Abstract
Purpose To evaluate the effect of toric intraocular lens implantation in cataract patients with irregular corneal steep and flat meridian. Methods Data of 112 eyes of 78 patients who underwent toric intraocular lens implantation were analyzed retrospectively. Steep meridian deviations (not 180°) and steep and flat meridian deviations (not 90°) were classified as 0, 1–9, 10–19, 20–29, 30–39, and over 30°. Meridian deviation was measured with a sagittal map of a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany) using PicPickTools (NGWIN, Seoul, Korea). Results Residual astigmatism (D) of 0 (0.51 ± 0.13, 0.55 ± 0.15) and 1–9 (0.61 ± 0.16, 0.66 ± 0.19) groups were significantly lower than that of 10–19 (0.92 ± 0.24, 0.90 ± 0.28), 20–29 (0.10 ± 0.32, 1.01 ± 0.35), and over 30° groups (1.12 ± 0.37, 1.14 ± 0.40) both in steep meridian deviations and horizontal and vertical meridian deviations at 6 months (P < 0.05). Postoperative mean UCVA (logMAR) of 0 (0.09 ± 0.04, 0.09 ± 0.05) (logMAR) and 1–9 (0.10 ± 0.04, 0.11 ± 0.08) groups was significantly improved compared to that of 10–19 (0.14 ± 0.05, 0.17 ± 0.10), 20–29 (0.18 ± 0.08, 0.21 ± 0.10), and over 30° groups (0.20 ± 0.09, 0.22 ± 0.11) both in steep meridian deviations and horizontal and vertical meridian deviations at 6 months (P < 0.05). Conclusions Correction of astigmatism with toric intraocular lens implantation is not accurate in corneas with steep meridian deviations and steep and flat meridian deviations of more than 10°. Therefore, care should be taken when we perform toric intraocular lens implantation in patients with irregular corneal meridian.
Highlights
Cataract is the most common cause of visual impairment in elderly people [1]
About 60% of patients who have undergone cataract surgery have over 0.75 diopters (D) of corneal astigmatism [2], and 20% of patients have astigmatism 1.5 D or greater [3]
If this astigmatism is not uncorrected, it results in reduced visual acuity and increased spectacle dependence even after cataract surgery [4]
Summary
About 60% of patients who have undergone cataract surgery have over 0.75 diopters (D) of corneal astigmatism [2], and 20% of patients have astigmatism 1.5 D or greater [3] If this astigmatism is not uncorrected, it results in reduced visual acuity and increased spectacle dependence even after cataract surgery [4]. Toric IOL is designed for correcting regular corneal astigmatism such that the angle of steep and flat meridian in the cornea is exact 90°. Ere may be a deviation of astigmatism meridian even in normal corneas In this case, steep meridian is not a linear shape (180°) or angle of steep and flat meridian is not 90°. E entire toric effect is lost in cases with 30° of misalignment of toric IOL [5]. Toric IOL implantation can improve visual acuity properly in patients with regular corneal astigmatism
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