Undesirable High Astigmatism after Penetrating Keratoplasty in Pseudophakia Corrected with an Add-On Toric Intraocular Lens

The purpose of the present case is to report the visual outcomes of a pseudophakic patient with high post-penetrating keratoplasty astigmatism treated with implantation of toric AddOn (R) intraocular lens (IOL) in the sulcus. A 79-year-old man with a ophthalmologic history of pseudoexfoliative glaucoma and Fuchs endothelial dystrophy had a graft failure after Descemet's stripping automated endothelial keratoplasty procedure on his right eye. Consequently, a penetrating keratoplasty was performed, and a high corneal astigmatism of -9.8 D to 140 degrees resulted in that eye after selective suture removal. A secondary AddOn (R) toric IOL customized for the patient with a manufacturer-calculated power of +11.0 D was implanted to 50 degrees in sulcus of the right eye. Subjective refraction was used for IOL calculation. Final refraction was +1.0 D of sphere and -2.0 D of cylinder power to 105 degrees, with spherical equivalent of 0.0 D. Best corrected visual acuity was logMAR 0.1 (20/25, 0.8 decimal) 1 year after the IOL implant. Our case report demonstrates that the toric AddOn (R) secondary IOL can be effective and safe in correcting residual refractive error of high regular astigmatism after keratoplasty in pseudophakic eyes.