Old clear penetrating keratoplasty with high astigmatism: conservative solution with customized foldable Toric Piggyback intraocular lens.

PURPOSE: To evaluate the efficacy and safety of toric foldable intraocular lens (IOL) for high astigmatism correction in eyes with prior penetrating keratoplasty (PK).

METHODS

Clinical data were retrospectively collected at baseline and 12 months postoperatively from pseudophakic patients with high astigmatism (> 2 D), and previous PK, who underwent implantation of customized foldable toric IOLs using the piggyback technique. Uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest refraction, keratometry, refractive and topographic cylinder, endothelial cell count (ECC), and complications were assessed. To account for inter-eye correlation, analyses were performed using generalized estimating equations (GEE), and estimated differences (est.) with 95% confidence intervals (CI) were reported.

RESULTS

Fourteen eyes of 11 patients (2 women, 9 men; mean age 62 ± 21 years) were included. The mean interval between PK and piggyback implantation was 24.18 years. Uncorrected and best-corrected visual acuity improved at 12 months (UCVA: est. - 0.69 logMAR; 95% CI, - 0.84 to - 0.54; p < 0.001; BCVA: est. - 0.20 logMAR; 95% CI, - 0.29 to - 0.11; p < 0.001). Total refractive astigmatism was reduced (est. - 4.09 diopters; 95% CI, - 5.20 to - 2.99; p < 0.001), whereas topographic astigmatism remained unchanged (est. - 0.03 diopters; 95% CI, - 0.21 to 0.16; p = 0.76). Endothelial cell count did not show a statistically significant change over time (est. - 67.8 cells/mm2; 95% CI, - 139.6 to 4.0; p = 0.07). One eye experienced recurrent IOL rotation (80°), requiring explant and replacement.

CONCLUSIONS

The favorable refractive outcomes and safety profile support the use of the piggyback technique with a customized toric foldable IOL for correcting high astigmatism in pseudophakic eyes that have undergone PK many years before. Larger sample size and prospective study are needed.