OJOph  Vol.5 No.2 , May 2015
Toric Intraocular Lens Malposition Corrected by Lens Repositioning to Manifest Refractive Cylinder Axis in Patient with Irregular Astigmatism Due to Corneal Scar
Author(s) Riley Sanders1,2, Johnny Gayton1,2
A case is presented of a patient with an unexpected poor visual result and subsequent correction following cataract removal surgery via phacoemulsification and intraocular lens implantation using a toric intraocular lens implant (IOL). The initial operation resulted in an uncorrected vision of 20/100 (0.70 logMAR). Retrospective analysis of the patient’s corneal topography revealed irregular astigmatism secondary to remote trauma to the cornea. The cylinder axis on manifest refraction (MR) was significantly different from measured keratometry, so a second procedure was performed to align the cylinder axis of the IOL with the steep axis on MR. This repositioning procedure improved visual outcome to a final uncorrected vision of 20/25 (0.10 logMAR) and best corrected acuity of 20/20 (0.0 logMAR).

Cite this paper
Sanders, R. and Gayton, J. (2015) Toric Intraocular Lens Malposition Corrected by Lens Repositioning to Manifest Refractive Cylinder Axis in Patient with Irregular Astigmatism Due to Corneal Scar. Open Journal of Ophthalmology, 5, 61-64. doi: 10.4236/ojoph.2015.52010.
[1]   Bauer, N.J.C., de Vries, N.E., Webers, C.A.B., Hendrikse, F. and Nuijts, R.M.M.A. (2008) Astigmatism Management in Cataract Surgery with the AcrySoftoric Intraocular Lens. Journal of Cataract Refractive Surgery, 34, 1483-1488.

[2]   Nuijts, R.M.M.A., Bauer, N.J.C. and Visser, N. (2009) Optimize Surgical Results with Toric IOLs. Cataract and Refractive Surgery Today Europe, July/August, 17-25.

[3]   Koshy, J.J., Nishi, Y., Hirnschall, N., Crnej, A., Gangwani, V., Maurino, V. and Findl, O. (2010) Rotational Stability of a Single-Piece Toric Acrylic Intraocular lens. Journal of Cataract Refractive Surgery, 36, 1665-1670.

[4]   Shirayama, M., Wang, L., Weikert, M.P. and Koch, D.D. (2009) Comparison of Corneal Powers Obtained from 4 Different Devices. American Journal of Ophthalmology, 148, 528-535.

[5]   Vogel, A., Dick, H.B. and Krummenauer, F. (2001) Reproducibility of Optical Biometry Using Partial Coherence Interferometry: Intraobserver and Interobserver Reliability. Journal of Cataract Refractive Surgery, 27, 1961-1968.

[6]   Shah, G.D., Praveen, M.R., Vasavada, A.R., Vasavada, V.A., Rampal, G. and Shastry, L.R. (2012) Rotational Stability of a Toric Intraocular Lens: Influence of Axial Length and Alignment in the Capsular Bag. Journal of Cataract Refractive Surgery, 38, 54-59.

[7]   Tejedor, J. and Perez-Rodriguez, J.A. (2009) Astigmatic Change Induced by 2.8-mm Corneal Incisions for Cataract Surgery. Investigative Ophthalmology and Visual Science, 50, 989-994.

[8]   Alpins, N., Ong, J.K.Y. and Stamatelatos, G. (2014) Refractive Surprise after Toric Intraocular Lens Implantation: Graph Analysis. Journal of Cataract Refractive Surgery, 40, 283-294.

[9]   Koch, D.D., Ali, S.F., Weikert, M.P., Shirayama, M., Jenkins, R. and Wang, L. (2012) Contribution of the Posterior Corneal Astigmatism to Total Corneal Astigmatism. Journal of Cataract Refractive Surgery, 38, 2080-2087.

[10]   Alcon, Inc. AcrySofToric IOL Web Based Calculator.

[11]   Jin, H., Limberger, I.J., Ehmer, A., Guo, H. and Auffarth, G.U. (2010) Impact of Axis Misalignment of Toric Intraocular Lenses on Refractive Outcomes after Cataract Surgery. Journal of Cataract Refractive Surgery, 36, 2061-2072.

[12]   Mohammadi, S., Tahvildari, M. and Z-Mehrjardi, H. (2012) Physiology of Astigmatism, Astigmatism—Optics, Physiology and Management. In: Goggin, M., Ed., InTech, 1-13.

[13]   Lee, A.C., Qazi, M.A. and Pepose, J.S. (2008) Biometry and Intraocular Lens Power Calculation. Current Opinion in Ophthalmology, 19, 13-17.