1. Correction of Astigmatism with Toric IOL After Previous RKBy
Chirag R. Shah MD;
H. V. Gimbel MD, MPH; A. Dardzhikova MD
Authors have no financial interest
ASCRS 2008

2. Correction of Astigmatism with Toric IOL After Previous RK
Background
Post RK persistent hyperopic shift with or without increase in astigmatism is well documented in the literature
Prospective Evaluation of Radial Keratotomy (PERK): After a decade of patient follow-up, the study reported that RK remained a reasonably safe and effective technique
However, the study found that more than 40 percent of RK eyes continued to have a gradual shift toward farsightedness
Between 6 months and 10 years, the refractive error of 43% of eyes changed in the hyperopic direction by 1.00 D or more
A shift of the refractive error in the hyperopic direction continued 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):

3. Correction of Astigmatism with Toric IOL After Previous RK
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 keratomileusis
for consecutive hyperopia after radial keratotomy. JCRS Jul;33(7):
Oral D, Awwad ST, Seward MS, Bowman RW, McCulley JP, Cavanagh HD. Hyperopic laser
in situ keratomileusis in eyes with previous radial keratotomy. JCRS Aug;31(8):
Joyal H, Gregoire J, Faucher A. Photorefractive keratectomy to correct hyperopic shift after radial keratotomy. JCRS 2003 Aug;29(8):
Shah CR, Gimbel HV. Role of the Implantable Corrective Lens (ICL) in applications in secondary refractive surgery. ASCRS May 2007.

4. Correction of Astigmatism with Toric IOL After Previous RK
Various procedures are used to manage post-op RK hyperopic shift with astigmatism
Suturing Techniques PK
Corneal Segments
Damiano RE, Forstot SL, Frank CJ, Kasen WB. Purse-string sutures for hyperopia following radial keratotomy. J Refract Surg 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 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 Dec;33(12):

5. Correction of Astigmatism with Toric IOL After Previous RK
Purpose
To report the astigmatism and myopic correction after cataract surgery using the Alcon Toric IOL (TIOL) in an eye with previous RK

6. Correction of Astigmatism with Toric IOL After 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.

7. Correction of Astigmatism with Toric IOL After Previous RK
Case Results:
58 yr old female
Pre RK:
x 45 20/15
44.00 (8) (97)
RK incisions
Pre RK enhancement:
x 50 20/15
RK enhancement 1989
8 more incisions
Pre Cataract + TIOL:
x 36 20/30
38.14(7)39.57(97)

8. Correction of Astigmatism with Toric IOL After Previous RK
Cataract:
Cortical 1+
Nuclear Color/Opal 3+
PSC3+
ASC2+
Haigis +
Holladay II
similar

9. Correction of Astigmatism with Toric IOL After Previous RK
Cataract Sx 12 July 07
Pre-op astigmatism: x 97
Temporal Conjunctival Advancing Scleral Tunnel (CAST) incision
Alcon Acrysof Toric IOL
Spherical power 21.0 D
Cylinder power at IOL plane:
2.25 D
Cylinder power at corneal plane: D
Surgery induced astigmatism: x 97
Anticipated residual astigmatism: x 97

10. Correction of Astigmatism with Toric IOL After Previous RK
1 day p/o
UCVA 20/150
x /20-2
1+ corneal edema
IOL centered- oriented at 105°
2 weeks p/o
UCVA 20/25
+ 0.5 sph 20/20
8 weeks p/o
UCVA 20/30
sph 20/20
IOL centered-oriented at 105°
PC fibrosis 1+

11. Correction of Astigmatism with Toric IOL After Previous RK
6 months OS
UCVA 20/30
x75 20/25
PCO 2+
Nd:YAG Posterior Capsulotomy performed
Post YAG
UCVA 25
x71 20/20
Clear Capsulotomy
TIOL oriented at 110°
Patient very happy

12. Correction of Astigmatism with Toric IOL After Previous RK
Conclusion
The 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.