Extreme Astigmatism after sclera implanted IOL

Posted , 5 users are following.

Dear all,

I had 3 and a half weeks ago a luxation of my IOL on my right eye and a couple of days later surgery.

The toric lens was explanted trough a large clear cornea incision /7...8mm), as reverse optic capture wasn´t possible due to severe zonular laxity and teared capsule. A standard 3 piece IOL was fixated

to the sclera.

Since the surgery a have an extreme astigmatism and large ghostings. Astigmatism is almost twice as pre - operative. (6,5 dpt instead previously 3 dpt)

The clear cornea incision of 7..8 mm was placed at the steeper meridian at aprox. 40°)  and was not sutured. 

Here the keratometer values: 

PRE-OP 

R1 = 8,56 / 133°  ///  R2 = 8,00/ 30°   (ca. -2,95 dpt) 

Now:

R1 = 8,78 / 115°  ///  R2 = 7,60 / 20°   (ca.  6,4 dpt)

My surgeon was surprised and has no idea where that extreme reaction of the cornea comes from, especially as the cornea should have been flattening instead

of becoming steeper. His explanation was that a mild edema at the wound is the culprit, but the edema now is gone and the cornea still shows the same values with

no improvement.

Does somebody have an idea where this drastic change comes from? Will that corneal change or regress to at least pre- op values or am I now at risk to have this condition permanently?

Which options of treatment are there for such a case as mine? I hope that anybody can help me.

Thank you !

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  • Posted

    so, you are saying the IOL flipped from the capsule to the front of the eye...sclera? why would this happen?

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    • Posted

      hello Hudsongirl,

      as I wrote before. My IOL luxated due to capsule giant tear and weak zonules. The only option was to implant a scleral fixated three piece IOL. these lenses are not available as toric lenses. So I got back my uncorrected initial astigmatism. what I am concerned about is that now certainly due to the large incision needed for explantation of the luxated IOL my astigmatism is almost twice the "natural " pre op astigmatism

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    • Posted

      hi again...was not trying to make you repeat.did not understand fully how this happened to you. i had a dog who's natural lens luxated so was trying to understand your situation. can you wear a contact lens on that eye to correct the astigmatism or is that now impossible? is the eye painful?

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  • Posted

    i am sorry you had to go through this. can you use glasses for astigmatism?

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    • Posted

      Unfortunately not. too severe..i hope that it will regress to pre operative values.

      glasses are not an option

      I have almost zero on my left eye and like 6,5 diopters on the operated eye. imagine the glasses....

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    • Posted

      correct...glasses wont work as you'd get double vision.how bout contact lens? Right now, with contacts I am -4.50 in one eye and -.50 in other and my brain has adjusted to that. glasses for me are impossible too.

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  • Posted

    Sounds like this has been an awful experience for you. I hope the astigmatism does get better with time and healing. Why did you have the original toric lens explanted?

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    • Posted

      the toric lens had no more support in the eye due to torn capsule and to properly align such a lens elsewhere in the eye (in my case implanting it to the sclera) it is very difficult. also there are no 3 piece toric lenses and a one piece toric IOL has too bulky haptics to implant it transclerally.

      So only lens of choice was 3piece non toric lens in order to not leave me aphacic (with no lens)

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    • Posted

      did the capsule tear before explantation or during explantation? Have you had YAG.

      i read that some PCO may be necessary to make the capsule stronger and prevent tear.

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    • Posted

      wow makes me so nervous about pco. i read an article not too long ago that there is reason to think it is a matter of when not if. For sure square edge iols and surgical technique are better but it may only delay pco. with younger cataract patients now they see pco sometimes occurring now after 5 to 7 years.

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    • Posted

      so previous YAG caused the capsule to tear and the lens luxated. so now you have a 3 piece spheric sceral IOL leaving you very astigmatic. just clarifying. this is the first Ihave ever heard of this exact issue. I would guess PRK not an option. what does your surgeon suggest?

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