Abstract
Purpose. To evaluate outcomes in astigmatic patients implanted with the Trulign (Bausch + Lomb) toric presbyopia-correcting intraocular lens (IOL) during cataract surgery in a clinical practice setting. Methods. Retrospective study in 40 eyes (31 patients) that underwent cataract extraction and IOL implantation in a procedure using intraoperative wavefront aberrometry guidance (ORA system). Endpoints included uncorrected visual acuity (VA), reduction in refractive cylinder, accuracy to target, axis orientation, and safety. Results. At postoperative month 1, refractive cylinder was ≤0.50 D in 97.5% of eyes (≤1.00 D in 100%), uncorrected distance VA was 20/25 or better in 95%, uncorrected intermediate VA was 20/25 or better in 95%, and uncorrected near VA was 20/40 (J3 equivalent) or better in 92.5%. Manifest refraction spherical equivalent was within 1.00 D of target in 95% of eyes and within 0.50 D in 82.5%. Lens rotation was <5° and best-corrected VA was 20/25 or better in all eyes. Conclusion. The IOL effectively reduced refractive cylinder and provided excellent uncorrected distance and intermediate vision and functional near vision. Refractive predictability and rotational stability were exceptional. Implantation of this toric presbyopia-correcting IOL using ORA intraoperative aberrometry provides excellent refractive and visual outcomes in a standard of care setting.
Highlights
Corneal astigmatism affects a significant proportion of patients undergoing cataract surgery; studies have estimated that 22% to 25% of cataract patients have more than 1.50 D of corneal astigmatism [1, 2]
Five eyes were post-LASIK, 2 eyes had a history of epiretinal membrane, 2 eyes had mild irregular astigmatism that was not felt to be associated with substantial visual disturbance, and 1 eye had a history of macular pucker and trans-pars plana vitrectomy
25% of eyes in this study would have been excluded from the registration trial because of irregular corneal astigmatism, previous refractive surgery, macular pathology, and previous vitrectomy
Summary
Corneal astigmatism affects a significant proportion of patients undergoing cataract surgery; studies have estimated that 22% to 25% of cataract patients have more than 1.50 D of corneal astigmatism [1, 2]. Because residual postoperative refractive astigmatism compromises visual outcomes, concurrent reduction of astigmatism is vital to achieving patient satisfaction following cataract surgery. Techniques to assist with reduction of astigmatism include limbal relaxing incisions (LRIs), astigmatic keratotomy, excimer or femtosecond laser refractive surgery, and toric intraocular lenses (IOLs) [3]. Toric IOLs are generally a predictable treatment for astigmatism [3] and their use prevents the development of irregular astigmatism that may result from corneal manipulation, as well as potential complications associated with incisions, such as exacerbation of dry eye, variable wound healing, and infection. These IOLs effectively reduce astigmatism [4, 5], but if corrected for distance VA, patients typically still rely on glasses for computer work and reading
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