Intraocular Lens Misalignment Research Articles

Blue-Light Filtering Monofocal Intraocular Lenses: A Study on Optical Function and Tolerance to Misalignment.

To investigate the optical performance and tolerance to misalignment of blue-light filtering monofocal intraocular lenses (IOLs). The optical properties of two monofocal IOLs featuring yellow chromophores, CT Lucia 621 PY (Carl Zeiss Meditec AG) and Clareon CNA0T0 (Alcon Laboratories, Inc), were assessed in monochromatic and polychromatic light while introducing spherical aberration (SA). Optical quality metrics derived from the modulation transfer function were assessed after optimal IOL centration at 3- and 4.5-mm pupils. In addition, each IOL's tolerance to misalignment was examined by inducing up to 1 mm of decentration and the effect of tilting it by 5 degrees at 3 mm. The IOLs' resolution and contrast, while tested using a 3-mm aperture and an SA-neutral corneal model, indicated the CT Lucia 621 PY had a slightly higher modulation transfer function (MTF) at 50 lp/mm than the CNA0T0 under monochromatic conditions (0.77 vs 0.69). On introducing SA with (0.49 vs 0.40) and without (0.75 vs. 0.70) chromatic aberration, the CT Lucia 621 PY maintained its minimally better performance. When assessed with a 4.5-mm aperture in monochromatic light, the CT Lucia 621 PY displayed improved MTF with aberration-free cornea (0.71 vs 0.40) but performed worse after introducing SA (0.44 vs 0.62). However, both lenses achieved comparable MTF values under spherical and chromatic aberrations (0.28 vs 0.27). The IOL misalignment test revealed a better tolerance to tilt and decentration of the CT Lucia 621 PY across all conditions. The CT Lucia 621 PY and CNA0T0 showed similar optical quality in different situations, with equal simulated distance visual acuity for both models. However, the CT Lucia 621 PY's aspheric design offers an advantage when dealing with often imperfect physiological conditions, displaying a more robust performance under tilt and decentration. [J Refract Surg. 2024;40(2):e79-e88.].

Efficacy of the Image-Guided Alignment System for a Four-Haptic Hydrophobic Monofocal Toric Intraocular Lens.

To compare the difference in performance between the image-guided alignment system and the manual-marking method in the four-haptic hydrophobic monofocal toric intraocular lens (IOL). Medical records of patients who underwent cataract surgery with a four-haptic hydrophobic monofocal toric IOL implantation between May 2020 and April 2021 and with 3-month visit data available were investigated. Toric IOL misalignment, residual astigmatism, and mean prediction errors between the two groups were compared. This study included 49 eyes of 44 patients (women: 68%; mean age: 67.2±7.0 [range: 47-82] years). Twenty-nine eyes of 26 patients were treated with toric IOL implantation using the image-guided system and 20 eyes of 18 patients were treated using the manual-marking method. No statistical differences were observed regarding the baseline characteristics of the two groups. Three months after the surgery, the misalignment of the toric IOL was significantly lower in the image-guided group (2.18°±0.65°, range: 1.26°-3.95°) than in the manual; marking group (4.72°±0.74°, range: 3.44°-6.21°; P <0.001). In comparison to the manual-marking method, the image-guided system reduced the misalignment of a four-haptic hydrophobic monofocal toric IOL.

Outcomes of cataract surgery with toric intraocular lens implantation after keratoplasty.

