Mean Postoperative Astigmatism Research Articles

Rotational stability and refractive outcomes of a new hydrophobic acrylic toric intraocular lens

PurposeTo assess rotational stability and refractive outcomes of a new toric hydrophobic acrylic intraocular lens (IOL).DesignSingle-center, prospective, interventional clinical trial.MethodsA total of 130 eyes of 82 patients with age-related cataract and total corneal astigmatism of greater than 1.0 diopters (D) received a hydrophobic acrylic toric IOL Clareon CNW0T3-9. Baseline measurement for rotational stability evaluation was performed at the end of surgery (EOS), with the patient still supine on the operating table, using non-movable vessels as reference landmarks. Postoperative retroillumination pictures were taken at 1 h, 1 week, 1 month and 4–6 months postoperatively. Subjective manifest refraction was assessed at the 6 months follow-up visit.ResultsFinal results were obtained in 126 eyes of 80 patients. Mean absolute rotation from EOS to 6 months was 1.33 ± 2.00 [0.01, 19.80] degrees. Rotational stability values from EOS to 1 h, 1 h to 1 week, 1 week to 1 month and 1 month to 6 months were 0.86 ± 0.82 [0.00, 3.90], 1.06 ± 1.94 [0.00, 19.45], 0.47 ± 0.42 [0.00, 2.03] and 0.38 ± 0.40 [0.00, 2.56] degrees. Mean preoperative corneal astigmatism was 1.78 ± 0.83 [1.00, 4.76] D which changed to a mean postoperative refractive astigmatism of 0.33 ± 0.27 [0.00, 1.25] D at 6 months.ConclusionThe Clareon toric IOL presented very good rotational stability with a mean absolute rotation below 1.4° from EOS to 6 months. Only two IOLs rotated more than 5° with none of them requiring repositioning surgery. Refractive outcomes were satisfying with a mean residual refractive astigmatism below 0.50 D.Trial registrationRegistered at Clinicaltrials.gov NCT03803852; on May 17, 2022.

The Outcome of Manual Small Incision Cataract Surgery (MSICS) Using Ruit’s Technique in Phacomorphic and Phacolytic Glaucoma at Nan Hospital, Thailand

Objective: To evaluate the visual outcome and complications of manual small incision cataract surgery (MSICS) using Ruit’s technique in the treatment of patients with phacomorphic and phacolytic glaucoma. Materials and Methods: The medical records of 150 eyes in 147 patients with phacomorphic and phacolytic glaucoma who underwent MSICS by the Ruit’s technique between January 2009 and May 2022 at Nan Hospital, were retrospectively reviewed. Out of these 150 eyes from the 147 patients, 58 eyes from 58 patients missed the six-week follow-up, and 14 eyes from 14 patients had pre-operative vision impairing pathology. Records were analyzed of the patients with pre-operative, post-operative uncorrected visual acuity (UCVA), intraocular pressure (IOP), operative time, intraoperative difficulties and complications, and post-operative complications and astigmatism in the second and sixth week after surgery for the 78 eyes out of 75 patients. Results: Seventy-eight eyes of 75 patients treated by MSICS using Ruit’s technique with IOL implanted in the posterior chamber demonstrated no significant intraoperative or post-operative complications. The post-operative UCVA at the sixth-week follow-up was 20/70 or better in 76% of the phacomorphic glaucoma group and 64% of the phacolytic glaucoma group. In the sixth week after treatment, the mean post-operative astigmatism of the phacomorphic glaucoma group was –1.4±0.9 D and –1.3±0.7 D for the phacolytic glaucoma group. The mean post-operative IOP in the sixth week after surgery for phacomorphic glaucoma and phacolytic glaucoma were 10.7±3.7 mmHg and 9.8±4.3 mmHg, respectively. Conclusion: Manual small incision cataract surgery (MSICS) using Ruit’s technique is an effective method and excellent at controlling the IOP and achieving good visual acuity with a low rate of complications for patients with phacomorphic and phacolytic glaucoma. Keywords: Ruit’s technique; Manual small incision cataract surgery; Phacomorphic glaucoma; Phacolytic glaucoma

