Kolozsvári Bence L, Losonczy Gergely, Pásztor Dorottya, Fodor Mariann
Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4012, Debrecen, Hungary.
BMC Ophthalmol. 2017 Jan 13;17(1):3. doi: 10.1186/s12886-016-0397-8.
Toric intraocular lens (IOL) implantation can be an effective method for correcting corneal astigmatism in patients with vitreoretinal diseases and cataract. Our purpose is to report the outcome of toric IOL implantation in two cases - a patient with scleral-buckle-induced regular corneal astigmatism and a patient with keratoconus following pars plana vitrectomy. As far as we are aware, there are no reported cases of toric IOL implantation in a vitrectomized eye with keratoconus nor of toric IOL implantation in patients with scleral-buckle-induced regular corneal astigmatism.
Two patients with myopia and high corneal astigmatism underwent cataract operation with toric IOL implantation after posterior segment surgery. Myopia and high astigmatism (>2.5 diopter) were caused by previous scleral buckling in one case and by keratoconus in the other case. Pre- and postoperative examinations during the follow-up of included uncorrected and spectacle corrected distance visual acuity (UCDVA/CDVA), automated kerato-refractometry (Topcon), Pentacam HR, IOL Master (Zeiss) axial length measurements and fundus optical coherence tomography (Zeiss). One year postoperatively, the UCDVA and CDVA were 20/25 and 20/20 in both cases, respectively. The absolute residual refractive astigmatism was 1.0 and 0.75 Diopters, respectively. The IOL rotation was within 3° in both eyes, therefore IOL repositioning was not necessary. Complications were not observed in our cases.
These cases demonstrate that toric IOL implantation is a predictable and safe method for the correction of high corneal astigmatism in complicated cases with different origins. Irregular corneal astigmatism in keratoconus or scleral-buckle-induced regular astigmatisms can be equally well corrected with the use of toric IOL during cataract surgery. Previous scleral buckling or pars plana vitrectomy seem to have no impact on the success of the toric IOL implantation, even in keratoconus. IOL rotational stability and refractive predictability in patients with a previous vitreoretinal surgery can be as good as in uncomplicated cases.
对于患有玻璃体视网膜疾病和白内障的患者，植入散光型人工晶状体（IOL）可能是矫正角膜散光的有效方法。我们的目的是报告两例散光型IOL植入的结果——一例因巩膜扣带术导致规则性角膜散光的患者和一例玻璃体切割术后发生圆锥角膜的患者。据我们所知，尚无在玻璃体切割术后合并圆锥角膜的眼中植入散光型IOL的报道，也没有在巩膜扣带术导致规则性角膜散光的患者中植入散光型IOL的报道。
两名近视且角膜散光度数较高的患者在进行后段手术后接受了白内障手术并植入散光型IOL。其中一例患者的近视和高度散光（>2.5屈光度）是由先前的巩膜扣带术引起的，另一例是由圆锥角膜引起的。随访期间的术前和术后检查包括未矫正和戴镜矫正的远视力（UCDVA/CDVA）、自动角膜屈光测量（拓普康）、Pentacam HR、IOL Master（蔡司）测量眼轴长度以及眼底光学相干断层扫描（蔡司）。术后一年，两例患者的UCDVA和CDVA分别为20/25和20/20。绝对残余屈光性散光分别为1.0和0.75屈光度。两眼的IOL旋转均在3°以内，因此无需重新定位IOL。我们的病例中未观察到并发症。
这些病例表明，植入散光型IOL是矫正不同病因复杂病例中高度角膜散光的一种可预测且安全的方法。在白内障手术中，使用散光型IOL可以同样有效地矫正圆锥角膜引起的不规则角膜散光或巩膜扣带术引起的规则散光。先前的巩膜扣带术或玻璃体切割术似乎对散光型IOL植入的成功没有影响，即使在圆锥角膜患者中也是如此。既往接受玻璃体视网膜手术的患者，IOL的旋转稳定性和屈光可预测性与未合并并发症的病例一样好。
