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    Toric IOLs in abnormal corneas: How the two can work together

    Careful patient selection, expectation management, adjunctive procedures are paramount to success


    In patients with mild guttata but no morning blur or Descemet’s folds and a central corneal thickness of 630 µm or less, cataract surgery can be performed with or without implantation of a toric IOL, Dr. Starr advised.

    The rule of thumb in these patients is that all posterior lamellar grafts cause hyperopic shifts. In Descemet’s stripping automated endothelial keratoplasty (DSAEK), –1 to –1.5 D is typically targeted. In Descemet membrane endothelial keratoplasty, –0.25 to –0.5 D should be targeted, according to Dr. Starr.

    “My preference in DSAEK is a 90-µm thick graft, and my IOL target is about –1 D,” he said.

    “Premium IOLs can be used successfully in patients with abnormal corneas,” Dr. Starr said. “For the best refractive outcomes, adjunctive procedures are often needed before, during, and sometimes after cataract surgery, which can delay surgery and/or the time needed to achieve a satisfactory uncorrected visual acuity.”



    Christopher E. Starr, MD

    E: [email protected]

    This article was adapted from Dr. Starr’s presentation during Cornea Subspecialty Day at the 2014 meeting of the American Academy of Ophthalmology. Dr. Starr has no financial interest in any aspect of this report.


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