Femtolaser Assisted Cataract Surgeryand Toric Lenses in Patients with Astigmatism. Review

Abstract

The presence of concomitant corneal astigmatism is the most common cause of low visual functions in patients with surgical treatment of cataracts. The implantation of toric intraocular lenses is procedure of choice in the correction of corneal astigmatism from 1.0 DPT and more in patients with cataracts. Successful results depend on several factors, the most important of which: the correct and stable position of the intraocular lens (IOL) in the capsule bag, the absence of residual astigmatism, the choice of the implanted IOL’s model, taking into account material and design of lens elements. Deviation of the cylindrical component by 10 degrees reduces visual acuity up to 35 %. Repeated intervention for the purpose of toric lens reposition, according to the literature, varies from 0,65 to 9 % and is carried out with the rotation of IOL more than 10°. Femtolaser-assisted phacoemulsification allows partially automate the surgical process, making it more efficient and safe, creating a theoretical advantage over manual techniques of surgery. In practice, the capsulorexis formed by the femtolaser is characterized by a regular rounded shape with a given diameter and provides a coating of optical part of IOL for 360°, which, according to various sources, contributes to a lesser degree of decentralization and tilt of the lens in the capsule bag and can be considered as one of the reasons for obtaining a more accurate refractive result and, as a consequence, higher visual functions. The review presents the results of clinical studies of corneal astigmatism correction during standard and femtolaser-assisted phacoemulsification with implantation of various models of toric IOLs: visual acuity, rotational stability, residual astigmatism percentage, wave front change. Researchers continue to discuss the advantages and disadvantages of modern technologies. However, the problem of increasing the predictability of the surgical outcome in order to obtain a higher refractive result both in the early and in the long-term postoperative period remains unquestionable.