Toric Intraocular Lens Implantation Research Articles

Оптические методы коррекции посткератопластической аметропии

Purpose. The analysis of the advantages and disadvantages of existing optical methods for correcting postkeratoplastic ametropia (PA). Material and methods. When studying the literature review on PA correction, a search was carried out for sources in the PubMed and Scopus abstract databases for the period up to 2021 inclusive. In total, 50 articles related to the topic of the review were selected, including long-term observations on the methods of optical correction of PA that are currently used worldwide. Results. Today, in addition to spectacle and contact correction, there is a large selection of various methods of surgical correction of PA: wedge resection, various options for keratotomy, implantation of toric intraocular lenses, phakic toric lenses, refractive laser surgery – photorefractive keratectomy, laser in situkeratomileusis, ReLEx SMILE technology, and also implantation of intrastromal corneal segments. The choice of the most optimal optical method for PA correction, depending on the initial individual clinical and functional parameters of the patient, remains quite relevant today. This is due both to a large number of different methods of PA correction, each of which has its own advantages and disadvantages, which necessitates their improvement, and to the need to develop new techniques. Conclusion. Currently, there are a large number of various methods for correcting postkeratoplastic ametropia, each of which has its own advantages and disadvantages. It is necessary to develop a systematic approach to the personalized choice of an optical method for correcting postkeratoplastic ametropia, taking into account its effectiveness and safety, depending on the individual clinical and functional data of the patient. There is a need for the development of new methods of correction that would effectively and safely correct high values of postkeratoplastic ametropia, especially with an asymmetric type of keratotopogram. Key words: postkeratoplastic ametropia, femtosecond laser, corneal segments, scleral contact lenses

Extensive misalignment of plate-haptic rotationally asymmetric multifocal toric intraocular lens.

Plate-haptic rotationally asymmetric multifocal toric intraocular lenses (IOL) (Lentis Comfort Toric) occasionally rotate extensively after surgery. We conducted the current study to investigate the incidence of extensive misalignment of this IOL and its association with clinical parameters. Retrospective case series. Data were collected from patients who had undergone phacoemulsification and implantation of a plate-haptic multifocal toric IOL. Among 332 eyes, extensive misalignment of toric IOLs ≥ 45º occurred in 3.3% (11 eyes). The amount of misalignment in eyes with extensive misalignment was 81.6 ± 22.9º, while in those without extensive misalignment, it was 3.0 ± 2.7º. The eyes with extensive misalignment showed significantly greater axial length (p < 0.001), larger corneal diameter (p = 0.034), and flatter corneas (p = 0.044) than those without extensive misalignment. Repositioning surgery to correct toric IOL misorientation was conducted in 9 eyes between 7 and 28 days after cataract surgery. In 2 eyes, repositioning surgery was carried out twice. In majority of cases plate-haptic multifocal toric IOLs showed satisfactory rotational stability, but extensive misalignment ≥ 45º occurred in 3.3% of cases.

Outcomes of preloaded toric intraocular lens implantation in eyes undergoing phacoemulsification.

To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow-up. At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow-up (P < 0.001, Wilcoxon signed-rank test). The mean refractive cylinder improved from - 1.56 ± 1.25 D preoperatively to - 0.12 ± 0.31 D at 3 months follow-up (P < 0.001) while the mean spherical equivalent value changed from - 1.93 ± 3.71D preoperatively to - 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 μm while the average contrast sensitivity value (Pelli-Robson chart) was 1.56 ± 0.10 log unit, at the final follow-up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow-up. There were no intraoperative or postoperative complications. SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability.

Factors Predictive of Refractive Error After Toric Lens Implantation.

To identify factors related to suboptimal refractive outcomes after toric intraocular lens implantation. A retrospective case-control chart review of 446 eyes with toric lens insertion by the same surgeon at a university hospital from 2016 to 2020 was conducted. Pre-operative exam findings, biometry, and one month and three month post-operative vision and refraction were noted. Reviewed charts were considered cases if uncorrected distance visual acuity (UDVA) was worse than 20/40, spherical equivalent (SE) >1 diopter (D) off target, or cylinder >1 D off target. Overall, 93.7% (n = 343) of eyes achieved UDVA of 20/40 or better, 92.7% (n = 306) were within 1 D of target SE, and 90.9% (n = 300) were within 1 D of target cylinder. UDVA cases had more eyes with prior LASIK (21.7% vs 7.0%, p = 0.01) and keratoconus (8.7% vs 0.6%, p < 0.001) than controls. More SE cases had prior radial keratotomy (RK) (8.3% vs 0%, p < 0.001) and keratoconus (12.5% vs 0%, p < 0.001) than controls. More cylinder cases had prior LASIK (30.0% vs 8.7%, p < 0.001) and higher mean astigmatism (2.3 vs 1.5 D, p = 0.02) than controls. More cases in all three analyses had higher toric cylinder power (T5-T9) than controls. Age, sex, eye laterality, axial length, anterior chamber depth, lens power, dry eye, anterior basement membrane dystrophy, and Fuchs' endothelial dystrophy differences were not significant. Prior LASIK or RK, keratoconus, and higher astigmatism may increase the chance of a suboptimal outcome.

