Toric Intraocular Lens Implantation Research Articles

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.

Evaluation of the Efficiency of a Digital Workflow for Cataract Planning in Patients with Astigmatism.

To evaluate the efficiency and associated costs of a digital cataract workflow system and manual cataract workflow system for patients, with astigmatism presenting for cataract surgery in Brisbane, Australia. Sixty patients with bilateral cataract requiring toric intraocular lenses (IOL) were sequentially assigned to a manual cataract workflow (n = 30) or digital workflow (n = 30) using EQ Workplace (SW v1.7.0) running on FORUM (SW v.4.2.1.66) (Carl Zeiss Meditec, Jena, Germany). Each step of preoperative data acquisition and analysis was timed. Steps in each workflow were divided into presurgical planning time and total workflow time, the latter including the time required to input toric data into CALLISTO eye (Carl Zeiss Meditec). Secondary outcomes included staff costs within each workflow. Median presurgical planning time using a digital workflow process was 6.51 ± 0.65 minutes, and using a manual workflow process, 12.32 ± 0.56 minutes (p < 0.001). Similarly, median total workflow time using a digital workflow process was 6.93 ± 0.57 minutes and using a manual workflow process, 13.49 ± 0.47 minutes (p < 0.001). Evaluating the staff remuneration during presurgical planning and the operating costs associated with running EQ Workplace, there was a cost-reduction of 35% per patient when using the digital cataract workflow process. Using a digital cataract workflow process is more efficient and provides staff cost-savings compared to a manual workflow process when planning for toric IOL implantation.

Comparison of corneal topography maps obtained using the IOLMaster 700® and the Anterion® in candidates for toric IOL implantation.

To compare central corneal topography (CT) obtained using the IOLMaster 700® biometer to corneal topography obtained using a Swept-Source OCT-based predicated topographer (PT), in candidates for toric intraocular lens (IOL) implantation. A retrospective comparative study was conducted in consecutive patients undergoing a routine cataract surgery assessment with significant astigmatism on keratometry. Each patient was examined using both the IOLMaster 700® (Carl Zeiss Meditec, Jena, Germany) and the Anterion® (Heidelberg Engineering, Heidelberg, Germany) for routine preoperative measurements. The corneal axial anterior power map obtained with each device was then anonymized and analysed independently by two ophthalmologists using a reading grid. The reading grid assessed the usual parameters describing astigmatism and evaluated if a toric IOL was indicated or a second topography examination was needed to confirm the indication. In total, 169 eyes of 120 patients were included. The inter-examination agreement for the astigmatism description ranged from 56 to 85% depending on the reader and parameter. The decision to implant a toric IOL based on the axial map was the same in 59-60% of cases depending on the examiner. A second examination was needed in 18-25% and 8-14% of cases after CT and PT, respectively. The IOLMaster 700® central anterior axial map allowed toric IOL implantation in 58-70% of cases with no need for second corneal examination. The agreement between the anterior axial maps obtained using both devices was good. However, in about a quarter of the cases, dedicated topography had to be performed to confirm the surgical indication.

Effectiveness of toric intraocular lens implantation for correcting irregular corneal astigmatism in cataract eyes

A retrospective cohort study was conducted to observe the correction effect of Toric intraocular lens (IOL) implantation in cataract eyes with specific types of irregular corneal astigmatism. Thirty-four eyes with either the "asymmetric bow-tie" pattern (Type I) or the "angled bow-tie" pattern (Type II) were included. Corneal topography was assessed using Pentacam HR, and changes in preoperative corneal astigmatism, visual acuity, manifest refraction, and objective visual quality were measured and compared. The average uncorrected distance visual acuity improved significantly from 0.86 ± 0.40 logMAR to 0.22 ± 0.15 logMAR (P < 0.001). Preoperative corneal astigmatism of 2.05 ± 0.90 D was corrected to a postoperative residual astigmatism of 0.78 ± 0.57 D (P < 0.001), with 32% of eyes within 0.50 D. The residual astigmatism prediction errors in Type I and Type II cases were (0.97 ± 0.68 D) and (0.66 ± 0.37 D), respectively (P = 0.100). The mean spherical equivalent prediction error in Type II cases (0.07 ± 0.36 D) was significantly smaller than that in Type I cases (− 0.29 ± 0.52 D) (P = 0.030). This study concludes that Toric IOL implantation effectively corrects specific types of irregular corneal astigmatism in cataract surgery. Eyes with the "angled bow-tie" pattern show higher accuracy in refractive predictions compared to eyes with the "asymmetric bow-tie" pattern.

