Astigmatism correction in highly hyperopic patients - which way to choose?

Purpose. To assess the efficacy and safety of implanting a supplementary toric intraocular lens (IOL) in the ciliary sulcus in one eye and a toric IOL in the fellow eye in highly hyperopic patients with concomitant astigmatism. Methods. This study included highly hyperopic patients (axial length 21.3-22.0 mm) with concomitant regular corneal astigmatism. The group consist of 6 patients aged from 40 to 76 years. Supplementary IOL (Sulcoflex Toric 653T, Rayner) was implanted in the ciliary sulcus in the pseudophakic eye 1 month after previous phacoemulsification surgery. A toric IOL (AcrySof IQ Toric, Alcon) was implanted in the fellow eye. Postoperative follow-up visits were performed at 1 week, 1 month and 6 months. Results. Postoperatively, in all patients UDVA (uncorrected distance visual acuity) improved and remained stable throughout the follow-up period. Lower visual acuity in the eyes with toric IOLs is associated with errors in IOL calculation, occurring often in “short eyes”. Conclusion. Using different IOL types for astigmatism correction in highly hyperopic patients is justified and can give good visual results. A “short eye” is not a contraindication for supplementary IOL implantation, but it is necessary to perform laser iridotomy to minimize the risk of pupillary block.