To evaluate the efficacy and predictability of cataract extraction with toric intraocular lens (IOL) implantation after deep anterior lamellar keratoplasty (DALK) or mushroom penetrating keratoplasty (PK). Villa Igea Hospital, Forlì, Italy. Prospective case series. Toric IOL implantation was offered to patients with cataract, corneal astigmatism >1.5 diopters (D) and regular central corneal topography after complete suture removal. Phacoemulsification was performed through a 2.4 mm scleral tunnel and an enVista monofocal toric MX60T or Eyecryl monofocal toric IOL was inserted in the capsular bag. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, total prediction error, and IOL misalignment. 37 consecutive patients who had previously undergone either DALK (n = 27, 73%) or 2-piece mushroom PK (n = 10, 27%) were included. All patients completed the 6-month follow-up. The mean toric IOL power was 5.3 ± 1.1 D. Both UDVA and CDVA significantly improved (from 1.02 ± 0.27 to 0.46 ± 0.31 logMAR and from 0.65 ± 0.27 to 0.11 ± 0.12 logMAR, respectively; P < .001). 20 eyes (54%) reached UDVA ≥20/40, whereas 35 eyes (95%) reached a CDVA ≥20/40. Final refractive astigmatism was 0.93 ± 0.87 D, with 35 eyes (95%) within 2 D. Prediction error was ≤1 D in 18 eyes (49%). Absolute IOL misalignment was 3.3 ± 3.5 degrees. Toric IOL implantation in postkeratoplasty eyes allowed reduction of refractive astigmatism to predictably low levels with concomitant improved visual outcomes.

Comparison of the clinical outcomes of Eyecryl™ and Tecnis® toric intraocular lenses: A real-world study.

Purpose:To compare the postoperative uncorrected distance visual acuity (UDVA) and refractive outcomes of cataract patients with astigmatism following implantation of Eyecryl™ and Tecnis® toric intraocular lenses (IOLs).Methods:We conducted a single-center, retrospective study including patients who had undergone phacoemulsification and implantation with either Eyecryl™ toric (Group 1) or Tecnis® toric (Group 2) IOL. The primary outcome measures included postoperative UDVA and residual astigmatism at 3 months. The secondary outcome measure was IOL misalignment >10° throughout the follow-up period.Results:One hundred and eight eyes of 76 patients (44 males and 32 females) were analyzed. Twenty-nine patients (38 eyes) received Eyecryl™ toric IOL (Group 1), and 47 patients (70 eyes) received Tecnis® toric IOL (Group 2). Groups 1 and 2 showed a mean postoperative logMAR UDVA of 0.09 ± 0.11 and 0.06 ± 0.09, respectively, at 3 months (P = 0.114). In both groups, all the eyes achieved a postoperative UDVA of ≤0.3 logMAR. The postoperative residual astigmatism of group 1 and group 2 was -0.29 ± 0.34 D and -0.16 ± 0.27 D, respectively (P = 0.038). Postoperative astigmatism was within ± 1.00 D in all the eyes. No eyes had an IOL misalignment >10° throughout the follow-up period.Conclusion:Both Eyecryl™ and Tecnis® toric IOLs provided significant improvement in uncorrected visual acuity and astigmatism correction postoperatively. The Tecnis® toric IOL provided statistically significant lower residual astigmatism than Eyecryl™toric IOL. However, the difference in postoperative astigmatism between the two IOLs was clinically insignificant.

Misalignment of a toric introaocular lens and reoperation after phacoemulsification with implantation of AT TORBI 709M: A case report

<br>We aimed to report a case of two-time misalignment of a toric intraocular lens (IOL) AT TORBI 709M shortly after cataract surgery and the solution to the problem. A 53-year-old man had progressively decreased vision in his left eye (OS) for more than 5 years. The uncorrected visual acuity was 20/100 in the left eye. Phacoemulsification and toric IOL implantation (AT TORBI 709M, +16.5D with cyl +2.5D) were smoothly performed in the left eye. Only 1 week after surgery, the toric IOL became misaligned. So repositioning surgery was performed 1 month later. However, the toric IOL misalignment reoccurred only 1 day after repositioning surgery. Finally, 2 weeks after repositioning surgery, toric lens replacement (Rayner T-flex Aspheric, +17.0D with cyl +2.5D) was performed in the left eye. The toric IOL became stable in the next 2 months. We concluded that Toric IOLs with larger size are more stable in larger eyes.<br>

Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes.

Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.

Optical bench simulation for intraocular lenses using field-tracing technology.

