Cataract surgery with corneal astigmatism and aphakia correction by implanting an IOL with a wavefront formation mechanism in patients who had penetrating keratoplasty

Purpose. To evaluate the clinical efficacy of IOL implantation with a wavefront formation mechanism as part of cataract surgery of patients who underwent penetrating keratoplasty. Material and methods. 4 patients – one man and three women (4 eyes) (1 man, 3 women) aged 24 to 58 underwent phacoemulsification after penetrating keratoplasty (PKP) (performed in all patients more than 1.5 years ago, in 3 cases for keratoconus IV, in 1 case due to herpetic keratitis). The corneal sutures were removed 1 year after the PKP in all patients. All patients received cataract phacoemulsification through a 2.2 mm corneal tunnel. In one case, Alcon AcrySof IQ Vivity was implanted, in three cases, who had had corneal astigmatism, the same model was used but with a toric component. The IOL calculation was based on current optical biometrics data (IOL-Master 700, Carl Zeiss, Germany) and Scheimpflug-keratotopographic measurements (Oculyzer, Alcon, USA). The optical power of the IOL was calculated by the formulas of Barrett True K, Kane, Barrett Universal II, Hoffer Q, and Haigis. Results. It all cases, surgeries had no complications. Visual acuity, both with (BCVA) and without correction (UCVA), increased with respect to preoperative values in all cases (before surgery, mean BCVA values were 0.05; after surgery, 0.55; mean UCVA values before surgery, 0.34; after surgery, 0.68). The average observed cylindrical component of refraction before the opening operation was 2.25 D; the implantation of a toric IOL reduced it to 1.13 D. In all cases, a smooth transition of the defocusing curve from +0.5 D to -1.5 D (corresponding to 66 cm) was observed. The most effective formulas achieving target refraction were those by Kane and Barrett True K. Conclusion. The paper presents Russia’s first clinical experience of using IOL with a wavefront formation mechanism Alcon IQ Vivity и Vivity Toric in patients who underewent penetrating keratoplasty. In all cases, these IOLs were calculated and implanted taking account of the initial corneal astigmatism, which made it possible to significantly improve both BCVA and UCVA with a smooth transition to the middle distance. Despite the high values of higher order aberrations, none of the operated patients complained of undesirable photopic phenomena, such as halos and glare, which are inherent in intraocular lenses with diffractive technology.

1. Cung LX, Hang DT, Hiep NX, et al. Evaluation of phacoemulsification cataract surgery outcomes after penetrating keratoplasty. Open Access Maced J Med Sci. 2019 Dec; 7 (240): 4301–5. doi: 10.3889/oamjms.2019.379

2. Baek JW, Park SJ. Finite element analysis of cornea deformation and curvature change during the keratoplasty suturing process. Biomedical Engineering Letters. 2019 May; 9 (2): 203–9. doi: 10.1007/s13534-019-00100-4

3. Penbe A, Kanar HS, Simsek S. Efficiency and safety of scleral lenses in rehabilitation of refractive errors and high order aberrations after penetrating keratoplasty. Eye and Contact Lens. 2021 May; 47 (5): 301–7. doi: 10.1097/ICL.0000000000000755

4. Rocha GA, Miziara PO, Castro AC, Rocha AA. Visual rehabilitation using mini-scleral contact lenses after penetrating keratoplasty. Arq Bras Oftalmol. 2017; 80: 17–20. doi: 10.5935/0004-2749.20170006

5. Barnett M, Lien V, Li JY, Durbin-Johnson B, Mannis MJ. Use of scleral lenses and miniscleral lenses after penetrating keratoplasty. Eye and Contact Lens. 2016; 42: 185–9. doi: 10.1097/ICL.0000000000000163

6. Wade M, Steinert RF, Garg S, Farid M, Gaster R. Results of toric intraocular lenses for post-penetrating keratoplasty astigmatism. Ophthalmology. 2014; 121. №. 3. P. 771–7. doi: 10.1016/j.ophtha.2013.10.011

7. Fedyashev G.A., Khvan D.A., Ruchkin M.P. Implantation of an intraocular lens with a wavefront formation mechanism in the surgical treatment of cataracts in patients after penetrating keratoplasty. Fyodorov Journal of Ophthalmic Surgery. 2022; 4: 13–7 (In Russ.). doi: 10.25276/0235-4160-2022-4-13-17

8. Visser N, Nuijts RMMA, de Vries NE, Bauer NJV. Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation. Journal of Cataract and Refractive Surgery. 2011; 37: 2034–42. doi: 10.1016/j.jcrs.2011.05.041

9. Alcon Research LLC. AcrySof IQ Vivity product information (US version). 2021. Available at: https://ifu.alcon.com/downloadPDF.aspx?Keycode=927409848&GUID=1cd859dd-dc3f-43fa-98aa-cc01808407a8. Accessed January 2, 2022

10. Alcon Research. A clinical study of the ACRYSOF IQ EDF intraocular lens (IOL). 2020. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03010254. Accessed April 6, 2021

11. Alcon Laboratories, Inc. AcrySof IQ SN60WF product information. Fort Worth, TX: Alcon Laboratories, Inc.; 2020. Available at: http://embed.widencdn.net/pdf/plus/alcon/6qz43p5sid/40-500-044_us_en.pdf?u=4rqn9d. Accessed February 25, 2021

12. AcrySof® IQ Vivity™ Extended Vision IOL DFU. Alcon Laboratories, Inc.; 2020. Available from: https://www.alcon.com/media-release/alcon-announces-launchacrysof-iq-vivity-first-and-only-non-diffractive-extended [Accessed 27th July 2022]