Toric intraocular lens combined with a supplementary pinhole implant to treat irregular corneal astigmatism.

A case of refractive lens exchange with the implantation of a supplementary intraocular pinhole (IOPH) to treat a challenging case of keratoconus is presented. Four months after the initial procedure, an intraocular lens (IOL) exchange (under the IOPH) was performed to a toric implant to correct the residual manifest astigmatism. This significantly improved both distance and near acuities and demonstrates how a toric IOL and astigmatism correction in combination with a pinhole device could be used to treat selected cases of keratoconus.