Результаты коррекции астигматизма малых цилиндров мультифокальными и мультифокально-торическими линзами

Purpose. To study the data of low astigmatism correction after multifocal and multifocal toric intraocular lens implantation. Material and methods. We examined 64 patients (77 eyes) with corneal astigmatism 0.5–0.75 D, of them 34 patients (38 eyes) underwent phacoemulsification (PE) with Acrysof IQ PanOptix Toric IOL implantation (group 1 or main group), and 31 patients (39 eyes) — with Acrysof IQ PanOptix IOL implantation (group 2 or control group). Results. 1 months after PE the sphere of ±0.5 D was observed in 92.1 % of cases in the main group and in 74.4 % in the control group. Residual astigmatism with PanOptix Toric implants was –0.18 ± 0.07 D in the main group and 0.91 ± 0.25 D in the control group. By 3 months after surgery uncorrected visual acuity (UCVA) of 0.8 and better was observed in 94.7 % of cases in the main group and in 82.1 % (p &lt; 0.05) in the control group. Near visual outcomes under photopic and mesopic lighting conditions in the two groups after 6 months of follow-up did not make big difference. When assessing the mid vision, the control group showed significantly lower UCVA values. Questionnaire data (according to VFQ-14): the average value in the main group — 96.7 ± 1,2 points (variability 95.1–100), in the control group — 82.8 ± 2.3 (78.6–92.3), the difference was statistically significant (p &lt; 0,05). Conclusion. The comparative analysis showed that PE with multifocal toric IOL implantation in small cylinder astigmatism (0.5–0.75 D) results in better mid and distaance visual acuity under different lighting conditions than PE with multifocal IOL implantation. Therefore, when choosing an IOL in this category of patients, it is preferable to implant multifocal toric IOLs. Keywords: multifocal IOLs, multifocal-toric IOLs, astigmatism of small cylinders, cataract phacoemulsification

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design

To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. Single-center retrospective study. This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was≤6̊ (1 month) and≤10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

A new intraocular lens marker to guide the implantation of toric intraocular lenses in small and mid-dilating pupils

Insufficient pupillary dilatation is a significant challenge during cataract surgery, as it increases the risk of various intraoperative complications. Implantation of toric intraocular lenses (TIOL) is particularly difficult in eyes with small pupils, as the toric marks are provided in the periphery of the IOL optic, making the visualization of the same difficult for proper alignment. Attempts at visualizing these marks using a second instrument such as a dialler or iris retractor lead to additional manipulations in the anterior chamber resulting in increased chances of postoperative inflammation and intraocular pressure rise. A new intraocular lens (IOL) marker to guide the implantation of TIOLs in eyes with small pupils is described, which can potentially be beneficial in achieving accurate alignment of toric IOLs in small pupils, without the need for additional manipulations, thus improving safety, efficacy, and success rates of TIOL implantation in these eyes.

Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism.

The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism. This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation. Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2-13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2-12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from -5.30 ± 1.86 D to -1.62 ± 1.94 D ( P < 0.001) and from -4.00 ± 4.46 D to -0.25 ± 1.25 D ( P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P < 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively. Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.

Short-term clinical results with a trifocal diffractive toric intraocular lens using an optimized preoperative and intraoperative protocol.

To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy.

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was -0.29 ± 0.43 vs. -0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85D@93° ± 2.42° vs. 0.23D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1D vs. 2.28 ± 1.03D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24D@28° ± 0.57° vs. 0.03D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31D vs. 0.42 ± 0.31D, respectively (P = 0.44) (D diopters). The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

Visual and Refractive Outcomes of a Trifocal Toric Intraocular Lens Implanted in Eyes With High Corneal Astigmatism.

