Rotational stability of two different piggyback toric intraocular lenses for correction of high post-keratoplasty pseudophakic ametropia.

Publisher: Massachusetts Eye and Ear Infirmary Country of Publication: United States NLM ID: 9605355 Publication Model: eCollection Cited Medium: Internet ISSN: 1542-8958 (Electronic) Linking ISSN: 15428958 NLM ISO Abbreviation: Digit J Ophthalmol Subsets: MEDLINE

Original Publication: Boston, MA : Massachusetts Eye and Ear Infirmary, c1995-

Pseudophakia*/surgery ; Pseudophakia*/physiopathology ; Lenses, Intraocular* ; Visual Acuity* ; Keratoplasty, Penetrating*/adverse effects ; Keratoplasty, Penetrating*/methods ; Prosthesis Design* ; Lens Implantation, Intraocular*/methods; Humans ; Male ; Aged ; Keratoconus/surgery ; Keratoconus/diagnosis ; Refraction, Ocular/physiology ; Postoperative Complications/surgery ; Postoperative Complications/etiology ; Reoperation ; Rotation

We present the case of a 65-year-old man with bilateral keratoconus and history of bilateral penetrating keratoplasty (PK) who developed gradual visual decline in the left eye due to cataract formation. Following successful left eye cataract surgery and monofocal, non-toric intraocular lens (IOL) in-the-bag implantation, the patient experienced persistently low uncorrected distance visual acuity (UDVA) due to high residual refractive error and intolerance to contact lenses. A supplementary toric IOL was placed in the ciliary sulcus, but subsequent rotational instability of the lens required repeated realignment. Despite two attempts at IOL repositioning, the rotational instability persisted, necessitating the replacement of the original Sulcoflex IOL with a toric, implantable Collamer lens. Following the implantation of the toric ICL, the patient achieved excellent UDVA with no adverse events over a 4-year follow-up period. This case highlights the potential rotational instability associated with toric piggyback IOLs in keratoconic, post-PK, pseudophakic eyes and the special considerations on choosing the type of piggyback lens in these eyes.
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Date Created: 20240704 Date Completed: 20240704 Latest Revision: 20240705

20250114

PMC11218835

10.5693/djo.02.2024.02.002

38962666