Transscleral fixation of a toric intraocular lens to correct aphakic keratoplasty with high astigmatism

A 71-year-old man with penetrating keratoplasty (PKP) and aphakia in the right eye and a preoperative refraction of +20.0 −11.0 × 38 and logMAR visual acuity of 20/60 presented to our hospital. The capsular support was absent because of previous complicated intracapsular cataract extraction. The implanted IOL was a custom-made Rayner 570T with +20.5 diopters (D) sphere and +11.0 D cylinder. The IOL's special haptics allowed it to be safely fixated in the sagittal plane. The postoperative refraction was +1.0 −2.0 × 5 with logMAR acuity of 20/60. Follow-up of 2 years revealed no IOL decentration. Transscleral fixation of a toric IOL requires exact outlining. Our case shows that this is possible and can result in improved visual rehabilitation.