To analyze the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with high degrees of corneal astigmatism. A total of 29 eyes from 21 patients who underwent implantation of a trifocal toric IOL (FineVision PODFT; PhysIOL) were evaluated in this study. Phacoemulsification with femto-second laser and intraoperative aberrometry were performed in all cases. All IOLs used exhibited a cylinder power of 3.75 diopters (D) or greater. The main outcome measures were refractive error and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) values. Eyes were evaluated during a follow-up period of 5 years. A total of 96.30%, 100%, 95.83%, and 89.47% of eyes were within ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. Furthermore, 92.31%, 86.36%, 82.61%, and 84.21% of eyes showed a refractive cylinder value of ±1.00 D at 1, 2, 3, and 5 years postoperatively, respectively. During the entire follow-up period, between 81.48% and 91.30% of eyes showed a CDVA of 20/25 or better. The mean monocular Snellen decimal CDVA values were 0.90 ± 0.12, 0.90 ± 0.11, 0.91 ± 0.11, and 0.90 ± 0.12 at 1, 2, 3, and 5 years postoperatively, respectively. No significant rotation was reported in any eye during follow-up. The current study suggests that use of this trifocal toric IOL in eyes with high amounts of corneal astigmatism provides accurate refractive outcomes with good distance visual acuity. [J Refract Surg. 2023;39(4):229-234.].

Toric intraocular lenses versus paired opposite corneal incisions in correction of low-grade astigmatism after phacoemulsification

Purpose To compare toric intraocular lens (IOL) implantation versus monofocal (Eyhance) IOL with paired corneal incisions for correction of low-grade astigmatism after phacoemulsification. Patients and methods A retrospective comparative study included 30 patients with low-grade astigmatism (−0.75 to −1.50 D) who underwent phacoemulsification: group 1 underwent toric IOL implantation (TECNIS toric) and group 2 underwent enhanced monofocal IOL (TECNIS Eyhance) with paired corneal incision along steep corneal meridian. Best-corrected visual acuity, astigmatism power, and axis were assessed preoperatively and 3 months postoperatively. Vector analysis of astigmatism was done using the Alpins method. Results The mean postoperative residual astigmatism was significantly lower in group 1 versus group 2 (−0.357±0.128 and −0.538±0.225 D, respectively; P=0.015). A significantly higher decrease in astigmatism was noted in group 1 (−0.93±0.18 and −0.38±0.69 D, respectively; P=0.006), with no significant difference in postoperative visual acuity. Paired comparison revealed significant decrease in astigmatism (P&lt;0.0001 in group 1 and 0.04 in group 2) and improvement in uncorrected visual acuity (P&lt;0.0001 for both groups). A significantly higher percentage of success was noted in group 1 (P=0.017), with a higher difference vector in group 2 (P=0.008). Conclusion Our results suggest that both toric IOL and paired corneal incision are efficient methods for postoperative astigmatism correction and achieving postoperative spectacle independence in patients with low-grade astigmatism. Toric IOL is superior in reducing postoperative astigmatism, reflecting more consistent results. The recommendation of IOL type and astigmatism correction should be tailored according to the patient's requirements, especially with the expanded need for good intermediate vision for everyday tasks that may benefit from enhanced IOLs.

Six-year follow-up of toric intra-ocular lens implantation for post keratoplasty astigmatism and cataract – Case reports

We describe the long-term outcomes of two patients who underwent toric intra-ocular lens (IOL) implantation for cataract with post-keratoplasty astigmatism. At 6 years, the IOL was found to be stable with a rotation of less than 2°. Neither of our patients had graft rejection after IOL implantation. There was no significant increase in the corneal thickness, and graft clarity was maintained. The endothelial cell loss in our patients was 10.8% at 1 year, 13.2% at 2 years, and 7.8% at 6 years in case 1 and 9.3% at 1 year, 12.4% at 2 years, and 37.3% at 6 years in case 2.

Visual performance and rotational stability of a multifocal toric intraocular lens in myopic eyes.

This study aimed to evaluate the visual performance and rotational stability of the multifocal toric intraocular lens in myopes. This prospective, observational study included patients with an axial length of ≥24.5 mm and regular corneal astigmatism of >1 diopter who underwent phacoemulsification cataract surgery and implantation of a multifocal toric intraocular lens (AT LISA toric 909M). The visual acuity, defocus curves, residual astigmatism, rotational stability, higher-order aberrations (HOAs), modulation transfer function (MTF), spectacle dependence and patient satisfaction were evaluated 3 months after surgery. Forty-three eyes from 30 patients were enrolled in this study. Postoperatively, uncorrected distance and near visual acuities (logMAR) were 0.09 ± 0.08 (standard deviation, SD) and 0.14 ± 0.08, respectively. The defocus curve analysis provided a bimodal curve showing two peaks of maximum vision at 0.0 D and at -3.0 D defocus level. The multifocal toric intraocular lens showed excellent rotational stability; the mean rotation was 4.02 ± 2.49 (SD) degrees at 3 months postoperatively. Refractive predictability was excellent with a mean spherical equivalent of 0.19 ± 0.37 (SD) diopters (D) and a mean refractive cylinder of -0.34 ± 0.39 (SD) D. The diffractive multifocal toric intraocular lens, AT LISA toric 909M, provided effective distance and near visual acuities in myopic eyes. It was a predictable and effective device with good rotational stability for the correction of preexisting astigmatism during cataract surgery. In this study, more than 80% of patients achieved spectacle independence.

