[Implantation of an ARTISANtrade mark toric phakic intraocular lens to correct high astigmatism after penetrating keratoplasty].

BACKGROUND: Visual outcome after penetrating keratoplasty is often Iimited by residual astigmatism. Sometimes conservative treatment modalities like glasses or contact lenses fail to correct the keratoplasty-associated astigmatism. Refractive options are arcuate keratotomy, photorefractive keratectomy or laser in situ keratomileusis. The implantation of an ARTISAN toric intraocular lens presents an additive option to correct corneal astigmatism in phakic eyes. This toric intraocular lens (IOL) has an optical zone of 5.0 mm with a sphericaI front and a toric back. The torus of the IOL is available up to 7 D in half dioper steps.

CASE REPORT: A 27-year old female presented with a bestcorrected visual acuity of 20/32. Penetrating keratoplasty was performed in 1997 because of a decompensated keratoconus. Despite a clear allgraft visual acuity was limited because of a keratoplasty-related high astigmatism of 7.6 D/124 degrees, which could not be sucessfully treated with glasses or contact lenses. An ARTISAN toric intraocular lens with - 3 D spherical and 7.0 D/0 degrees cylindrical power (individually manufactured) was implanted via a sclerocorneal tunnel incision into the anterior chamber. Postoperatively an optimal graft clarity with a well-centered and stable-positioned IOL was found. After 3 months uncorrected visual acuity was 20/25. Six months after implantation the IOL was still well-centered and uncorrected visual acuity was 20/20.

CONCLUSION: Implantation of an ARTISAN toric intraocular lens in phakic eyes is an alternative and new option to correct higher astigmatism. In contrast to the keratorefractive option minor manipulation on the allograft can be expected. For a final conclusion of the endothelial cell loss longer follow-up is necessary.