Toric Intraocular Lens Implantation Research Articles

Intraocular Lens Rotational Stability after Cataract Surgery with and without Primary Posterior Continuous Curvilinear Capsulorrhexis

Purpose: To evaluate intraocular lens (IOL) rotational stability and capsular fusion process after cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC). Setting: Fujian Provincial Hospital, Fujian, China. Design: Prospective, intraindividual, randomized clinical trial. Methods: This study included 56 adult patients (112 eyes) with bilateral cataract undergoing phacoemulsification cataract surgery with PPCCC in one eye (PPCCC group) and conventional cataract surgery in the contralateral eye (NPCCC group). IOL axis orientation and fusion footprint length were measured at 1 day, 1 week, 1 month, 3 months, and 1 year after surgery using OPD-Scan III, while capsular bend index (CBI) was assessed at the same time points using Pentacam AXL. Results: No between-group difference was found in the absolute rotation from 1 day to 1 year (2.93 ± 1.72 vs 2.66 ± 1.61 degrees, P=0.54). The absolute rotation from 1 week to 1 month in NPCCC group was higher than that in PPCCC group (1.65 ± 0.68 vs 1.27 ± 0.32 degrees, P=0.01). At 1 month after surgery, both fusion footprint length (9.11 ± 2.74 vs. 10.67 ± 2.06 mm, P = 0.02) and CBI (2.92 ± 0.60 vs. 3.25 ± 0.59, P = 0.03) were lower in NPCCC group. Conclusion: Cataract surgery involving PPCCC demonstrates comparable outcomes to conventional procedures regarding long-term IOL rotational stability, therefore is a promising option for adult cataract patients scheduled for toric IOL implantation. PPCCC slightly reduces IOL rotation in the early postoperative period, which can be attributed to accelerated capsular fusion.

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BackgroundTo evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.MethodsThis was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.ResultsThere were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.ConclusionsLess surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Comparison of the Accuracy Between the Z CALC2 Calculator and Barrett Toric Calculator in Toric IOL Calculation.

To compare the accuracy of the Z CALC2 calculator and Barrett toric calculator in toric intraocular lens (IOL) calculation. Eighty-five eyes of 85 patients who underwent uneventful cataract surgery with toric IOL implantation were included. The accuracy was compared between the Z CALC2 calculator and Barrett toric calculator under two calculation modes: using simulated keratometry (SimK) from the IOLMaster 700 (Carl Zeiss Meditec AG) for posterior corneal astigmatism (PCA) prediction and employing total corneal astigmatism (total corneal refractive power [TCRP] or measured PCA) obtained from the Pentacam (Oculus Optikgeräte GmbH). The centroid of prediction errors, percentage of eyes with prediction errors within ±0.50 diopter (D), mean prediction error, and mean absolute prediction error were calculated. Subgroup analysis was conducted based on the orientation and magnitude of anterior corneal astigmatism and axial length. When using SimK, the two calculators with predicted PCA showed comparable accuracy. When employing total corneal astigmatism, the Barrett toric calculator with measured PCA showed a lower centroid error (0.15 vs 0.38 D), a higher percentage of eyes with prediction errors within ±0.50 D (47.1% vs 32.9%, P = .018), and a lower mean prediction error (0.57 vs 0.71 D, P = .033) compared to the Z CALC2 calculator with TCRP in the 4-mm zone. In subgroup analysis, when employing total corneal astigmatism, the Barrett toric calculator with measured PCA exhibited superior accuracy, especially in the with-the-rule and anterior corneal astigmatism of 2.00 D or less subgroups. When using SimK, the Z CALC2 calculator and Barrett toric calculator yield comparable accuracy. The Barrett toric calculator with measured PCA may be more recommended when employing total corneal astigmatism. [J Refract Surg. 2024;40(10):e681-e691.].

Rotational stability of plate-haptic toric intraocular lenses implantation with a capsular tension ring: a prospective randomized paired-eye study.

