Effectiveness of cataract phacoemulsification with toric intraocular lenses in addressing astigmatism after keratoplasty

PURPOSE: To assess the effectiveness of toric intraocular lenses (IOLs) in the management of post-keratoplasty astigmatism. SETTING: Public university hospital, Auckland, New Zealand. DESIGN: Retrospective case series. METHODS: The study analyzed post-keratoplasty eyes after cataract surgery and toric IOL (Acrysof SN6OAT or T-flex 623T/573T) implantation. RESULTS: Twenty-six eyes were included. The mean age at cataract surgery was 57.1 years +/- 11.2 (SD). Previous keratoplasty was penetrating (84.6%) or deep anterior lamellar (15.4%). Keratoconus (73.1%) was the major indication for keratoplasty. The mean IOL cylinder power was 6.85 +/- 3.02 diopters (D). No IOL required postoperative realignment. The mean follow-up was 14 +/- 11 months. The mean refractive spherical equivalent decreased significantly, from 3.67 +/- 5.76 D to 0.58 +/- 1.71 D (P=.01). The mean refractive astigmatism also decreased significantly, from 5.49 +/- 3.72 D to 2.61 +/- 2.10 D (P<.01). There was a significant improvement in the mean uncorrected distance visual acuity (UDVA) (from 1.12 +/- 0.67 logMAR to 0.45 +/- 0.39 logMAR) and in the mean corrected distance visual acuity (CDVA) (from 0.70 +/- 0.66 logMAR to 0.15 +/- 0.16 logMAR) from preoperatively to the last follow-up (both P<.01). Postoperatively, the UDVA and CDVA were 20/40 or better in 61.5% of eyes and 92.3% of eyes, respectively. CONCLUSION: Cataract surgery with toric IOL implantation was safe and effective in significantly reducing corneal astigmatism and improving visual acuity in a large cohort of post-keratoplasty eyes.