Outcomes of Toric Intraocular Lens Implantation after Radial Keratotomy

Purpose: To report high toric intraocular lens (IOL) implantation in a patient with previous radial keratotomy and significantly flat corneal powers. Methods: Case report. Results: A 64-year-old woman with previous bilateral 8-incision radial keratotomy was referred for cataract surgery. Corrected distance visual acuity was 20/70 in the right eye and counting fingers in the left eye (could not be refracted). The power of the flat meridian was below 30.00 diopters (D) bilaterally, so no IOL power predictions were reported by standard biometric devices. Calculations were run with the American Society of Cataract and Refractive Surgery (ASCRS) IOL Calculator for Eyes with Prior Radial Keratotomy using data from biometry, tomography, and topography. Toric cylinder and meridian were calculated with the ASCRS Barrett Toric Calculator. Given reasonable agreement in corneal cylinder and meridian between imaging modalities, toric IOLs (3.75 D IOL cylinder) were implanted. Postoperatively, spherical equivalent was −0.50 D in the right eye and plano in the left eye. Cylinder was reduced from 3.24 to 1.00 D in the right eye and from 4.13 to 1.00 D in the left eye. Conclusions: Toric IOLs offer an opportunity to reduce postoperative astigmatism in radial keratotomy cases with high cylinder, significantly flat corneal powers, and no classic bowtie pattern on topography. Pre-cataract refractions are useful in these cases after radial keratotomy, because corneal imaging modalities may underestimate astigmatism after radial keratotomy. [ Journal of Refractive Surgery Case Reports. 2022;2(4):e68–e71.]