To compare the rotational stability and visual outcomes of plate-haptic toric intraocular lenses (IOLs) with and without a capsular tension ring (CTR) in paired eyes. Eye and Ears, Nose, and Throat Hospital of Fudan University, Shanghai, China. Prospective, randomized, paired-eye study. Patients with bilateral cataracts and coexisting regular corneal astigmatism were enrolled. The two eyes of each patient were randomly assigned to the CTR or non-CTR (NCTR) group. Both eyes of each patient were subjected to phacoemulsification and toric IOL implantation. CTRs were implanted into the eyes of the CTR group. All patients were followed-up for 12 months; the uncorrected distance visual acuity (UDVA), residual astigmatism (RAS), and rotational degree of the toric IOL were recorded. In total, 186 eyes of 93 patients were eligible for analysis. At each visit, UDVA improved significantly after surgery in all eyes (p < 0.001). The mean rotational degree and RAS were significantly smaller in the CTR group at the 2-week visit (p < 0.05). The toric IOLs achieved rotational stability at 1 week postoperatively in the CTR group while at 2 weeks postoperatively in the NCTR group. In the subgroup analyses, CTR co-implantation significantly reduced the 2-week IOL rotation in eyes meeting specific ocular measurements. CTR co-implantation could increase the rotational stability of plate-haptic toric IOLs, by reducing the amount of the IOL rotation in the early postoperative period and accelerating the stabilization of IOLs in the capsular bag.

Refractive Error after Toric Intraocular Lens Implantation in a Patient with Bilateral Posterior Keratoconus

Refractive Error after Toric Intraocular Lens Implantation in a Patient with Bilateral Posterior Keratoconus

Clinical Outcomes of Iris-Supported Phakic Toric Intraocular Lenses in Corneal Ectasia.

Our aim was to evaluate the visual and refractive outcomes of iris-fixated phakic toric intraocular lenses (IOLs)for visual rehabilitation in eyes with stable corneal ectasia. We conducted a study looking at the clinical outcomes of iris-fixated toric IOLs (Artisan) in 33 eyes of 27 patients diagnosed with mild-to-moderate corneal ectasia at a single center (Queen Victoria Hospital, East Grinstead, UK). The main outcome measures were functional improvement [accuracy of post-operative spherical equivalent (SE), astigmatic correction, topographic parameters, uncorrected and corrected distance visual acuity (UCVA, CDVA)] and safety of the procedure: endothelial cell count and intra- and post-operative complications. Eighteen males and nine females of mean age 38.85 were included in the study with a mean follow-up of 18months. All patients had ectasia due to keratoconus except one with post-refractive laser ectasia. Twelve patients had crosslinking, eight had intracorneal rings, and eight had previous keratoplasties. Mean pre-operative logMAR UCVA was 0.75 ± 0.35 improving to 0.02 ± 0.17 (p = 0.000). Mean pre-operative logMAR CDVA was 0.16 ± 0.17 improving to 0.02 ± 0.17 (p = 0.000). Mean pre-operative (SE) was -3.5 ± 3.9 improving to -2.75 ± 1.39 (p = 0.000) with up to 36-42months of follow-up. The mean value of endothelial cell density in the overall sample was 2252.54 ± 473.24cells/mm2 pre-operatively and 2126.75 ± 365.21cells/mm2 at 24-36months of follow-up visit. Two patients have intra-operative hyphemia secondary to iris prolapse. Implantation of iris-fixated phakic toric IOLs has shown high efficacy and safety in patients with mild-to-moderate astigmatism in corneal ectasia.

Comparison of two digital alignment systems for toric intraocular lens implantation

PurposeTo compare the two most used digital alignment systems regarding precision, repeatability and loss of track.Methods15 eyes of 15 patients older than 21 years with cataracts were included in this...

Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes

PurposeTo investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.MethodsThis retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from − 4.50 to -17.00 diopters (D) and cylindrical refraction from − 0.75 to -5.50 D.ResultsFifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was − 10.06 ± 2.69 D and − 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was − 2.06 ± 1.16 D and − 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.ConclusionThe Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

The Effects of Axis-flip of the Refractive Cylinder on vision and patient reported outcome measures following Toric Intraocular Lens implantation.

To investigate the effects of cylinder axis-flip following toric intraocular lens (TIOL) implantation on vision and patient reported outcome measures (PROMs). Teaching hospital in the United Kingdom. Post-hoc analysis of data from patients who participated in a prospective randomised study of TIOLs. Axis-flip was defined as a change in post-operative refractive cylinder axis of 900 +/- 22.50 from the pre-operative biometric axis. Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), residual refractive cylinder (RC), and CATPROM-5 and EQ5D3L quality of life (QOL) scores were analysed. At 6 months, axis flip occurred in 29 (34.5%) of 84 eyes, of which 28 had with-the-rule astigmatism (WTR) pre-operatively. Mean (+/-standard deviation) UDVA (logMAR) was 0.13 (0.16) in flipped cases (FC) and 0.10 (0.14) in un-flipped cases (UF) (p=0.88). BDVA was 0.01 (0.11) in FC and was 0.00 (0.09) in UF (p=0.68). Mean RC was 0.74 dioptres (D) (0.41) in FC and 0.93D (0.47) in UF (p=0.08). Mean CATPROM-5 score was -6.22.98 (2.56) in FC and -5.52 (3.03) in UF (p=0.29). Mean EQ5D3L calibrated score was 0.89 (0.19) in FC and 0.85 (0.19) in UF (p=0.35). Retrospectively applying coefficients of adjustment to account for posterior corneal astigmatism (PCA), suggested that 6 eyes (21%) of FC with WTR might have avoided axis-flip. Axis flipping following TIOL implantation did not adversely influence visual acuity or PROMs scores. Most FC had WTR pre-operatively. Adjusting for PCA might have reduced axis flip in some of these eyes.