Accuracy of toric intraocular lens power calculation depending on different keratometry values using a novel network based software platform.

To compare different corneal keratometry readings (swept-source-OCT-assisted biometry and Scheimpflug imaging) with a novel software platform for calculation of toric intraocular lenses. Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Retrospective, non-randomized, clinical trial. Twenty-three eyes undergoing toric intraocular lens implantation were included. Inclusion criteria were preoperative regular corneal astigmatism of at least 1.00 D, no previous refractive surgery, no ocular surface diseases and no maculopathies. Lens exchange was performed with CALLISTO eye (Zeiss). For each patient, the expected postoperative residual refraction was calculated depending on three different corneal parameters of two different devices: standard K-front (K) and total keratometry (TK) obtained by a swept-source-OCT-assisted biometry system (IOL Master 700, Zeiss) as well as total corneal refractive power (TCRP) obtained by a Scheimpflug device (Pentacam AXL, Oculus). Barrett's formula for toric intraocular lenses was used for all calculations within a novel software platform (EQ workplace, Zeiss FORUM®). Results were statistically compared with postoperative refraction calculated according to the Harris dioptric power matrix. The standard K values (mean PE 0.02 D ± 0.45 D) and TK values (mean PE 0.09 D ± 0.43 D) of the IOL Master 700 reached similar results (p = 0.96). 78% of eyes in both K and TK groups achieved SE within ±0.5 D of attempted correction and all eyes (100%) were within ±1.0 D of attempted correction in both groups. By contrast, the prediction error in the IOL calculation using the TCRP of the Scheimpflug device was significantly greater (mean PE -0.56 D ± 0.49 D; p = 0.00 vs. standard K and p = 0.00 vs. TK) with adjusted refractive indices. Thirty-nine and Ninety-one percentage of eyes in the TCRP group achieved SE within ±0.5 D (p = 0.008 K vs. TCRP and p = 0.005 TK vs. TCRP) and ± 1.0 D (p = 0.14 vs. TCRP) of attempted correction, respectively. All three corneal parameters (standard K, TK, TCRP) performed well in calculating toric IOLs. The most accurate refractive outcomes in toric IOL implantation were achieved by IOL calculations based on swept-source-OCT-assisted biometry. The SS-OCT-based K-front and TK values achieve comparable results in the calculation of toric IOLs.

Bilateral anterior capsular phimosis in an 85-year-old female patient after stand-alone cataract extraction with intraocular lens implantation

Introduction: Anterior capsular phimosis is a rare complication after cataract extraction with intraocular lens implantation. Patient and clinical findings: An 85-year-old female underwent manual phacoemulsification with toric intraocular lens implantation in the right eye (OD) without any post-operative complications. Approximately 1.5 weeks later, she had the same procedure in the left eye (OS) with similar success. At post-operative week 6 OD and week 4 OS, distance visual acuity without correction was 20/400 OD and hand motion (HM) OS. Anterior segment examination revealed intraocular lens implants with a significant fibrotic anterior capsule in both eyes. Posterior segment examination showed pigmentary macular changes in both eyes that were unchanged from the pre-operative evaluation. Diagnosis, intervention, and outcomes: The patient was diagnosed with bilateral anterior capsular phimosis. She underwent Nd:YAG laser capsulotomy in the left eye, then in the right eye 1 week later. At Nd: YAG laser capsulotomy post-operative day 4 OD and week 2 OS, distance visual acuity without correction was 20/40 OD, OS with best corrected visual acuity 20/30 OD, OS. Conclusions: Anterior capsular phimosis can occur in both eyes sooner than 4 weeks after cataract extraction with intraocular lens implantation in a patient with no risk factors.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients.

Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients. To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods. This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication. There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group. This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Implantation of Hydrophobic Acrylic Toric Intraocular Lens with High-Water Contents Using Swept-Source Optical Coherence Tomography Biometer Integrated with a Surgical Guiding System.

