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To evaluate the effectiveness of astigmatism reduction following phacoemulsification with monofocal toric intraocular lens implantation in patients with previous radial keratotomy.
A retrospective chart review of data from patients with previous radial keratotomy (RK) who underwent routine cataract surgery with insertion of a monofocal toric IOL between January 2010 through September 2018 was performed. Fifty-one eyes of 35 patients were included in this study. This was a consecutive series of patients with a minimum 3-month postoperative follow up. No patients were excluded from the study. The outcome measurements included average keratometric K, pre- and postoperative best corrected visual acuity (BCVA), postoperative uncorrected visual acuity (UCVA), manifest refraction, keratometric astigmatism, and postoperative uncorrected visual acuity.
Average autokeratometric mean was 39.33 D and average keratometric astigmatism was 3.34 D (1.26 - 14.73D). BCVA averaged 0.33 (Snellen equivalent of 20/42) ± 0.16 logMAR preoperatively and 0.08 (Snellen 20/24) ± 0.13 logMAR postoperatively. Fifty-five percent of the eyes achieved an UCVA of 20/30 or better and 73% with 20/40 or better. Mean UCVA postoperative vision was 0.24 (Snellen 20/34) +/- 0.17 logMAR. Residual refractive astigmatism of ≤1.00 D was achieved in 68% of eyes and <1.5 D in 80%. A Welch’s T-test showed a significant difference in the mean scores (µ = .06, SD=0.114) between post-operative BCVA logMAR for mean K ≤ 36 and (µ = .19, SD= 0.136) for mean K >36 (p-value of 0.023).
To our knowledge, this is the first study to report the outcomes of monofocal toric intraocular lens implantation in patients having phacoemulsification after previous RK surgery. Implantation of this lens in patients with previous RK surgery is a safe, effective method of reducing refractive astigmatism in cataract patients.