Visual outcomes following bilateral implantation of a non-diffractive extended depth of focus toric intraocular lens using a mini-monovision approach.

To evaluate the clinical outcomes following bilateral implantation of the AcrySof™ IQ Vivity™ toric extended depth of focus (EDOF) intraocular lens (IOL). Prospective interventional case series. Patients with bilateral significant cataracts and pre-existing corneal astigmatism underwent cataract surgery and implantation with the AcrySof™ IQ Vivity™ toric IOL. Dominant eyes were targeted at emmetropia and non-dominant eyes at -0.50D. Primary endpoints were binocular uncorrected distance (UDVA), intermediate (UIVA at 66cm) and near (UNVA at 40cm) acuities at 3months. Secondary outcomes were corrected distance (CDVA), distance corrected intermediate (DCIVA) and distance corrected near (DCNVA), refractive predictability, rotational stability, binocular defocus curve, contrast sensitivity, Questionnaire for Visual Disturbances (QUVID) and Visual Function Index (VF-14) questionnaire scores. All visual acuities were converted to logarithm of minimum angle of resolution (logMAR) for analysis. 30 patients underwent uneventful phacoemulsification. The mean binocular UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.11 ± 0.10 and 0.26 ± 0.10 respectively. The mean refractive spherical equivalent (MRSE) for dominant and non-dominant eyes were - 0.07D ± 0.27 and - 0.12D ± 0.54 respectively. 92.4% of dominant eyes and 84.6% of non-dominant eyes within 0.50D of target. The mean IOL rotation was 3.85° ± 5.09 with 86.7% of eyes with less than 5° of rotation. 26.7%, 20% and 36.7% of patients reported starbursts, haloes and glare respectively. The mean VF-14 score was 91.77. Bilateral implantation of the AcrySof™ IQ Vivity™ Toric IOL resulted in very good unaided visual acuities for far and intermediate distance with functional near vision. Dysphotopsias were reported but despite this, a high level of visual function was achieved.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review.

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.

Clinical examples of correct orientation of a toric intraocular lens in patients with postkeratotomic corneal ectasia

BACKGROUND: Surgical treatment of cataract in patients with postkeratotomic corneal ectasia has various features. First, difficulties arise when calculating the optical strength of an intraocular lens and its cylindrical component and determining the location of the main axes of astigmatism for toric intraocular lens implantation. Additionally, not all modern keratotopography installations are able to accurately determine the refractive power of the cornea in such patients owing to pronounced irregular astigmatism and a large difference in keratometric parameters in the main meridians. CLINICAL CASES DESCRIPTION: Two clinical cases of surgical treatment of cataract in combination with postkeratotomic keratectasia are presented. Patients underwent a standard preoperative ophthalmological examination. TMS-4 Tomey keratotopograph was used to accurately determine the refractive power of the cornea. The optical power of toric intraocular lens were calculated using the Holladay 2 formula with amendments for radial keratotomy and the Johnson Johnson VISIC online calculator. SN6AT9 intraocular lens (Alcon) and a Tecnis ZCT800 toric intraocular lens (Johnson Johnson) were implanted in patients. The orientation of the position of the cylinder axis of toric intraocular lens was performed perpendicular to the most flattened meridian, corresponding to the position of the keratectasia zone, determined by the most expanded keratotomy scar. Before surgery, the best corrected visual acuity of patient M was OD=0.2, OS=0.4 and that of patient K was OD=0.4, OS=0.2. After surgery, the best corrected visual acuity of patient M was OD=0.8, OS=0.8 and that of patient K was OD=0.8, OS=0.7. CONCLUSION: This study aimed to familiarize practicing ophthalmologists, clinical residents, and postgraduates with a possible treatment option for cataracts by phacoemulsification with implantation of a toric intraocular lens in patients with postkeratotomic keratectasia. The resulting high visual acuity and subjective satisfaction of patients indicate the accuracy of chosen treatment tactics. A reliable visual guide for choosing the cylinder axis is the meridian of the greatest degree of keratectasia (cornea flattening), which is determined by the maximally expanded keratotomy scar position. The intraocular lens cylinder axis is oriented perpendicular to the keratectasia meridian. Ultrasound phacoemulsification of cataract with implantation of a toric intraocular lens is an effective method for correcting induced ametropia after radial keratotomy against the background of postkeratotomy keratectasia with high astigmatism.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia.

