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Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism

Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism . Jonathan M. Davidorf, MD Los Angeles, CA ASCRS Annual Meeting San Francisco, CA April, 2009 I have no financial interest in the products, devices, or techniques discussed in this presentation.

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Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism

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  1. Acrysof Toric IOL Implantation to Correct Post-Penetrating Keratoplasty Astigmatism Jonathan M. Davidorf, MD Los Angeles, CA ASCRS Annual Meeting San Francisco, CA April, 2009 I have no financial interest in the products, devices, or techniques discussed in this presentation

  2. Case Report:Initial Presentation • October, 2005, a 64 y.o. female presents with Fuch’s Corneal Endothelial Dystrophy, BSCVA 20/50- OD, 20/40+ OS c/o difficulty driving/glare • 3+ guttata OU, trace nuclear sclerosis OD, otherwise normal exam • Penetrating keratoplasty (PKP) performed OD (shortly prior to the first DSEK at our clinic); • 12 interrupted, 12 bite running; 8.0 mm host, 8.5 mm donor

  3. Follow-up • 4M postop BSCVA OD:-4.25+2.00x178 = 20/25- • 2 sutures removed in horizontal meridian • Patient lost to follow-up • Returns 1 year later (15 M s/p PKP OD) c/o irritation, blurred vision OD • -3.75+2.75x171 = 20/40 OD • Dx: suture abscess/corneal ulcer OD • Exposed suture removed (running suture), treated with Zymar/Pred Forte, resolution of abscess

  4. 2 ½ Years Post-PKP OD c/o Failed Driving Test • -6.00+5.75x157 = 20/30+ OD-4.50+1.25x103= 20/40- OS • Slit-lamp: OD: 1+ anterior subcapsular and 2+ posterior subcapsular cataract OD, clear graft, no horizontal suturesOS: 4+ guttata, 1-2+ nuclear sclerosis

  5. 2.6 D WTR corneal astigmatism on Orbscan (steep at 005o) • 2.68 D WTR corneal astigmatism on IOLMaster (steep at 006o)

  6. Cataract Surgery with 16D AcrySof Toric (T5) IOL at 180o • 20/30 UCVA on POD 1 (toric IOL at approximately 175o)

  7. Postoperative Course • 1 week s/p cataract/toric IOL OD:20/30+ UCVA-1.50+1.00x026 = 20/20 • Stable at last follow-up, 1 month following cataract surgery

  8. Conclusions • The AcrySof toric IOL can correct post-PKP regular astigmatism during cataract surgery. • Efficacy and refractive stability likely predicated on stability of corneal curvature • Further studies are needed to evaluate the safety, predictability, and stability of the technique.

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