To evaluate the image quality of intraocular lenses (IOLs) using field-tracing optical simulation and then compare it with the image quality using conventional ray-tracing simulation. We simulated aspheric IOLs with a decenter, tilt, and no misalignment using an aspheric corneal eye model with a positive spherical aberration. The retinal image, Strehl ratio, and modulation transfer function (MTF) were compared between the ray-tracing and field-tracing optical simulation and confirmed by the results reported in an in vitro experiment using the same eye model. The retinal image showed interference fringes from target due to diffraction from the object in a field-tracing simulation. When compared with the experimental results, the field tracing represented the experimental results more precisely than ray tracing after passing over 400 μm of the decentration and 4 degrees of the tilt of the IOLs. The MTF values showed similar results for the case of no IOL misalignment in both the field tracing and ray tracing. In the case of the 200-μm decentration or 8-degree tilt of IOL, the field-traced MTF shows lower values than the ray-traced one. The field-tracing optical bench simulation is a reliable method to evaluate IOL performance according to the IOL misalignment. It can provide retinal image quality close to real by taking into account the wave nature of light, interference and diffraction to explain to patients having the IOL misalignment.

Time-efficiency assessment of guided toric intraocular lens cataract surgery: pilot study.

To compare the time spent on toric intraocular lens (IOL) implantation during cataract surgery using a manual-marking vs a digital image-guided system (t Verion) for toric IOL alignment. Instituto Oftalmológico Quirónsalud ophthalmology clinic, A Coruña, Spain. Experimental and longitudinal study. A total of 98 eyes of 65 participants (68.2 ± 12.2 years) were divided into 2 groups: 49 eyes operated with toric IOL alignment using a manual-marking technique (manual group) and another 49 eyes operated using image-guided marking (Verion group). The primary variable for comparison between both groups was cataract surgery time. Other outcomes such as toric IOL misalignment, spherical equivalent, astigmatism, uncorrected distance visual acuity, and corrected distance visual acuity were also measured. The total cataract surgery time was 2:09 minutes shorter (P < .001) with the Verion system (12:12 ± 2:20 in 49 eyes operated) compared with the surgical procedure performed using manual marking (15:27 ± 3:04 in 49 eyes operated). One month after surgery, there were no statistical differences in terms of toric IOL misalignment between the Verion (3.38 ± 2.95 degrees) and the manual group (4.66 ± 3.95 degrees). No statistical differences were observed between groups for refractive and visual outcomes (P ≥ .05). The cataract surgery time was reduced when the procedure was assisted using the Verion system to align the IOL compared with manual marking, maintaining the same efficacy in terms of toric IOL misalignment, residual refraction, and visual acuity.

Simulations of Decentration and Tilt of a Supplementary Sulcus-Fixated Intraocular Lens in a Polypseudophakic Combination Using Ray-Tracing Software

This study aimed to assess image quality after the tilt and decentration of supplementary intraocular lenses (IOLs) in a two-lens configuration. One was designed for sulcus fixation with a nominal power range of 1D–10D and was combined with a capsular fixation 20D IOL. The optical performance of a ray-tracing model was tested under IOL misalignment through the area under the modulation transfer function (MTFa) and wave aberrations. Tilting by 10° resulted in a 4% reduction of the MTFa for a 10D IOL as compared to 9% for the 20D lens. The two models demonstrated good tolerance to a 1 mm decentration; as for the 10D sulcus-fixated lens, the MTFa loss was 2%, and 4% for the capsular fixation lens. Coma and astigmatism increased three- and four-fold, respectively, after a 10° tilt compared to the aberration level induced by the 1 mm decentration. Both analyses showed a trend towards a lower MTF impact and fewer optical errors with decreasing nominal power. In conclusion, when misaligned, low-power sulcus-fixated IOLs might retain their good optical quality. An extreme tilt of 10° has a more detrimental effect on the IOL performance than a 1 mm decentration. The proper alignment of a high-power capsular fixation lens is important in achieving a desirable postoperative outcome.

Effect of misalignment at different orientations associated with angle κ on optical performance of aspheric intraocular lenses with different surface designs.

Intraocular lens (IOL) misalignment and angle κ have had significant negative impact on post-operative quality of vision. ZEMAX software has been used to imitate the optical performance of pseudophakic eyes with different IOL surface designs at different orientations of IOL misalignment (decentration of 0.4 mm and tilt of 7°, and with the existence of 0.5 mm angle κ). We found that an aspheric balanced curve optic surface maintained better optical performance via inducing less coma aberration. Coma aberration played an unexpectedly important role in the optical performance. With angle κ, the impact of IOL misalignment on visual quality was associated with the orientation of decentration and tilt, indicating that the coma compensation also took effect in pseudophakic eyes. Due to the high incidence of post-operative IOL misalignment, our results provide evidence of the importance of considering personalized angle κ before cataract surgery for patients.