To evaluate postoperative outcomes after implantation of toric intraocular lenses (IOLs) made of high-water-content hydrophobic acrylic material in Japanese patients using a swept-source optical coherence tomography (SS-OCT) biometer integrated with a surgical guiding system. In this prospective observational study, toric IOL models CNW0T3 to CNW0T9 (Alcon) were implanted in 33 eyes of 33 patients and followed-up for one month. Powers and toric models were determined using an SS-OCT biometer ARGOS® Ver 1.5 (Alcon), and the IOLs were aligned using surgical guidance. Differences between planned and actual axis positions at the end of the surgery (misalignment) and rotations from the end of surgery to one month postoperatively were measured. Additionally, postoperative uncorrected visual acuity, refraction, and residual astigmatism were evaluated. Mean and median misalignments were 2.3° (standard deviation [SD]: 1.6, 95% confidence interval [CI]: 1.7-2.9) and 2°, and those of postoperative rotation were 2.4° (SD: 2.6, 95% CI: 1.5-3.4) and 2°, respectively. Mean postoperative refraction was 0.06 D (SD: 0.62). Prediction errors within ±0.5 and ±1.0 D were 69.7% and 93.9%, respectively. Mean residual astigmatisms were 0.19 D (SD: 0.41), and mean uncorrected visual acuity was 0.00 logMAR (SD: 0.11), and 64% of the eyes scored 20/20 or better. Implantation of high-water-content hydrophobic acrylic toric IOLs using SS-OCT biometry integrated with a surgical guiding system effectively corrected corneal astigmatism with accurate IOL alignment in Japanese patients.

Functional Approach to IOL Selection in Eyes With Combined Cataract and Keratoconus With an Option for Refractive Lens Exchange.

To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].

Significant Changes of Corneal Astigmatism After Levator Muscle Surgery for Acquired Blepharoptosis.

To investigate the change of corneal astigmatism after the correction of blepharoptosis. This was a single-center retrospective cohort study conducted in Taiwan from 2017 to 2021. The medical records of patients with acquired blepharoptosis who had received levator muscle surgeries were collected. The differences in corneal astigmatism between the measurements before and at least 1 month after surgeries were investigated. Subgroup analysis of various severities of blepharoptosis and different types of corneal astigmatism was performed to determine their impacts on the axial changes after blepharoptosis surgeries. A total of 120 eyes of 68 patients were enrolled in this study. The mean axial change of corneal astigmatism was 17.4° after blepharoptosis surgeries, and 55 eyes (45.8%) had a change of at least 10°. In the subgroup analysis, the eyes with against-the-rule, with-the-rule, and oblique astigmatism had 42.9%, 68.4%, and 91.7% with an axial change of at least 10° after surgeries, respectively. The averaged axial change of corneal astigmatism after surgeries was 22.7° in eyes with severe blepharoptosis (margin to reflex distance1 < 1 mm), whereas it was 12.0° in eyes with mild-to-moderate blepharoptosis (margin to reflex distance1 ≥ 1 mm). A high proportion of eyes had a crucial axial change in corneal astigmatism after blepharoptosis surgeries, especially in those with oblique astigmatism and severe blepharoptosis. For blepharoptosis patients needing refractive surgeries or astigmatism correction with toric intraocular lens implantation, a surgical correction of blepharoptosis may be considered beforehand.

Accuracy of Ten Intraocular Lens Formulas in Spherical Equivalent of Toric Intraocular Lens Power Calculation.

The aim of this work is to evaluate the accuracy of the Barrett Universal II (BU II), Emmetropia verifying optical (EVO) 2.0, Haigis, Hoffer Q, Hoffer QST (Savini/Taroni) (HQST), Holladay 1, Kane, Ladas Super, Sanders-Retzlaff-Kraff/theoretical (SRK/T), and T2 intraocular lens (IOL) power formulas for calculating spherical equivalent (SE) of toric IOL. This study enrolled consecutive patients who underwent phacoemulsification and toric IOL implantation at the Eye Hospital of Wenzhou Medical University in Hangzhou from 2015 to 2022. We compared the new-generation formulas with Gaussian optics-based standard formulas, and calculated the mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ± 0.25 diopter (D), ± 0.50D, ± 0.75D and ± 1.00D of the target refraction. Subgroup analyses were conducted based on the anterior chamber depth (ACD), keratometry (K), and toricity (T). A total of 207 eyes of 207 patients were included in this study. Overall, the Kane and EVO2.0 formulas demonstrated the lowest MedAEs. The EVO2.0 formula exhibited the highest percentage of eyes within ± 0.50D, ± 0.75D, ± 1.00D. Moreover, the EVO2.0 formula showed the lowest MedAE for flat K subgroup, the highest percentage of eyes within ± 0.50D, ± 1.00D for shallow ACD subgroup, the highest percentage of eyes within ± 0.75D for regular ACD, flat K, T2-T3, T4-T5 subgroups. The Kane and formula performed the lowest MedAE in the T4-T5 subgroup. Application of the Kane and EVO2.0 formulas significantly improved the prediction of postoperative SE outcome for toric IOL compared to the other formulas.

Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study

PurposeTo compare the rotational stability of a monofocal and a diffractive multifocal toric intraocular lens(IOLs) with identical design and material.MethodsThis prospective study enrolled patients who underwent plate-haptic toric IOL (AT TORBI 709 M and AT LISA 909 M) implantation. Propensity score matching (PSM) was performed to balance baseline factors. Follow-up examinations were conducted at 1 h, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was used to investigate the changes in IOL rotation over time. A 2-week timeframe was utilized to assess differences in IOL rotation between the two groups.ResultAfter PSM, a total of 126 eyes were selected from each group for further analysis. Postoperatively, the time course of IOL rotation change in the two groups remained consistent, with the greatest rotation occurring between 1 h and 1 day postoperatively. At the 2-week postoperative mark, the monofocal toric IOL exhibited a higher degree of rotation compared to the multifocal toric IOL (5.40 ± 7.77° vs. 3.53 ± 3.54°, P = 0.015). In lens thickness(LT) ≥ 4.5 mm and white-to-white distance(WTW) ≥ 11.6 mm subgroups, the monofocal toric IOL rotated greater than the multifocal toric IOL (P = 0.026 and P = 0.011, respectively).ConclusionThe diffractive multifocal toric IOL exhibits superior rotational stability compared to the monofocal toric IOL, especially in subgroups LT ≥ 4.5 mm and WTW ≥ 11.6 mm. Moreover, the time course of IOL rotation change is consistent for both, with the maximum rotation occurring between 1 h and 1 day postoperatively.

Clinical outcomes and rotational stability after implantation of a monofocal toric intraocular lens with textured haptics in normal vs high axial lengths.

To compare the clinical outcomes and rotational stability after implantation of a toric intraocular lens (IOL) with textured haptics in eyes with normal vs high axial lengths (ALs). Nethradhama Superspeciality Eye Hospital, Bangalore, India. 2-arm, retrospective comparative study. This retrospective study included 114 eyes of 114 patients who underwent femtolaser cataract surgery followed by implantation of the HOYA Vivinex Toric monofocal IOL (Model XY1A-SP), of which 62 and 52 eyes belonged to normal (≤23.9 mm) and high (≥24 mm) AL groups, respectively. 1 week and 3 months postoperatively, clinical outcomes and rotational stability of the toric IOL was evaluated. 3 months postoperatively, % eyes achieving refractive astigmatism accuracy within ≤0.50 diopter, was 100% (n = 62) in the normal vs 94% (n = 49) in the high AL group. All eyes that is, 100% (n = 62) in the normal and 96.15% (n = 50) eyes in the high myopia group were <5 degrees of the intended axis. The mean change in postoperative rotation from 1 week to 3 months was 0.28 ± 0.09 degrees in the normal, and 0.30 ± 1.11 degrees in the high AL group ( P = .80). No significant correlation was observed between AL and white-to-white diameter with 1-week postoperative rotation values. No eye required repositioning of toric IOL for significant misalignment. No significant differences were observed for clinical outcomes and postoperative rotational stability between eyes with normal and high ALs, suggesting excellent rotational stability of the Vivinex Toric IOL with textured haptics in all eyes, irrespective of the preoperative AL measurements.

Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies.

