Background: High postkeratoplasty astigmatism remains a challenge for the surgeon. First experiences after implantation of a toric PMMA IOL in three eyes from patients with cataracts are reported.
Materials and methods: After routine phacoemulsification we implanted an individually manufactured toric PMMA posterior chamber IOL via a sclerocorneal 6-mm tunnel incision in three postkeratoplasty eyes with high, topographically relatively regular astigmatism. One eye with the intraoperative aspect of circular zonular instability also received a capsular tension ring. A complete standard ocular examination was performed pre- and postoperatively including corneal topography, evaluation of anterior chamber depth, ultrasonic biomicroscopy and perimetry.
Results: Implantation and intraoperative alignment of the toric IOL were uneventful. The refractive astigmatisms of 5.0, 6.0 and 7.5 cyl D preoperatively, were reduced to 2.0, 1.75 and 3.0 cyl D, 10 and 12 months postoperation, respectively. The eye with the capsular tension ring showed no morphological or refractive changes during follow-up. In the other two eyes we observed IOL rotation of 20 and 30, respectively after 6 months. There were no posterior capsule opacification or capsular folds in the optical centre.
Conclusion: Toric IOL technology allows enhancement of IOL surgery with improved refractive outcome. Simultaneous implantation of a capsular tension ring may improve long-term stability.