Three-Random-Point Marking Method for Toric Intraocular Lens Alignment Using the iTrace Aberrometer

Purpose To evaluate the clinical outcome of the three-random-point (TRP) marking method for toric intraocular lens (IOL) alignment using the iTrace aberrometer (Tracey Technologies Corp., Houston, TX). Setting. Department of Ophthalmology, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. Design Prospective, randomized comparative trial. Method Thirty eyes of 30 patients undergoing cataract surgery with coexisting corneal astigmatism of over 1.0 D were included in this study. All patients were prospectively randomized into the TRP marking group or slit-lamp horizontal meridian (SHM) marking group. TRP marking involved marking three points randomly in the corneal limbus of the patients and accurately marking the horizontal meridian was not required. The follow-up duration was 3 months after cataract surgery. Results Fifteen eyes of 15 patients were in the TRP marking group and 15 eyes of 15 patients in the SHM marking group. There was no statistically significant difference in BCVA, UDVA, preexisting corneal astigmatism, or residual astigmatism between the groups before or after surgery (P > 0.05). The mean toric IOL misalignment was lesser but without significance in the TRP marking group than in the SHM marking group after 3 postoperative months (2.66° ± 1.42° versus 3.29° ± 1.67°; P=0.295). Conclusion The TRP marking method using the iTrace aberrometer is simple and accurate for preoperative marking of toric IOLs. It can eliminate the potential systematic errors resulting from varying head positions during the preoperative keratometry measurement and from manual marking.

Misalignment and tilt effect on aspheric intraocular lens designs after a corneal refractive surgery.

PurposeTo numerically evaluate and compare the tolerance to misalignment and tilt of aspheric intraocular lenses (IOLs) designed for three eyes: with standard cornea and with simulated corneas after myopic and hyperopic laser ablation surgery.MethodsThree aspheric IOLs of +20.00 diopter (D) with different spherical aberration (SA) () values have been designed using a theoretical model eye. Drastic changes on the theoretical eye anterior corneal asphericity have been performed to simulate myopic and hyperopic refractive surgeries. The effect of IOL misalignment and tilt on the image quality has been evaluated using a commercial optical software design for the three eye models. Image quality was assessed from the modulation transfer function (MTF), root mean square (RMS) values of defocus, astigmatism, coma and spherical aberration (), and retinal images obtained from a visual simulator using an aleatory optotype of 0.00 LogMar visual acuity (VA).ResultsIOL misalignment and tilt reduced MTF values in general, and increased wavefront aberrations errors. Aberration-free IOLs maintained best the MTF values when misalignments were applied, together with good on-axis optical quality. IOLs with negative SA () correction decreased the MTF value under 0.43 for misalignments values higher than 0.50 mm with the three corneas. The effect of misalignment on RMS astigmatism and coma was correlated with the IOL SA () and with the three corneas.ConclusionsThis theoretical study shows that the largest degradation in image quality arises for the IOL with the highest amount of spherical aberration (). Moreover, it has been found that the aspherical design has a more influential role in misalignment tolerance than in tilt tolerance.

Sources of Error in Toric Intraocular Lens Power Calculation.

To evaluate the influencing factors on remaining astigmatism after implanting a toric intraocular lens (IOL) during cataract surgery. This retrospective study included parameters that were considered to have an influence on toric IOL power calculation. Therefore, data from the literature and the authors' own data were used. This included axial eye length, anterior chamber depth, central corneal thickness, corneal radii (anterior and posterior), diurnal changes of the cornea, inter-device differences, rotational misalignment of the IOL, tilt and decentration of the IOL, pupil size, angle kappa, and surgically induced astigmatism. Ray-tracing and Gaussian error propagation analysis was performed to quantify the sources of error. In total, 4,949 eyes (4,365 eyes of 42 studies and 584 eyes of retrospectively analyzed study data) were included in the study and the difference vector between aimed and calculated remaining astigmatism was 0.81 diopters (D). The main source of error was the preoperative measurement of the cornea (27%), followed by IOL misalignment (14.4%) and IOL tilt (11.3%). Other factors, such as angle kappa (10.9%), pupil size (8.1%), surgically induced astigmatism (7.8%), anterior chamber depth (7.5%), axial eye length (7.5%), and decentration (5.6%), also contributed to the refractive astigmatic error. The main source of error in toric IOL power calculation is the preoperative corneal measurement followed by IOL misalignment and tilt. [J Refract Surg. 2020;36(10):646-652.].

Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs.

To evaluate the comparative rotational stability and the repositioning rates and outcomes of a hydrophilic and hydrophobic acrylic monofocal toric intraocular lens (IOLs). Single center, Aravind Eye Hospital in Madurai, India. Retrospective cohort study. All patients had either an Auroflex hydrophilic acrylic toric IOL (n = 4603) or AcrySof hydrophobic acrylic toric IOL (n = 926) implanted between January 2015 and April 2019. Surgical repositioning was offered if the toric IOL was 15 degrees or greater misaligned or there was a 2-line or greater improvement in uncorrected distance visual acuity (UDVA) predicted with repositioning. A total of 5529 single-piece toric IOLs were implanted during the study period. There was no statistically significant difference between the hydrophilic and hydrophobic acrylic toric IOL groups in need for surgical repositioning (2.5% vs 1.9%; P = .34) or actual surgical repositioning rate (1.8% vs 1.5%; P = .59). A higher rate of surgical toric IOL repositioning was associated with younger age (62.7 vs 67.2 years; P < .0001), higher presurgical astigmatism (2.32 vs 1.99 diopters [D]; P < .0001), and with-the-rule astigmatism (4.7% vs 2.1% against-the-rule astigmatism; P = .002). In 95 eyes that underwent toric IOL repositioning, there was significant preoperative to postoperative improvement in UDVA (0.48 vs 0.12 logarithm of the minimum angle of resolution; P < .001), mean residual cylinder (1.79 vs 0.7 D; P < .001), and mean toric IOL misalignment (49.7 vs 5.4 degrees; P < .001). The repositioning outcomes were statistically similar with both toric IOL models. There were no major complications or recurrent toric IOL rotation after surgical repositioning. The hydrophilic acrylic toric IOL had comparable rates of postoperative misalignment and surgical repositioning with the hydrophobic acrylic toric IOL. Early postoperative surgical repositioning was both safe and effective with both toric IOLs.

Iris Registration Capsulotomy Marking Versus Manual Marking for Toric Intraocular Lens Alignment in Cataract Surgery

To compare the accuracy of toric intraocular lens (IOL) alignment and visual outcomes using femtosecond laser-assisted capsulotomy marking (CM) versus conventional slit lamp-assisted manual marking (MM). Prospective cohort study. A total of 57 patients who required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T8) were assigned to the CM group (26 eyes) or the MM group (31 eyes). Uncorrected distant visual acuity (UCDVA), best-corrected distant visual acuity (BCDVA), residual astigmatism (RA), IOL misalignment, and modulation transfer function (area ratio [AR] value) were measured 1 and 3months after surgery. Postoperative UCDVA (logarithm of minimal angle of resolution [logMAR]) was significantly lower in the CM group than that in the MM group (P < .05). Postoperative RA and IOL misalignment were significantly lower in the CM group than that in the MM group (both P < .05). No significant difference between the groups was observed for BCDVA or AR value (both P > .05). UCDVA (logMAR) was positively correlated with RA (r= 0.339; P < .05) and IOL misalignment (r= 0.317; P < .05) and negatively correlated with the the AR value (r=-0.272; P < .05); RA was positively correlated with IOL misalignment (r= 0.405; P < .05). The accuracy of the axis alignment was significantly higher in the CM group, which resulted in lower residual astigmatism and better visual outcomes.

Evaluation of axis alignment and refractive results of toric phakic IOL using image-guided system.

