Correction of postkeratoplastic ametropia in patients with cataract

Синицын, М. В.; Pozdeeva, N. A.

doi:10.17816/ov109153

Ophthalmology Reports

2022

DOI: 10.17816/ov109153

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Correction of postkeratoplastic ametropia in patients with cataract

М. В. Синицын

N. A. Pozdeeva

Abstract: BACKGROUND: Penetrating keratoplasty leads, on the one hand, in 100% of cases, to the formation of induced astigmatism of variable degree, on the other hand, to a decrease in the density of endothelial cells of the corneal graft, which can reach from 19.1 to 38.3%. Thus, today the task of safe cataract extraction with minimal loss of density of endothelial cells and maximal correction of corneal astigmatism by the aid of an implantation of a toric intraocular lens is paramount. AIM: The aim of the study … Show more

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Cited by 3 publications

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Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant

Синицын

Pozdeyeva²

2023

Ophthalmology Reports

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BACKGROUND: The MyoRing implantation into a corneal transplant can significantly compensate for irregular post-keratoplastic astigmatism. However, the cataract that occurs in this category of patients and the lack of information in the literature on its phacoemulsification and the calculation of a toric intraocular lens (tIOL) power in them determines the relevance of our study. AIM: The aim of the study is to conduct a clinical and functional analysis of phacoemulsification in patients after previously performed implantation of a MyoRing into a corneal transplant. MATERIALS AND METHODS: We operated on 21 patients (21 eyes) who had previously undergone the MyoRing implantation into a corneal transplant. According to keratotopography, all patients were diagnosed with a regular form of corneal astigmatism. All patients underwent phacoemulsification with tIOL implantation. When calculating the tIOL power, its diopter value was corrected depending on the average value of the corneal transplant keratometry according to the keratotopogram data. The observation period duration was 6 months. RESULTS: One month after the procedure, there was an increase in uncorrected visual acuity by 0.2 0.9 LogMAR, best corrected visual acuity by 0.3 1.0 LogMAR, the spherical component of refraction up to 0.4 0.44 D, the cylindrical component of refraction up to 0.62 0.18 D, all of which did not change later on. CONCLUSIONS: Phacoemulsification with tIOL implantation, with its power calculated taking into account an additional correction for its diopter value, is an effective, predictable and safe method of treating patients after previously performed MyoRing implantation into a penetrating corneal transplant.

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Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant

Синицын

Pozdeyeva²

2023

Ophthalmology Reports

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Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

Sinitsyn,

Pozdeyeva

2023

Acta biomedica scientifica

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Background. Many patients after penetrating keratoplasty (PK) experience induced postkeratoplastic astigmatism, which is often irregular and causes an increase in corneal aberrations that reduce visual acuity and quality. The aim of the study. To conduct a comparative analysis of the effect of rigid gas permeable scleral lenses and the MyoRing implantation method on clinical and functional parameters in patients with IPA. Material and methods. The clinical study included 60 patients (60 eyes). The age of patients with IPA was from 25 to 42 years. All patients underwent penetrating keratoplasty. All patients were divided into two groups depending on the method for irregular postkeratoplastic astigmatism correction. Group I included 30 patients (30 eyes) who were fitted with rigid gas permeable scleral lenses. Group II consisted of 30 patients (30 eyes) who underwent implantation of the MyoRing into a penetrating corneal graft. The observation period was 1 year. Results. After 12 months of observation, there was a greater increase in uncorrected visual acuity by an average of 3 lines, in corrected visual acuity – by 2 lines; a greater decrease in corneal aberrations in photo- (root mean square (RMS) of total aberrations (RMS total) by 0.30 ± 0.08 µm, RMS of higher order aberrations (RMS HOA) – by 1.01 ± 0.24 μm) and mesopic conditions (RMS total – by 0.33 ± 0.09 μm, RMS HOA – by 0.08 ± 0.03 μm) in patients wearing rigid gas permeable scleral lenses compared with patients after MyoRing implantation into a penetrating corneal graft. Conclusion. Patients of group I, wearing rigid gas permeable scleral lenses, showed a greater improvement in visual acuity and a decrease in corneal aberrations in photo- and mesopic conditions compared to the patients of group II (after MyoRing implantation) at a follow-up period of 12 months.

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A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

Sinitsyn,

Pozdeyeva

2024

Acta biomedica scientifica

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Background. Performing penetrating keratoplasty in 100 % of cases leads to the occurrence of induced postkeratoplasty astigmatism, which can be more than 12,0 D. If cataracts occur in this category of patients, performing cataract phacoemulsification with implantation of a toric intraocular lens (tIOL) does not completely solve the problem. The use of the method of implantation of intrastromal corneal segments at stage I before cataract phacoemulsification makes it possible to reduce the degree of postkeratoplasty astigmatism and create optimal conditions for additional correction of residual postkeratoplasty astigmatism due to the implantation of tIOL during cataract phacoemulsification.The aim. To analyze the clinical and functional indicators of correction of regular high-grade postkeratoplasty astigmatism in a patient with cataracts using a combined method, including first implantation of intrastromal corneal segments and subsequent cataract phacoemulsification with implantation of toric intraocular lens using the example of a clinical case.Material and methods. A 55-year-old patient with cataracts, who had a history of undergoing penetrating keratoplasty, contacted us. According to the keratotopogram data, a regular postkeratoplasty astigmatism of 18.68 D was diagnosed. The patient underwent a combined method. At stage I, intrastromal corneal segments were implanted into the corneal graft, then after 6 months stage II was performed – cataract phacoemulsification with implantation of tIOL.Results. Six months after intrastromal corneal segments implantation, the patient’s keratometric data stabilized, and corneal astigmatism decreased to 8.98 D. Then the patient underwent cataract phacoemulsification with tIOL implantation. After 1 month, the spherical component of refraction was 0.5 D, the cylindrical component of refraction was –0.5 D, visual acuity increased to 1.0.Conclusions. A combined method for correcting regular high-grade postkeratoplasty astigmatism in a patient with cataracts showed high refractive results, stability and safety in the long-term postoperative period.

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Correction of postkeratoplastic ametropia in patients with cataract

Cited by 3 publications

References 11 publications

Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant

Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant

Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

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