Refractive Outcomes after Secondary Scleral Sutured Toric Intraocular Lenses for the Correction of Corneal Astigmatism.

Abstract

Purpose: To describe refractive outcomes in eyes with regular corneal astigmatism undergoing scleral sutured toric intraocular lens (SSTIOL) placement with complete pars plana vitrectomy (PPV) using an MX60 toric intraocular lens (IOL) and 8-0 GoreTex suture.

Setting: Academic clinical hospital, Mayo Clinic, Rochester, MN, USA.

Design: Retrospective, single-institution, consecutive case series.

Methods: All eyes in patients with over 1.0D of regular astigmatism undergoing secondary IOL implantation were included. Patients with irregular astigmatism or under the age of 18 were excluded. Primary outcomes included uncorrected distance visual acuity, best corrected visual acuity, degree of astigmatism, and mean percent reduction in cylinder after surgery.

Results: Twenty-three eyes from 21 patients were included. Mean pre-operative uncorrected visual acuity was 1.12 ± 0.6 logMAR (20/270 Snellen; range 20/30- count fingers (CF) Snellen) and mean pre-operative keratometric astigmatism was 2.42 ± 1.07 D. Astigmatism improved in 22 (95.7%) eyes. Postoperatively, mean uncorrected visual acuity was 0.27 ± 0.26D logMAR (20/37 Snellen; range 20/20-20/150 Snellen) and mean best corrected visual acuity was 0.15 ± 0.23D logMAR (20/28 Snellen, range 20/20-20/150 Snellen) (p<0001). Mean post-operative refractive astigmatism was 0.76 ± 0.61D, and mean change in astigmatism was -1.66 ± 1.24D (p<0001), resulting in a 67.06 ± 25.48 mean percent reduction in cylinder. At the final post-operative visit, 16/22 (72.73%) eyes were within 1D, and 12/22 (54.55%) eyes were within 0.5D of planned refractive spherical equivalent target.

Conclusions: Patients with regular corneal astigmatism in the absence of capsular support may benefit from astigmatic-correcting toric secondary IOLs. Patient selection and pre-operative counseling is imperative prior to proceeding with SSTIOL surgery.