To evaluate accuracy of axis alignment and refractive results of toric phakic intraocular lens (IOL) implantation using a digital imaging system. This retrospective study investigated toric implantable collamer lens (ICL) implantation in 30 eyes of 21 patients with myopic astigmatism more than 2.0 D guided with digital imaging system. Data were collected during the first week after phakic IOL implantation. Thirty eyes of 21 patients were included in our study. Patients includes 9 males and 12 females. The mean age of the patients was 26.5±7.1 (range 21-44)y. The mean preoperative manifest astigmatism was 3.2±1.7 (range from 2.25 to 4.75) D. The mean postoperative uncorrected distance visual acuity (UCDVA) were 0.07±0.07 (range from 0.1 to 0.0) logMAR. The mean postoperative residual refractive cylinder was 0.25±0.29 (range 0-0.75) D. Eyes with postoperative residual refractive cylinder of 0.5 D or less represented 80% (24 eyes). The mean postoperative toric IOL misalignment measured by the OPD scan III was 1.9°±1.45° (range from 0 to 5°). Image guided system allows accurate alignment of toric ICL. This is associated with good postoperative visual acuity and low residual refractive astigmatism which correlates with the precision of toric phakic IOL alignment.

Effect of Capsular Tension Ring Implantation on Postoperative Rotational Stability of a Toric Intraocular Lens.

To analyze clinical outcomes of cataract surgery with implantation of a toric intraocular lens (IOL) and to evaluate the effect of capsular tension ring (CTR) presence or absence on the rotational stability of implanted IOLs and postoperative refraction. This cohort study included 64 eyes of 41 patients who underwent uneventful cataract surgery with implantation of a toric IOL (enVista toric MX60T; Bausch & Lomb, Rochester, NY) to correct preoperative corneal astigmatism. In 30 eyes, a CTR (11 SR model; Videris s.r.o., Prague, Czech Republic) was co-implanted. Analyzed parameters were refraction, visual acuity, and misalignment of toric lenses. The mean patient age was 67 years (range: 42 to 89 years) and the mean follow-up period was 5 months. Mean manifest astigmatism improved from -1.53 ± 1.15 diopters (D) preoperatively to -0.40 ± 0.61 D postoperatively (P < .001). Postoperative uncorrected distance visual acuity was 0.10 ± 0.13 logMAR (20/25 Snellen). Mean absolute IOL misalignment was 3.70° with CTR and 3.85° without CTR (P = .683). In eyes with an axial length of 24 mm or greater, IOL axis matched the planned axis in 90.5% of eyes with CTR and 81.8% of eyes without CTR (P = .964). Four eyes (6.25%) needed additional surgical IOL rotation. In eyes after cataract surgery with implantation of a toric IOL, there were no significant differences in the rotational stability of the lens with respect to the presence or absence of CTR. In eyes with an axial length of 24 mm or greater, better IOL alignment was observed in the group with CTR. [J Refract Surg. 2020;36(3):186-192.].

Comparison of visual and refractive outcomes of 2 trifocal intraocular lenses.

To compare clinical outcomes after cataract surgery and bilateral implantation of 2 diffractive trifocal toric intraocular lenses (IOLs). Hospital da Luz, Lisbon, Portugal. Double-arm, randomized, prospective case series. A total of 60 patients were randomly allocated to receive bilateral implantation of either the FineVision Pod FT toric IOL (PhysIOL) or the AcrySof IQ PanOptix toric IOL (Alcon). Visual and refractive outcomes, contrast sensitivity, IOL misalignment, and quality of vision outcomes (QoV questionnaire) were evaluated at 3 months postoperatively. Surgically induced astigmatic changes were evaluated by vector analysis. Each group (FineVision toric and AcrySof IQ PanOptix toric) comprised 30 patients (60 eyes). No significant differences between groups were found regarding uncorrected and corrected distance and near visual outcomes (P ≥ .333). Mean postoperative distance-corrected intermediate visual acuity at 60 cm was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and 0.09 ± 0.11 logMAR in the PanOptix and Pod FT group, respectively (P = .032). Mean IOL axis misalignment was 1.59 degrees ± 2.15 degrees (PanOptix group) and 1.89 degrees ± 3.31 degrees (Pod FT group) (P = .821). Mean magnitude of error of astigmatic correction was -0.09 diopters (D) and -0.11 D in the PanOptix group and Pod FT group, respectively (P = .333). Contrast sensitivity, QoV scores for the presence of photic phenomena, and the level of spectacle independence were similar in both groups (P > .05). Both trifocal toric IOLs allowed complete patient visual restoration, and good spectacle independence and good visual quality outcomes. The PanOptix IOL provided superior intermediate visual acuity for distances around 60 cm.