To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia. Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires. A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups. In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Сравнительный анализ рефракционных и функциональных результатов имплантации торической интраокулярной линзы с механизмом формирования волнового фронта при хирургическом лечении катаракты у пациентов после сквозной кератопластики

Abstract Comparative analysis of the refractive and functional results of toric intraocular lens with wavefrontshaping mechanism implantation during the surgical treatment of cataracts in patients after penetrating keratoplasty. D.A. Khvan, , G.A. Fedyashev Pacific State Medical University Ministry of Health of Russia, Vladivostok, Russian Federation Primorskii center of eye microsurgery, Vladivostok, Russian Federation Relevance. This study presents a comparative analysis of the effectiveness of toric intraocular lens (IOL) with a wavefront shaping mechanism implantation in cataract surgical treatment in patients after penetrating keratoplasty (PKP). Purpose. To evaluate the effectiveness of toric IOL with a wavefront shaping mechanism implantation in cataract surgical treatment in patients after PKP. Material and methods. This prospective study included 65 patients (65 eyes) who underwent cataract surgery after prevous PKP (the time after removal of corneal sutures averaged 1.4±0.8 years). In the 1st group of patients (34 patients, 34 eyes) the AcrySof IQ Toric IOL was implanted, in the 2nd group – the AcrySof IQ Vivity IOL (31 patients, 31 eyes). In both groups, IOL power was calculated at a target refraction of (–) 0.5 D. The observation period was up to 6 months. Results. In all groups, there was a significant (p&lt;0.001) improvement in uncorrected (UCVA) and best-corrected visual acuity (BCVA) on the first day, after 1, 3 and 6 months. In 1st group, by the 6th month of observation, there was a tendency towards a slight significant (relative to the 3rd month) decrease in UCVA of 0.134±0.1 (p=0.019). In 2nd group, UCVA was significantly (p&lt;0.001) higher than in 1st group at all periods of postoperative follow-up and was 0.075±0.063 before surgery (in 1st group 0.053±0.029), on the first day after surgery 0.348± 0.139 (in the 1st group 0.097±0.05), 1st month 0.516±0.144 (in the 1st group 0.133±0.076), 3rd month 0.642±0.143 and by the 6th month 0.642±0.139 (in 1st group 0.16±0.1 and 0.134±0.1, respectively). Statistically significant (p=0.03) differences were obtained when comparing the error of the spherical equivalent of refraction (SE) from the expected result in the 1st and 2nd groups (1.22±0.875 and 0.76±0.582, respectively) during the observation period up to 6 months. Conclusion. AcrySof IQ Vivity Toric IOL implantation during the cataract surgical treatment in patients with previous keratoplasty allows to obtain significantly higher postoperative UCVA, due to more accurate access to target refraction, which confirmed by a significantly lower spherical equivalent error. Key words: wavefront, cataract, penetrating keratoplasty, EDOF, Vivity

Relation between change of effective lens position and toric IOL rotation after toric IOL implantation

PurposeTo evaluate the relationship between change of effective lens position (ELP) and toric intraocular lens (IOL) rotation in patients with increasing postoperative refractive astigmatism after successful toric IOL implantation. MethodsThe subjects include 61 people (61 eyes) with increasing residual astigmatism >0.5 D 3 months after successful toric IOL implantation. Clinical measurements included preoperative, 1-week, and 1-, 2-, and 3-month postoperative visual acuity; refraction; keratometer; anterior and posterior corneal astigmatism; ELP by Scheimpflug camera imaging; and IOL axis by slit-lamp biomicroscopic photograph with pupil dilation. ResultsResidual astigmatism in postoperative month 3 (0.81 ± 0.50 D) is higher than that at postoperative week 1 (0.41 ± 0.38 D; p < 0.05). ELP decreased by 264.44 ± 163.25 μm, and the IOL rotated by 2.91 ± 1.44 degrees from week 1 to month 3 (p < 0.05). The ELP change had a positive correlation with IOL rotation (R2 = 0.383; p = 0.006), and the postoperative refractive astigmatic change had a positive correlation with ELP change (R2 = 0.272; p = 0.027) and IOL rotation (R2 = 0.272; p = 0.0001) from week 1 to month 3. ConclusionELP change can influence toric IOL rotation and increase residual astigmatism after toric IOL implantation.

