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Purpose: To report about the design and first clinical result with a new Fresnel-Zone toric posterior chamber intraocular lens with central port for the correction of high hyperopic astigmatism.

Method: A 23 year old male with high bilateral hyperopic astigmatism not eligible for laser refractive surgery received intraocular surgery with bilateral implantation of a new Fresnel-based toric posterior chamber intraocular lens. The lens is equipped with a central port avoiding the requirement for preoperative iridotomy. Lens sizing was performed by direct sulcus measurement using CASIA2 optical coherence tomography (Tomey Corp., Nagoya, Japan). Lens power was calculated with matrix based Gaussian optics and optimized with non-paraxial ray-tracing (ANSYS Zemax OpticStudio).

Results: Preoperative refraction was (OD/OS) +4.25 -5.00 x 10° and +4.00 -4.00 x 175°. Uncorrected distance visual acuity (UDVA) was 0.4 and 0.3 logMAR, respectively. Lenses were implanted uneventfully using conventional injection systems at Medipolis Oogcentrum (Antwerp, Belgium).

First day postoperatively, objective refraction was +0.37 -0.53 x 107° and -0.11 -1.06 x 57°, UDVA was 0.0 logMAR in both eyes. He reported mild, non-disturbing halos around christmas illumination while having relatively large pupil diameter of > 6 mm.

Six weeks after surgery, the patient had returned to the United States for follow-up at Waring Vision Institute. He was highly satisfied with the result and the spectacle refraction was +0.25 -0.50 x 84 OD and +0.25 -0.75 x 45 OS with a UDVA of -0.1 logMAR and 0.0 logMAR, respectively.

Conclusion: To our knowledge this is the first report on a customized Fresnel-zone based toric phakic intraocular lens with a central port for hyperopic astigmatism. The design offers new possibilities for permanent correction of high hyperopic astigmatism reducing the risk of acute angle closure and the requirement for preoperative iridotomy.