Refractive outcomes after secondary scleral-sutured toric intraocular lenses for the correction of corneal astigmatism.

PURPOSE: To describe refractive outcomes in eyes with regular corneal astigmatism undergoing scleral-sutured toric intraocular lens (SS-TIOL) placement with complete pars plana vitrectomy using an MX60 toric intraocular lens (IOL) and 8-0 Gore-Tex suture.

SETTING

Academic clinical hospital, Mayo Clinic, Rochester, Minnesota.

DESIGN

Retrospective, single-institution, consecutive case series.

METHODS

All eyes in patients with more than 1.0 diopter (D) of regular astigmatism undergoing secondary IOL implantation were included. Patients with irregular astigmatism or aged younger than 18 years were excluded. Primary outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity, degree of astigmatism, and mean percent reduction in cylinder after surgery.

RESULTS

23 eyes from 21 patients were included. Mean preoperative UDVA was 1.12 ± 0.6 logMAR (20/270 Snellen; range 20/30-count fingers Snellen), and mean preoperative keratometric astigmatism was 2.42 ± 1.07 D. Astigmatism improved in 22 (95.7%) eyes. Postoperatively, mean UDVA was 0.27 ± 0.26 D logMAR (20/37 Snellen; range 20/20-20/150 Snellen), and mean CDVA was 0.15 ± 0.23 D logMAR (20/28 Snellen, range 20/20 to 20/150 Snellen) ( P < 001). Mean postoperative refractive astigmatism was 0.76 ± 0.61 D, and mean change in astigmatism was -1.66 ± 1.24 D ( P < 001), resulting in a 67.06 ± 25.48 mean percent reduction in cylinder. At the final postoperative visit, 16 of 22 (72.73%) eyes were within 1 D and 12 of 22 (54.55%) eyes were within 0.5 D 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 preoperative counseling are imperative before proceeding with SS-TIOL surgery.