Outcomes of cataract surgery with toric intraocular lens implantation after keratoplasty

Purpose: The purpose of this study was to evaluate the efficacy and predictability of cataract extraction with toric intraocular lens (IOL) implantation following deep anterior lamellar keratoplasty (DALK) or mushroom penetrating keratoplasty (PK). Setting: “Villa Igea” Hospital, Forlì, Italy. Design: Prospective case series. Methods: Toric IOL implantation was offered to patients with cataract, corneal astigmatism > 1.5D and regular central corneal topography after complete suture removal. Phacoemulsification was performed through a 2.4-mm scleral tunnel and an enVista monofocal toric MX60T (Bausch & Lomb, Rochester, NY) or Eyecryl monofocal toric IOL (Biotech Vision Care, Ahmedabad, India) was inserted in the capsular bag. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, total prediction error and IOL misalignment. Results: 37 consecutive patients that had previously undergone either DALK (n= 27, 73%) or two-piece mushroom PK (n = 10, 27%) were included. All patients completed the 6-months follow-up. The mean toric IOL power was 5.3±1.1 D. Both UDVA and CDVA significantly improved (respectively, from 1.02±0.27 to 0.46±0.31 logMAR, from 0.65±0.27 to 0.11±0.12 logMAR; p<.001). 20 eyes (54%) reached UDVA ≥20/40, while 35 eyes (95%) reached a CDVA ≥20/40. Final refractive astigmatism was 0.93±0.87 D, with 35 eyes (95%) within 2 D. Prediction error was ≤1 D in 18 eyes (49%). Absolute IOL misalignment was 3.3±3.5°. Conclusions: Toric IOL implantation in post-keratoplasty eyes allows reduction of refractive astigmatism to predictably low levels with concomitant improved visual outcomes