Toric intraocular lenses (IOLs) have been developed to enhance visual acuity impaired by cataracts and correct corneal astigmatism. However, residual astigmatism caused by postoperative rotation of the toric IOL is an important factor affecting visual quality after implantation. To decrease the rotation of the toric IOL, significant advancements have been made in understanding the characteristics of toric IOL rotation, the factors influencing its postoperative rotation, as well as the development of various measurement techniques and interventions to address this issue. It has been established that factors such as the patient's preoperative refractive status, biological parameters, surgical techniques, postoperative care, and long-term management significantly impact the rotational stability of the toric IOL. Clinicians should adopt a personalized approach that considers these factors to minimize the risk of toric IOL rotation and ensure optimal outcomes for each patient. This article reviews the influence of various factors on toric IOL rotational stability. It discusses new challenges that may be encountered to reduce and intervene with rotation after toric IOL implantation in the foreseeable future.

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability.

The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8(Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

A clinical case of a combined method for correcting postkeratoplastic astigmatism of a high degree in a patient with cataract

Background. Performing penetrating keratoplasty in 100 % of cases leads to the occurrence of induced postkeratoplasty astigmatism, which can be more than 12,0 D. If cataracts occur in this category of patients, performing cataract phacoemulsification with implantation of a toric intraocular lens (tIOL) does not completely solve the problem. The use of the method of implantation of intrastromal corneal segments at stage I before cataract phacoemulsification makes it possible to reduce the degree of postkeratoplasty astigmatism and create optimal conditions for additional correction of residual postkeratoplasty astigmatism due to the implantation of tIOL during cataract phacoemulsification.The aim. To analyze the clinical and functional indicators of correction of regular high-grade postkeratoplasty astigmatism in a patient with cataracts using a combined method, including first implantation of intrastromal corneal segments and subsequent cataract phacoemulsification with implantation of toric intraocular lens using the example of a clinical case.Material and methods. A 55-year-old patient with cataracts, who had a history of undergoing penetrating keratoplasty, contacted us. According to the keratotopogram data, a regular postkeratoplasty astigmatism of 18.68 D was diagnosed. The patient underwent a combined method. At stage I, intrastromal corneal segments were implanted into the corneal graft, then after 6 months stage II was performed – cataract phacoemulsification with implantation of tIOL.Results. Six months after intrastromal corneal segments implantation, the patient’s keratometric data stabilized, and corneal astigmatism decreased to 8.98 D. Then the patient underwent cataract phacoemulsification with tIOL implantation. After 1 month, the spherical component of refraction was 0.5 D, the cylindrical component of refraction was –0.5 D, visual acuity increased to 1.0.Conclusions. A combined method for correcting regular high-grade postkeratoplasty astigmatism in a patient with cataracts showed high refractive results, stability and safety in the long-term postoperative period.

The Application of Femtosecond Laser–Assisted Astigmatic Keratotomy on the Correction of Asymmetric Astigmatism: A Case Series

Purpose: To present the use of femtosecond laser–assisted astigmatic keratotomy (FSAK) with or without a toric intraocular lens (IOL) for the correction of asymmetric astigmatism. Methods: Case series and review of the literature. Results: Cases 1 and 2 showed low-grade but asymmetric astigmatism on the corneal topography. After FSAK management, which made two corneal incisions in both patients, case 1 revealed prominently reduced corneal astigmatism and manifest refraction and the astigmatic axis of case 2 became more direct. Cases 3 to 5 demonstrated higher degrees of asymmetric astigmatism and FSAK was performed with toric IOL implantation in patients with asymmetric astigmatism, creating an incision at the corneal surface with a higher amount of astigmatism. Postoperatively, the corneal astigmatism displayed considerable decrement in cases 3 to 5. No optical symptoms were reported in any cases. Conclusions: FSAK is a safe and effective method for correcting moderate asymmetric astigmatism and can be combined with toric IOL implantation. [ Journal of Refractive Surgery Case Reports. 2024;4(1):e15–e19.]

Hydrophobic Trifocal Toric Intraocular Lens Outcomes in Japanese Eyes After Cataract Surgery.

To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism. A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery. Sixty-five eyes (98.48%) were within ±0.50D of spherical equivalent, and all were within ±1.00D (mean: 0.00±0.21D). Moreover, 63 eyes (95.45%) had ≤0.50D of residual astigmatism, and all had ≤1.00D (mean: -0.08±0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥20/25 UNVA and DCNVA, respectively. Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry.

To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US. This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL). Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty. Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser.

To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA). This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm). Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively. The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.