Visual and refractive outcomes of intracapsular and add-on toric intraocular lenses in postkeratoplasty astigmatism: retrospective study

PURPOSE: To assess visual and refractive outcomes of intracapsular and add-on toric intraocular lens (tIOL) implantation in postkeratoplasty astigmatism. SETTING: Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. DESIGN: Retrospective observational analysis. METHODS: This study analyzed postkeratoplasty eyes which underwent either intracapsular (G1) or supplementary sulcus-fixated tIOL implantation (G2). Refractive outcomes were assessed by performing vector analysis. RESULTS: 134 eyes of 117 patients with previous penetrating (n = 129, 96.3%) or deep anterior lamellar keratoplasty (n = 5, 3.7%) were included. Intracapsular tIOL implantation was performed in phakic eyes (n = 115, 85.8%), while add-on tIOL implantation in the ciliary sulcus was performed in pseudophakic eyes (n = 19, 14.2%). Data were obtained for 102 eyes (76%) at 6 weeks and for 121 eyes (90%) at 10 months. Mean IOL cylinder power was 8.4 ± 2.6 diopters (D) for G1 and 5.7 ± 0.5 D for G2. Mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA, logMAR/Snellen) in G1 significantly improved from 1.1 ± 0.4 (∼20/250) to 0.5 ± 0.3 (∼20/63) and from 0.5 ± 0.3 (∼20/63) to 0.2 ± 0.2 (∼20/32), respectively (both P < .001). In G2, mean UDVA and CDVA significantly improved from 1.1 ± 0.2 (∼20/250) to 0.5 ± 0.1 (∼20/63) and from 0.5 ± 0.2 (∼20/63) to 0.3 ± 0.2 (∼20/40, both P < .001), respectively. Mean refractive cylinder decreased from -6.9 ± 2.6 to -2.6 ± 1.8 D in G1 and from -8.0 ± 2.7 to -4.2 ± 1.9 D in G2 (both P < .001). CONCLUSIONS: Intracapsular and add-on tIOL implantation can effectively reduce moderate to high mostly regular postkeratoplasty astigmatism while improving visual acuity.