Scleral Sutured Toric Intraocular Lens With Pars Plana Vitrectomy for the Correction of Corneal Astigmatism Without Capsular Support

PURPOSE: To describe the repair of a patient with bilateral subluxed cataract and corneal astigmatism in the setting of a coloboma of the iris, zonules, lens, and retina. Preoperatively, his best-corrected acuity was 20/500 in the right eye and 20/200 in the left eye. His preoperative refraction was -7.25 +1.00 at 080 in the right eye and -7.75 +3.00 at 040 in the left eye. On corneal topography, he had 1.95D and 1.45D of regular astigmatism in the right and left eye, respectively. METHODS: This technique involves pars plana vitrectomy in combination with the placement of a MX60 toric intraocular lens fixated to the sclera using 8-0 Gore-Tex in line with the axis of steep corneal astigmatism. The lens is affixed through two pairs of nasal and temporal sclerotomies, with each pair located 3 mm posterior to the limbus and 5 mm apart, centered along the axis of steep astigmatism. RESULTS: Postoperatively, uncorrected visual acuity in this patient was 20/25 in the right eye and 20/20 in the left eye with a refraction of -0.75 +0.50 at 180 in the right eye and -0.75 +1.00 at 180 in the left eye. CONCLUSION: Scleral sutured toric intraocular lens placement and pars plana vitrectomy is a viable solution for patients with regular corneal astigmatism and cataract repair in the absence of zonular support.