 1 month, 3 months, 6 months, 12 months, and the final follow-up examination (8.4±4.9 months), respectively. Spherical equivalent was reduced from −4.90±5.50 D before surgery to −0.96±0.86 D at the final follow-up. The uncorrected and best-corrected visual acuities were ≥20/40 in 42% and 100% of eyes, respectively. There was no loss of best-corrected visual acuity and a gain of at least 2 lines in 50% of eyes. The percent reduction in refractive astigmatism, topographical astigmatism, and anisometropia of defocus were 78.0±11.5%, 20.3±34.9%, and 77.0±12.0%, respectively. The astigmatism correction index was 102.8±18.6%. Satisfaction increased from 3.2 to 8.3 after implantation. The endothelial cell loss was 7.6±18.9% at 3 months and 16.6±20.4% at the last follow-up. In 1 patient, a reversible graft rejection occurred.

Conclusions

Artisan toric lens implantation after penetrating keratoplasty was effective for reduction of refractive astigmatism and ametropia. All patients were suitable for spectacle correction after implantation. A longer follow-up and a larger number of patients are needed to assess the safety and the effect of the lens on the corneal graft endothelium.

Section snippets

Patient population

The 16 eyes of 16 patients included in this study could not be corrected by spectacle wear because of anisometropia, because of the magnitude of refractive cylinder, or because the patients were contact lens intolerant. Exclusion criteria were as follows: a preoperative spectacle-corrected visual acuity worse than 20/50, an anterior chamber depth less than 3.0 mm, glaucoma, retinal pathologic features, or an endothelial cell count lower than 500 cells/mm2. Investigational review board approval

Patient population

Thirteen patients were female and 3 were male. The mean age was 67.3±11.9 years (range, 39–81 years). The mean interval between penetrating keratoplasty and toric lens implantation was 48.9±17.7 months (range, 34–90 months), and the interval between suture removal and lens implantation was 21.3±9.6 months (range, 8–37 months). Twelve eyes were pseudophakic after previous implantation of a posterior chamber intraocular lens. The initial diagnosis requiring corneal transplantation was Fuchs'

Discussion

This prospective study of 16 eyes demonstrates the efficacy and stability of the Artisan toric IOL for correction of postkeratoplasty astigmatism. Until now, LASIK seemed to be the preferred technique for correction of anisometropia and astigmatism after keratoplasty (Table 2).16, 17, 18, 19, 20, 21 The use of the Artisan toric IOL, with a power range of 7.5 D of cylinder and −20.5 D of myopia to +12.0 D of hyperopia, provides a wide field for correction of postkeratoplasty astigmatism and

References (44)

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    The preoperative SE was successfully neutralized in this study and, as previously noted, all patients had improved CDVA postoperatively. Other published studies of toric IOLs in post-keratoplasty eyes report a postoperative CDVA of 20/40 or better in 50% of eyes22 using posterior chamber toric IOLs and 80.6% of eyes4 and 100 of eyes24 using the Artisan iris-fixated toric IOL. ( The latter 2 studies included a mixture of pseudophakic and phakic eyes.)

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    Significant levels of refractive error may remain uncorrected in eyes with high ametropia that exceeds the limits of corneal surgery. Others have reported on the efficacy of phakic IOL use after keratoplasty.13,14,16,18,31–33 The benefits of phakic IOLs are ease of reversibility, preservation of accommodation, and lower risk of capsular rupture.

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    To our knowledge, no previous studies have analyzed the Artiflex toric pIOL. However, the rigid Artisan toric pIOL has been extensively studied.3–14 In a European multicenter clinical study, Dick et al.4 found no loss of CDVA and a gain of 1 or more lines from the preoperative CDVA in 65.7% of eyes; in 88.6% of eyes, the UDVA was 20/40 or better.

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None of the authors has a financial or proprietary interest in any product or device mentioned.

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