Impact of Total Corneal Astigmatism Estimated With the Abulafia-Koch Formula Versus Measured With a SS-OCT Biometer on the Refractive Outcomes of a Toric Intraocular Lens in Cataract Surgery.

To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCAABU) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCATK) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation. Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCAABU (estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCATK (measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCAABU. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCAABU or TCATK). The cylinder power and the axis of the posterior chamber IOL were compared. The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCAABU and 0.35 D at 148° with TCATK (P(x) < .001; P(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCAABU and 0.50 ± 0.37 D with TCATK (P < .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCAABU versus 50% of eyes with TCATK. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases. Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCAABU was used compared to TCATK measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup. [J Refract Surg. 2023;39(3):171-179.].

Efficacy of Toric Intraocular Lens Implantation in Patients Older Than 80Years with Cataracts and Corneal Astigmatism.

This study analyzed the visual outcome following cataract surgery with toric intraocular lenses (IOLs) in patients older than 80years with corneal astigmatism. A total of 159 patients (159 eyes) older than 80years with corneal astigmatism (≥ 0.75D) were included. Fifty-three eyes received Acrysof IQ® toric IOLs (SN6AT2-5), while the others received non-toric IOLs: 51 eyes received Acrysof IQ® IOLs (SN60WF) and 55 eyes received A1-UV IOLs. The uncorrected distance visual acuity, corrected distance visual acuity, and refraction (spherical equivalent, refractive cylinder) were assessed at 3months postoperatively. The prediction error of refractive outcome and percentages of eyes within ± 0.50D and ± 1.00D in the toric IOL group obtained using five toric IOL formulas (Barrett predicted posterior corneal astigmatism (PCA), Barrett measured PCA, Kane, EVO 2.0 and Næser-Savini) were compared. At 3months postoperatively, the average uncorrected distance visual acuity was better in the toric IOL group than the non-toric IOL group (p < 0.001). The mean residual refractive cylinder was lower in the toric IOL group than the non-toric IOL group (p < 0.001). The Næser-Savini formula achieved the lowest mean absolute error (0.39D) and had the highest percentages of eyes within an absolute error of 0.50D and 1.00D (72% and 98%) compared to the other formulas. The results demonstrate the efficacy of toric IOL implantation in patients older than 80years with corneal astigmatism and provide strong evidence for cataract surgeons to encourage such patients to choose toric IOLs.

Correction of Asymmetric Bowtie Corneal Astigmatism with a Toric Intraocular Lens: Outcomes and Accuracy of Measurement Modes.

The outcomes of toric intraocular lens (IOL) implantation in correcting asymmetric bowtie corneal astigmatism remain uncertain. The accurate measurement of corneal astigmatism is essential for surgical planning. In this prospective cohort study, patients with asymmetric or symmetric bowtie corneal astigmatism who underwent toric IOL implantation were recruited. Preoperative corneal astigmatism was measured with an IOLMaster and Pentacam (including the simulated keratometry (SimK), total corneal refractive power (TCRP), and wavefront aberration (WFA) modes). At 3 months after surgery, the refractive outcomes and residual astigmatic refractive errors were compared with patients with symmetric bowtie astigmatism. The prediction errors (the differences between the calculated actual corneal astigmatism and the measured corneal astigmatism) were compared among the different measurement modes in the asymmetric group. There were no differences in residual astigmatism between the asymmetric and symmetric groups. However, the mean absolute residual astigmatic refractive error was greater in the asymmetric group than in the symmetric group (0.72 ± 0.42 D vs. 0.53 ± 0.24 D, p = 0.043). In the asymmetric group, the mean absolute prediction errors for the IOLMaster, SimK, TCRP and WFA modes were 0.53 ± 0.40, 0.56 ± 0.47, 0.68 ± 0.52, and 0.43 ± 0.40 D, respectively. The Pentacam WFA mode was the most accurate mode (p < 0.05). The absolute prediction error of the WFA mode was positively correlated with the total corneal irregular astigmatism higher-order aberrations and coma (r = 0.416 and r = 0.473, respectively; both p < 0.05). Our study suggests toric IOL implantation effectively corrected asymmetric bowtie corneal astigmatism. The Pentacam WFA mode may be the most accurate measurement mode, although its accuracy decreased as asymmetry increased.

