An 86-year-old man presented for cataract surgery with corneal astigmatism of 5.12 diopters (D). After cataract extraction with small-incision techniques, 2 toric plate-haptic silicone intraocular lenses (IOLs) were implanted in the capsular bag, each with a 3.50 D cylinder add (2.30 D at the spectacle plane). Six weeks postoperatively, corneal astigmatism was 3.38 D at 70 degrees and refractive astigmatism was 1.00 D at 20 degrees. Uncorrected visual acuity was 20/40. No IOL rotation was observed. Implantation of piggybacked toric lenses may be a viable option for correcting moderate to high astigmatism.

Separating the cataract and glaucoma procedures frees the surgeon to use newer astigmatically neutral techniques for the cataract incision.

A single center, single surgeon, randomized, prospective clinical trial was performed comparing the effectiveness of small (3.5 mm to 4.0 mm) incision intraocular lens surgery and a larger (6.0 mm) incision in improving uncorrected visual acuity and reducing post-operative inflammation and surgically induced astigmatism. One hundred twelve eligible unilateral cases were randomized to receive a 3.5 mm to 4.0 mm incision with implantation of an Allergan Medical Optics three-piece SI-18NB silicone lens (56 cases) or a 6.0 mm incision with implantation of a three-piece biconvex poly(methyl methacrylate) lens (56 cases). At one day after surgery, significantly (P less than .01) more patients with 3.5 mm incisions had 20/40 or better uncorrected visual acuity than patients with 6.0 mm incisions (45% vs 20%). Forty percent of patients with 6.0 mm incisions vs 14% of patients with 3.5 mm incisions had visual acuities of 20/100 or worse. At one day after surgery, the larger incision group had significantly higher (P less than .01) mean keratometric cylinder (2.28 diopters vs 1.28 diopters in the small incision group). The two groups were comparable by three months. Laser flare/cell meter measurements were taken for each group but showed no significant differences in mean flare or cell measurements between the groups.

Two patients with a history of frequent recurrent corneal erosion for whom standard medical therapy was determined ineffective had phototherapeutic keratectomy (PTK) with an excimer laser. Before treatment, one patient had four episodes in a six-month period; the other had ten to 20 recurrences with four serious episodes in a seven-month period. After PTK, neither patient had a recurrence after 18 months follow-up. Subjectively, both patients felt the treated area healed faster than previous abrasions. Vision, refraction, keratometry, and corneal thickness measurements appeared unaffected by the treatment.