Introduction: In some cases, keratoplasty can result in extreme high corneal astigmatism which requires a customized intraocular lens (IOL) for adequate visual rehabilitation. Patient and Clinical Findings: We report a case of a 55-year-old man with very high astigmatism after deep lamellar anterior keratoplasty. The patient presented with slowly decreasing vision with uncorrected distance visual acuity of counting fingers at 50 cm and a pinhole visual acuity of 20/120. Diagnosis, Intervention, and Outcomes: A nuclear cataract was detected, and corneal tomography revealed regular corneal astigmatism with a magnitude of 20.3 diopters (D). He underwent routine cataract surgery with implantation of a customized hydrophilic toric IOL with 30 D toric power. 3 months postoperatively, the corrected distance visual acuity improved to 20/40 with a refraction of −2.5 D −4.5 D × 52 degrees. Conclusions: Patients with poor vision due to extremely high astigmatism can benefit from customized toric IOLs for visual rehabilitation avoiding additional corneal surgery.
Noor et al. (Thu,) studied this question.