Visual and Refractive Outcomes After Bi-aspheric Trifocal Toric Diffractive Intraocular Lens Implantation

Purpose: To assess clinical outcomes after cataract surgery with bilateral implantation of a new bi-aspheric diffractive intraocular lens (IOL). Methods: Thirty patients underwent bilateral implantation of the Asqelio Trifocal Toric IOL (AST Products, Inc) and were evaluated 3 months postoperatively. Main outcomes included refractive error, photopic monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CDIVA) at 60 cm, and near (UNVA, CDNVA) at 40 cm visual acuities. Mesopic monocular and binocular CDNVA were also measured. Defocus curves, binocular contrast sensitivity under photopic and mesopic conditions with and without glare and rotational stability were determined. Patients completed Catquest-9SF and visual symptoms questionnaires. Results: Average values of binocular photopic CDVA, CDIVA, and CDNVA, and mesopic CDNVA were −0.04 ± 0.06, 0.02 ± 0.08, 0.02 ± 0.07, and 0.22 ± 0.11 logMAR, respectively. All patients achieved cumulative CDVA ⩾ 20/25, and CDIVA and CDNVA of 20/32 or better. Binocular depth of focus was approximately 3.25 diopters (D). Mean postoperative spherical equivalent was −0.08 ± 0.26 D, with 95% of eyes within ±0.50 D. Mean postoperative refractive cylinder was −0.22 ± 0.27 D, with 91.67% of eyes within 0.50 D or less, respectively. IOL rotation averaged 0.25 ± 0.65 degrees, all eyes having rotation of less than 5 degrees. Contrast sensitivity was within or above normal levels under photopic and mesopic conditions, with or without glare, except for 12 cpd under mesopic conditions with glare. Questionnaire responses indicated 96.67% of patients were satisfied or very satisfied with postoperative vision, and 80.00% to 96.67% reported no difficulty in different daily activities. Conclusions: The Asqelio Trifocal Toric IOL demonstrated favorable outcomes, providing excellent visual performance at all distances, precise refractive results, and remarkable rotational stability. Patients reported high satisfaction levels and minimal difficulty in daily activities. [ J Refract Surg . 2024;40(6):e407–e419.]

Comparison between opposite clear corneal incision versus toric intraocular lens in correcting astigmatism.

To compare the visual outcomes and efficacy of opposite clear corneal incision (OCCI) and toric intraocular lens (IOL) implantation in correcting preexisting astigmatism (PEA) in patients undergoing phacoemulsification. This prospective interventional comparative study was conducted between June 2022 and January 2023 in patients having cataract with PEA undergoing phacoemulsification. Patients were divided into two groups - group A underwent phacoemulsification with OCCI and group B underwent phacoemulsification with toric IOL implantation. Uncorrected distance visual acuity (UDVA), manifest refractive cylinder, and corneal astigmatism using corneal tomography were measured preoperatively and at 6 weeks postoperatively. The eyes were categorized into three groups with PEA ranging from 1 to 1.5 D, 1.6 to 2 D, and 2.1 to 3 D. Depending upon the white-to-white corneal diameter, the eyes were also categorized into four groups with corneal diameter ranging from 10.5 to 10.9 mm, 11 to 11.4 mm, 11.5 to 11.9 mm, and 12 to 12.4 mm. Sixty eyes of 60 patients were studied. At postoperative 6 weeks, 83.3% (25 eyes) in the OCCI group and 96.7% (29 eyes) in the toric IOL group achieved UDVA of 6/9 or better. No statistically significant difference was noted between the groups ( P = 0.37). The reduction in mean corneal astigmatism was 0.63 ± 0.37 D in the OCCI group and 0.15 ± 0.12 D in the toric IOL group ( P < 0.001). The residual mean refractive cylinder was 0.60 ± 0.38 D in the OCCI group and 0.05 ± 0.15 D in the toric IOL group at 6 weeks ( P = 0.007). Both OCCI and toric IOL are effective in correcting PEA. However, in a resource-limited setting, OCCI is a better alternative surgical option for correcting astigmatism of 1-1.5 D during phacoemulsification without requiring additional skills or instruments.

