Correction of Astigmatism with Toric IOL After Previous RK By Chirag R. Shah MD; H. V. Gimbel MD, MPH; A. Dardzhikova MD Authors have no financial interest

Correction of Correction of Astigmatism with Astigmatism with

Toric IOL After Toric IOL After Previous RKPrevious RK

ByBy

Chirag R. Shah MD; Chirag R. Shah MD;

H. V. Gimbel MD, MPH; A. H. V. Gimbel MD, MPH; A. Dardzhikova MDDardzhikova MD

Authors have no financial interestAuthors have no financial interest

ASCRS 2008

Post RK persistent hyperopic shift with or without increase in Post RK persistent hyperopic shift with or without increase in astigmatism is well documented in the literatureastigmatism is well documented in the literature

– Prospective Evaluation of Radial Keratotomy (PERK): After Prospective Evaluation of Radial Keratotomy (PERK): After a decade of patient follow-up, the study reported that RK a decade of patient follow-up, the study reported that RK remained a reasonably safe and effective technique remained a reasonably safe and effective technique

– However, the study found that more than 40 percent of RK However, the study found that more than 40 percent of RK eyes continued to have a gradual shift toward eyes continued to have a gradual shift toward farsightednessfarsightedness

– Between 6 months and 10 years, the refractive error of 43% Between 6 months and 10 years, the refractive error of 43% of eyes changed in the hyperopic direction by 1.00 D or of eyes changed in the hyperopic direction by 1.00 D or moremore

– A shift of the refractive error in the hyperopic direction A shift of the refractive error in the hyperopic direction continued during the entire 10 years after surgerycontinued during the entire 10 years after surgery

Waring GO 3rd, Lynn MJ, McDonnell PJ: Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmology 1994 Oct; 112(10): 1298-308

Correction of Astigmatism with Correction of Astigmatism with Toric IOL After Previous RKToric IOL After Previous RK

Background


Various procedures are used to manage post-op RK hyperopic shift with astigmatism

• Femtosecond LASIK• Traditional LASIK• PRK• ICL•Munoz G, Albarran-Diego C, Sakla HF, Javaloy J. Femtosecond laser in situ keratomileusisfor consecutive hyperopia after radial keratotomy. JCRS. 2007 Jul;33(7):1183-9.

•Oral D, Awwad ST, Seward MS, Bowman RW, McCulley JP, Cavanagh HD. Hyperopic laserin situ keratomileusis in eyes with previous radial keratotomy. JCRS. 2005 Aug;31(8):1561-8.

•Joyal H, Gregoire J, Faucher A. Photorefractive keratectomy to correct hyperopic shift after radial keratotomy. JCRS 2003 Aug;29(8):1502-6.

•Shah CR, Gimbel HV. Role of the Implantable Corrective Lens (ICL) in applications in secondary refractive surgery. ASCRS May 2007.


•Damiano RE, Forstot SL, Frank CJ, Kasen WB. Purse-string sutures for hyperopia following radial keratotomy. J Refract Surg. 1998 Jul-Aug;14(4):408-13

•Parmley V, Ng J, Gee B, Rotkis W, Mader T. Penetrating keratoplasty after radial keratotomy. A report of six patients. Ophthalmology. 1995 Jun;102(6):947-50

•Koppen C, Gobin L, Tassignon MJ. Intacs to stabilize diurnal variation in refraction after radial keratotomy. J Cataract Refract Surg. 2007 Dec;33(12):2138-41

Various procedures are used to manage post-op RK hyperopic shift with astigmatism

•Suturing Techniques

•PK

•Corneal Segments


Purpose

To report the astigmatism and myopic correction after cataract surgery using the Alcon Toric IOL (TIOL) in an eye with previous RK


Methods

Case Report documents patient’s ophthalmic history of RK and RK enhancement surgery. Derived and measured keratometry was used for various IOL power calculation formulas. TIOL calculation, incision used, and targeted correction are discussed.

58 yr old female58 yr old female Pre RK: Pre RK:

– -6.0 -0.5 x 45 20/15 -6.0 -0.5 x 45 20/15

– 44.00 (8) 45.25 (97)44.00 (8) 45.25 (97) RK 1988-- 8 incisionsRK 1988-- 8 incisions Pre RK enhancement: Pre RK enhancement:

– -1.75 - 0.75 x 50 20/15 -1.75 - 0.75 x 50 20/15

RK enhancement 1989 RK enhancement 1989

– 8 more incisions8 more incisions Pre Cataract + TIOL: Pre Cataract + TIOL:

– -1.0 -1.5 x 36 20/30 -1.0 -1.5 x 36 20/30 38.14(7)39.57(97)38.14(7)39.57(97)


Case Results:

Cataract: Cortical 1+ Nuclear Color/Opal 3+ PSC3+ASC2+


Haigis +Holladay II

similar

Cataract Sx 12 July 07Cataract Sx 12 July 07

– Pre-op astigmatism: - 1.43 x Pre-op astigmatism: - 1.43 x 9797

– Temporal Conjunctival Temporal Conjunctival Advancing Scleral Tunnel Advancing Scleral Tunnel (CAST) incision(CAST) incision

Alcon Acrysof Toric IOLAlcon Acrysof Toric IOL

– Spherical power 21.0 DSpherical power 21.0 D

– Cylinder power at IOL plane: Cylinder power at IOL plane:

– 2.25 D2.25 D

– Cylinder power at corneal Cylinder power at corneal plane: 1.55 D plane: 1.55 D

– Surgery induced astigmatism: Surgery induced astigmatism: 0.25 x 97 0.25 x 97

– Anticipated residual Anticipated residual

astigmatism: 0.13 x 97astigmatism: 0.13 x 97


11 dayday p/op/o

– UCVA 20/150UCVA 20/150

– + 4.75 -0.5 x 29 20/20-2+ 4.75 -0.5 x 29 20/20-2

– 1+ corneal edema1+ corneal edema

– IOL centered- oriented at 105° IOL centered- oriented at 105° 2 weeks p/o2 weeks p/o

– UCVA 20/25UCVA 20/25

– + 0.5 sph 20/20+ 0.5 sph 20/20

– IOL centered- oriented at 105°IOL centered- oriented at 105° 8 weeks p/o8 weeks p/o

– UCVA 20/30UCVA 20/30

– - 0.75 sph 20/20- 0.75 sph 20/20

– IOL centered-oriented at 105° IOL centered-oriented at 105°

– PC fibrosis 1+PC fibrosis 1+



6 months OS 6 months OS – UCVA 20/30 UCVA 20/30 – +0.50-0.50x75 20/25+0.50-0.50x75 20/25– PCO 2+PCO 2+– Nd:YAG Posterior Nd:YAG Posterior

Capsulotomy performedCapsulotomy performed Post YAG Post YAG

– UCVA 25UCVA 25– +0.50-0.50x71 20/20 +0.50-0.50x71 20/20 – Clear CapsulotomyClear Capsulotomy– TIOL oriented at 110TIOL oriented at 110°°– Patient very happyPatient very happy


ConclusionThe TIOL is a safe and effective alternative to bioptic procedures, or limbal relaxing incisions, or AK, in cataract eyes especially when the latter cannot be performed as in this case of previous RK.

Documents

Correction of Astigmatism with Toric IOL After Previous RK By Chirag R. Shah MD; H. V. Gimbel MD, MPH; A. Dardzhikova MD Authors have no financial interest