Surgical management of hyperopic astigmatism in an eye with corneal lipoma: clinical case report

Abstract

Introduction: Though there are several medical and surgical methods of astigmatism control, astigmatic eyes with corneal surface deformities due to trauma, surgery or tumors are difficult cases, when very few methods can be helpful. In case surgery is chosen, the ultimate refraction will depend upon the tissue’s healing. Toric IOL implantation is to be considered in such cases, being more physiological, effective and predictable compared to corneal refractive surgery. Materials and methods: The work is based on the case of a patient with corneal stromal juxtalimbal lipoma that worsened the pre-existing hyperopic astigmatism. The chosen technique was the excision of the tumor with careful adjustment of the wound margins as a first step and the implantation of the AcrySof Toric IOL as the second step. The spherical power and axis placement to achieve emmetropia were estimated using a web-base Toric IOL calculation program. Special attention was given to pre- and postoperatory keratometry data. Results and discussion: The best corrected visual acuity increased rapidly after the first surgery, from 0,09 to 0,4. The postoperatory corneal sequelae resumed to a fine juxtalimbal stromal opacification. The visual acuity after IOL implantation was 0,6. Though corneal healing lasted a little longer than average, later examinations showed progressive improvement of visual functions and no complications. Conclusions: The use of Toric intraocular lense proved to be a safe choice in astigmatism treatment, taking into consideration the pre-existing excised corneal lipoma. The accurate tumor excision with proper sutures positioning provides a fine healing response which, along with the proper IOL axis alignment, assures a good refractive outcome with less risks.