Visual and autorefraction outcomes following toric intraocular lens insertion without calculation of posterior corneal astigmatism in the UK National Health Service.

To ascertain visual and refractive outcomes following toric intraocular lens (IOL) implantation in the UK National Health Service (NHS) without posterior corneal astigmatism calculation, with multiple surgeons of different grades, pooled input and output pathways and autorefraction as the refractive outcome measure. Preoperative and 1-month post-operative data were analysed retrospectively in 114 eyes (95 patients) receiving a toric IOL between 2014 and 2016 at Imperial College NHS Trust. Preoperative keratometric astigmatism was ≥2 dioptres (D). Mean preoperative best-corrected visual acuity (BCVA) was 0.50 logMAR (±0.46), improving to a mean uncorrected VA (UCVA) of 0.35 logMAR (±0.36) postoperatively (p < 0.001) with 65% of eyes attaining a UCVA ≤ 0.30 logMAR. Excluding 33 eyes with pre-existing visual comorbidities and one targeting monovision, mean post-operative UCVA was 0.24 logMAR (±0.29) (p < 0.001), and 85% had UCVA ≤ 0.30 logMAR, 62% UCVA ≤ 0.20 logMAR. Mean refractive astigmatism improved from 3.04 D (±1.46) to 1.36 D (±1.13) (p < 0.001). In total, 52% of eyes had post-operative refractive astigmatism ≤1.00 D. The Alpins correction index was 1.05 (±0.22), indicating a tendency to overcorrect. Toric IOL misalignment was noted in two eyes, and two cases of posterior capsule rupture were converted to a non-toric IOL. Visual outcomes of toric IOL implantation in our pooled pathway are comparable to single-surgeon case series where posterior corneal astigmatism has not been accounted for. However, with 1-month post-operative autorefraction, only 52% of eyes had ≤1 D refractive astigmatism, which is lower than previously published series, but may be standard for 1-month autorefraction outcomes.

Randomized trial comparing visual outcomes of toric intraocular lens implantation using manual and digital marker.

Purpose:The aim of this study was to compare the visual outcome of participants undergoing toric intraocular lens (IOL) implantation after cataract extraction using manual marking versus digital marking for intraoperative guidance.Methods:Randomized controlled trial of participants with cataract and corneal astigmatism of 1.00 D-4.50 D. The eyes were grouped into manual marking (Group 1) and digital marking (Group 2). Preoperative Uncorrected distance visual acuity (UDVA), Corrected distance visual acuity (CDVA), and corneal astigmatism were determined. IOL power and axis of alignment were determined using Barrett toric calculator. Eyes were marked by bubble marker and Mendez ring in group 1 and by VERION (Alcon, Fort Worth, Texas) digital overlay in Group 2. Postoperatively, UDVA, CDVA, residual refractive cylinder and IOL misalignment were determined (iTrace system, Tracey technologies) at 1 week, 6 weeks, and 3 months.Results:A total of 61 eyes of 50 participants, 31 in Group 1 and 30 in Group 2, were studied. The mean postoperative cylindrical error was 0.50 ± 0.39 D in Group 1 and 0.29 ± 0.34 D in Group 2 (P = 0.03). 67.74% (n = 21) and 93.55% (n = 29) eyes achieved a residual astigmatism of ≤0.50 D and ≤1.00 D, respectively, in Group 1, whereas 83.33% (n = 25) and 100% (n = 30) eyes achieved a residual astigmatism of ≤0.50 D and ≤1.00 D, respectively, in Group 2 at 3 months postoperatively. Toric IOL misalignment was 4.71 ± 3.12° in Group 1 and 4.03 ± 2.99° in Group 2 (P = 0.39).Conclusion:Accurate manual marking and digital marking are equally effective guides for toric IOL alignment, intraoperatively.