Comparison of Capsular Tension Ring Implantation before vs. after Toric Intraocular Lens for Rotational Stability.

To compare the effect of implanting the capsular tension ring (CTR) before or after a toric intraocular lens (IOL) on rotational stability in patients with cataract and astigmatism. This is a randomized retrospective study. Patients who underwent phacoemulsification combined with toric IOL implantation due to cataract and astigmatism between February 2018 and October 2019 were enrolled in the study. Group 1 consisted of 53 eyes of 53 patients in whom the CTR was placed into the capsular bag after the implantation of the toric IOL. On the other hand, group 2 consisted of 55 eyes of 55 patients in whom the CTR was placed into the capsular bag before implantation of the toric IOL. The two groups were compared in terms of preoperative and postoperative astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and postoperative IOL rotation degree. There were no significant differences between the two groups related to age and sex (p > 0.05) or the mean preoperative spherical value, UCVA, BCVA, and corneal astigmatism (p > 0.05). Although the mean postoperative residual astigmatism of the first group (- 0.29 ± 0.26) was lower than that of the second (- 0.43 ± 0.31), the difference was not statistically significant (p = 0.16). The mean degree of rotation was 0.75 ± 2.66° in group 1 and 2.90 ± 6.57° in group 2, which was found to be statistically significant (p = 0.02). The implantation of CTR after a toric IOL provides further rotational stability and more effective astigmatic correction.

Clinical outcomes of trifocal toric intraocular lenses.

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Safety and efficacy of toric intraocular lens implantation for more than 5 years

Objective: To evaluate the clinical safety and efficacy of toric intraocular lens (IOL) implantation for more than 5 years. Methods: This study was a prospective cohort study in which subjects were continuously observed over a two-year period (May 2014 to May 2016) in nine hospitals. The study randomly assigned subjects to two groups using a central dynamic randomization system: the study group, which received Proming® IQ toric IOL implants, and the control group, which received AcrySof® IQ toric IOL implants. The subjects completed a one-year follow-up, during which various measures were taken and evaluated, including visual acuity, IOL rotation, postoperative complications, intraocular pressure, and subjective evaluation (preoperatively and at 1 day, 6 months, 1 year, and 5 years post-surgery). The main statistical analysis methods include the Mann-Whitney U test, independent sample t-test, Wilcoxon signed rank test, paired sample t-test, chi-square test, and Fisher's exact test. Results: A total of 45 eyes (26 in the study group and 19 in the control group) completed the five-year continuous observation period. The mean age of the subjects was (72.07±10.67) years and the mean interval from surgery to the last visit was (5.39±0.47) years. After five years, there were no significant differences in uncorrected distance visual acuity (0.20±0.26 vs. 0.16±0.13, t=0.17,P=0.752), best corrected distance visual acuity[0.00(0.00, 0.20) vs. 0.05±0.10, U=188.00, P=0.880], uncorrected near visual acuity[0.50 (0.20, 0.60) vs. 0.42±0.20, t=0.35, P=0.857], and best corrected near visual acuity (0.13±0.16 vs. 0.17±0.23, U=161.00, P=0.884) between the two groups. However, all measures improved significantly from baseline levels in both groups (all P<0.05). Five years after surgery, no matter objective refraction [(-0.67±0.85) D vs. (-0.73±1.08)D] or subjective refraction[-0.50 (-1.00, 0.00)D vs. (0.69±0.87)D], the degree of cylindrical degree is significantly lower than preoperative corneal astigmatism [(1.27±0.49) D vs. (1.34±0.82) D, all P<0.001]. In addition, there were no significant differences in intraocular pressure, subjective evaluation of visual adverse symptoms, distance vision spectacle independence, or overall satisfaction evaluation between the two groups (all P>0.05). The IOL rotation was 3.0°(1.0°, 6.0°) in the study group and 4.0°(2.0°, 6.0°)in the control group (U=185.50,P=0.574), indicating no significant difference between the groups in terms of rotational stability. Five years after surgery, there were 7 cases of posterior capsular opacification in the study group and 4 cases in the control group. There were no cases of IOL glistening in the study group, but 5 cases (26.32%) were observed in the control group. Conclusions: The long-term effects of Proming® toric IOL implantation in correcting cataracts with regular corneal astigmatism are clear after five years, with few complications and stable results.