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Surgeon offers pearls on using toric lenses in keratoconus cases

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SCOTTSDALE, Ariz. — Toric IOLs can be a viable option in patients with astigmatism and keratoconus, according to a speaker here.

“We’ve shown with typical irregular astigmatism I can improve my outcomes quite a bit,” Karl Stonecipher, MD, said at Cornea360. “Let’s take that and incorporate it into some of these more difficult or irregularly shaped eyes.”

Knowing when to opt for a spherical lens instead of toric is a key point to successful IOL implantation, according to Stonecipher.

“For keratoconus, if you can’t get a good match, don’t do it,” he said. “Put a spherical lens in if it isn’t a mach.”

Once a surgeon decides the toric lens will be a good match, aberrometry and corneal dying can assist in properly fitting the lens.

Using topography-guided corneal cross-linking can often be a better option in these patients than a corneal transplant, with 82% of patients seeing results of 20/32 or better, but in older patients the results may vary.

Stonecipher cautioned that it is important to tell patients to stay sedentary for the first 2 weeks postop to avoid accidentally rotating the IOL.

“One of the biggest things that people don’t talk about in astigmatism, especially in these long eyes, is to not let them do anything for 2 to 3 weeks because they are going to rotate that lens. I tell them to stay off the Peloton, don’t go to the gym and just hang out,” he said.

He also said that a common misconception is that these patients cannot be fitted with contact lenses. If there is a refractive miss, contact lenses are a good option, he said.

“In summary, some of the pearls are know when to punt, if you plan to rotate the lens do it early, dynamic aberrometry for me is a great option if you can’t get a picture, you can fit these patients with contact lenses, and cross-linking may be an opportune enhancement,” Stonecipher said. – by Rebecca L. Forand and Robert Linnehan

Reference:

Stonecipher K. Keratoconus and cataract surgery: to toric or not to toric. Presented at: Cornea360; April 4 to 6, 2019; Scottsdale, Ariz.

Disclosure: Stonecipher reports no relevant financial disclosures.