Int Ophthalmol. 2026 Apr 22;46(1):209. doi: 10.1007/s10792-026-04081-z.
ABSTRACT
PURPOSE: To evaluate the efficacy and safety of toric foldable intraocular lens (IOL) for high astigmatism correction in eyes with prior penetrating keratoplasty (PK).
METHODS: Clinical data were retrospectively collected at baseline and 12 months postoperatively from pseudophakic patients with high astigmatism (> 2 D), and previous PK, who underwent implantation of customized foldable toric IOLs using the piggyback technique. Uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest refraction, keratometry, refractive and topographic cylinder, endothelial cell count (ECC), and complications were assessed. To account for inter-eye correlation, analyses were performed using generalized estimating equations (GEE), and estimated differences (est.) with 95% confidence intervals (CI) were reported.
RESULTS: Fourteen eyes of 11 patients (2 women, 9 men; mean age 62 ± 21 years) were included. The mean interval between PK and piggyback implantation was 24.18 years. Uncorrected and best-corrected visual acuity improved at 12 months (UCVA: est. – 0.69 logMAR; 95% CI, – 0.84 to – 0.54; p < 0.001; BCVA: est. – 0.20 logMAR; 95% CI, – 0.29 to – 0.11; p < 0.001). Total refractive astigmatism was reduced (est. – 4.09 diopters; 95% CI, – 5.20 to – 2.99; p < 0.001), whereas topographic astigmatism remained unchanged (est. – 0.03 diopters; 95% CI, – 0.21 to 0.16; p = 0.76). Endothelial cell count did not show a statistically significant change over time (est. – 67.8 cells/mm2; 95% CI, – 139.6 to 4.0; p = 0.07). One eye experienced recurrent IOL rotation (80°), requiring explant and replacement.
CONCLUSIONS: The favorable refractive outcomes and safety profile support the use of the piggyback technique with a customized toric foldable IOL for correcting high astigmatism in pseudophakic eyes that have undergone PK many years before. Larger sample size and prospective study are needed.
PMID:42018245 | DOI:10.1007/s10792-026-04081-z