Evaluating keratometry and corneal astigmatism data from biometers and anterior segment tomographers and mapping to reconstructed corneal astigmatism.

To compare results from different corneal astigmatism measurement instruments; to reconstruct corneal astigmatism from the postimplantation spectacle refraction and toric intraocular lens (IOL) power; and to derive models for mapping measured corneal astigmatism to reconstructed corneal astigmatism. Retrospective single centre study involving 150 eyes treated with a toric IOL (Alcon SN6AT, DFT or TFNT). Measurements included IOLMaster 700 keratometry (IOLMK) and total keratometry (IOLMTK), Pentacam keratometry (PK) and total corneal refractive power in 3 and 4 mm zones (PTCRP3 and PTCRP4), and Aladdin keratometry (AK). Regression-based models mapping the measured C0 and C45 components (Alpin's method) to reconstructed corneal astigmatism were derived. Mean C0 components were 0.50/0.59/0.51 dioptres (D) for IOLMK/PK/AK; 0.2/0.26/0.31 D for IOLMTK/PTCRP3/PTCRP4; and 0.26 D for reconstructed corneal astigmatism. All corresponding C45 components ranged around 0. The prediction models had main diagonal elements lower than 1 with some crosstalk between C0 and C45 (nonzero off-diagonal elements). Root-mean-squared residuals were 0.44/0.45/0.48/0.51/0.50/0.47 D for IOLMK/IOLMTK/PK/PTCRP3/PTCRP4/AK. Results from the different modalities are not consistent. On average IOLMTK/PTCRP3/PTCRP4 match reconstructed corneal astigmatism, whereas IOLMK/PK/AK show systematic C0 offsets of around 0.25 D. IOLMTK/PTCRP3/PTCRP4. Prediction models can reduce but not fully eliminate residual astigmatism after toric IOL implantation.

РЕЗУЛЬТАТЫ ДВУСТОРОННЕЙ ИМПЛАНТАЦИИ ФАКИЧНОЙ ТОРИЧЕСКОЙ ИНТРАОКУЛЯРНОЙ ЛИНЗЫ У ПАЦИЕНТА С РЕФРАКЦИОННОЙ АМБЛИОПИЕЙ СРЕДНЕЙ СТЕПЕНИ И МИОПИЕЙ ВЫСОКОЙ СТЕПЕНИ. КЛИНИЧЕСКИЙ СЛУЧАЙ

A case of bilateral implantation of a phakic toric intraocular lens “IPCL V2.0 TORIC” in a patient with moderate refractive amblyopia and high myopia is considered. The results of dynamic observation are presented: refraction data and indicators of maximum correctable visual acuity in the preoperative and postoperative periods, which allow monitoring the results of the surgical period with determining the timing of the postoperative period.

Visual Outcomes and Patient Satisfaction of Trifocal or Trifocal Toric IOLs in Chinese Cataract Patients: Focus on Near Vision at 33 cm.

To examine the visual outcomes, particularly at 33 cm, and assess patient satisfaction following the implantation of a diffractive trifocal intraocular lens (IOL) and its toric variant. This prospective single-arm observational study involved 45 Chinese patients (90 eyes) underwent bilateral cataract surgery and PanOptix or PanOptix toric intraocular lenses (IOLs) implantation. Postoperatively, visual acuity was evaluated at various distances, including 40 cm and 33 cm, for both monocular and binocular outcomes. Patient satisfaction was evaluated using the VF-14 questionnaire. 72 eyes underwent PanOptix IOLs implantation, and 18 eyes received PanOptix toric IOLs. At 3-month postoperative mark, the mean monocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.02±0.09, 0.00±0.07, 0.02±0.07, and 0.07±0.14 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 96.7%, 96.7%, 94.4%, and 74.4%, respectively. The mean binocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.05±0.06, -0.03±0.05, 0.00±0.05, and 0.04±0.07 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 97.8%, 100.0%, 100.0%, and 91.1%, respectively. When the near point shifted from 40cm to 33cm, some patients showed a decline for UDVA, but the average reduction was less than one line. The overall VF-14 questionnaire score was 4.02±4.19. PanOptix can provide Chinese patients with a full range of satisfying visual acuity, near to 33cm. Though the visual acuity of some patients at 33 cm did not match the level at 40 cm, the gap of one line may not carry clinical significant.