Toric intraocular lenses for astigmatic correction post-external retinal detachment repair surgery
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First Author: T.Murphy IRELAND
Co Author(s): A. McGlacken-Byrne P. Mullaney
To report the outcomes of toric intraocular lens implantation during phacoemulsification in patients with surgically-induced astigmatism secondary to encircling or segmental scleral buckle insertion for rhegmatogenous retinal detachment repair. We aimed to examine pre- and post-operative uncorrected visual acuity (UCVA), best- corrected visual acuity (BCVA), K-difference, refractive sphere, refractive cylinder and toric IOL rotational stability in this patient cohort.
Sligo University Hospital, Ireland. A large volume, tertiary level cataract referral centre.
Retrospective, non-comparative consecutive case series from 2014-2020. Using the Medisoft™ electronic record system, patients who underwent encircling or segmental scleral buckle surgery for rhegmatogenous retinal detachment repair and were referred to the centre for cataract surgery were identified. From this cohort, patients who had a visually significant cataract, absolute difference between k1D and k2D ≥1.5 and a flat retina with visual potential underwent routine phacoemulsifcation surgery with toric IOL implantation. Pre- and post-operative UCVA, BCVA, residual refractive sphere, residual keratometric and refractive cylinders, and toric IOL axis were measured.
Seventeen patients with scleral buckles presented for cataract surgery with toric IOL implantation in this study. The mean pre-operative BCVA was 0.4 (range 0.1-0.6). The mean pre-operative K-difference was 2.19 ±0.26D. The mean pre-operative cylinder was -2.17 ±1.78D and the mean pre-operative spherical equivalent was -4.76±4.80D. Patients were examined 4 weeks post- toric IOL implantation. The mean deviation from predicted post-operative refraction was -0.24±0.74D. The mean post-operative UCVA was 0.1 (range -0.1-0.2). Patients had a mean gain of 15.83± 8.43 letters (range 0-30 letters). The mean post-operative cylinder was -0.90±1.38 D and the mean post-operative spherical equivalent was -0.22±1.00D. None of the patients experienced rotational instability in their toric IOL.
Patients in this cohort had a statistically significant improvement in UCVA and BCVA (P<0.05). There was a statistically significant decrease in astigmatism post-operatively (P<0.05). This paper demonstrates that toric IOL implantation is a safe, predictable and effective procedure to reduce astigmatism induced from previous external retinal detachment repair surgery. This is the first paper describing these findings in this patient cohort.