20-Gauge vs. 23-Gauge Vitrectomy, in Terms of Surgically Induced Astigmatism

OBJECTIVES To compare the post-operative (post-op) surgically induced mean astigmatism in patients undergoing 20-gauge- and 23-gauge vitrectomy. METHODOLOGY Sixty patients were enrolled. Relevant information was recorded in a Performa for each patient. Patients were randomly grouped into A (20-gauge) and B (23-gauge) groups. Astigmatism was recorded by a single technician using the same keratometer for all patients. A single surgeon operated on all patients. Post-operatively, all patients were re-examined after 1 week and 6 weeks, and their surgically induced astigmatism was recorded. RESULTSOf 60 patients, 58.6% were males, and 41.4% were females, with a mean age of 53.77 ± 9.63 years. The post-operative astigmatism difference between the two vitrectomy procedures was investigated. In the 20-gauge group, with 30 patients, the mean post-operative astigmatism difference was 2.21 D (±0.66 SD), with a standard error mean of 0.12. In the 23-gauge group, with 30 patients, the mean post-operative astigmatism difference was 0.74 D (±0.44 SD), with a standard error mean of 0.08. The degrees of freedom (df) were 58, and the standard error of the difference was 0.145. The t-value was calculated at 10.1504, and the p-value was found to be 0.001, indicating a significant difference. CONCLUSION The observation that the 20-gauge group displayed a notably higher mean difference in astigmatism than the 23-gauge group suggests a potential association between the choice of vitrectomy procedure and the extent of astigmatism alteration in post-operative outcomes.

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<0.0001 in group 1 and 0.04 in group 2) and improvement in uncorrected visual acuity (P<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.

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.

Refractive and visual outcomes of plate-haptic toric intraocular lens implantation for astigmatic correction after uncomplicated microincision cataract surgery.

Objective: To evaluate visual and refractive outcomes with plate-haptic toric intraocular lens implantation (ph-toric) after uncomplicated microincision cataract surgery (MICS) to correct moderate-to-severe astigmatism. Design: Prospective cross-sectional study. Methods: The study was conducted at a tertiary eye care center in New Delhi, India, on patients with visually-significant cataract and moderate-to-severe astigmatism (>1.00 diopters [D]). Preoperative parameters like visual-acuity, keratometry and astigmatism values and lens power calculation were noted. After MICS via 1.8 mm incision, a ph-toric IOL was implanted. The outcome measures noted were uncorrected and corrected distant visual-acuity (UDVA, CDVA), decrease in astigmatism and rotational stability. Follow-up was done on day 1, day 7, 1-month and 3-months postoperative. Results: This study involved 30 eyes of 30 patients. 27 patients (90%) gained UDVA of 6/ 9 or better. Out of these, 27 patients (90%) achieved CDVA of 6/ 6. Mean CDVA changed from 0.967 ± 0.101 postoperative to 0.176 ± 0.82 preoperatively (p<0.001). The mean preoperative astigmatism was 2.08 ± 0.59 D and the mean postoperative astigmatism was 0.35 ± 0.39 D. The mean correction achieved was 1.28 ± 0.32 D. Statistically significant (p<0.001) correction of astigmatism was observed by use of ph-toric IOL. The mean reduction in astigmatism was 84.16 ± 10.61 with excellent reduction in 43.3%. IOL rotation was <10 degrees in all the eyes. No complications were observed. Patients had satisfaction with the procedure and visual outcomes. Conclusion: Implantation of a plate-haptic toric IOL after uncomplicated MICS via 1.8 mm incision is a feasible and safe option in cataract cases with astigmatism to provide good visual and refractive outcomes. No major drawbacks were observed attributable to ph-toric IOL. Abbreviations: SIA - surgically induced astigmatism, D - diopters, MICS - microincision cataract surgery, ph-toric IOL - plate-haptic toric IOL, IOL - intraocular lens, UDVA - uncorrected distant visual acuity, CDVA - corrected distant visual acuity.

Refractive outcomes of scleral-sutured posterior chamber intraocular lenses in post-traumatic eyes.

To evaluate the refractive outcomes of scleral-sutured IOL 2mm posterior to the limbus in post-traumatic eyes using SRK/T formula. This single-center retrospective case series included 35 eyes from 35 post-traumatic patients undergoing scleral-suture of ErgomaX IOLs by a single experienced surgeon. Preoperative predicted refraction, procedure-related complications, and postoperative spherical equivalent (SE) at least 1month after surgery were recorded. The prediction error (PE) was calculated as the difference between the postoperative SE and preoperative predicted refraction. Of the 35 post-traumatic patients, 28 patients were aphakia without capsular support, and 7 patients were traumatic lens dislocation or subluxation. The mean age at surgery was 56.03 ± 14.56years and 28 patients were men (80%). The mean postoperative spherical equivalent (SE) and postoperative astigmatism were - 1.23 ± 0.82 D and 1.57 ± 1.14 D, respectively. The mean prediction error (ME) of SRK/T formula was - 0.17 D. The mean absolute error (MAE) was 0.48D. The prediction accuracy was 60.0% for refractive errors of ± 0.50 D and 85.7% for refractive errors of ± 1.00D. Multiple linear regression analyses revealed that IOL power has positive correlation with PE. Assumption of in-the-bag IOL position when calculating IOL (52501TY, ErgomaX) power for standardizing scleral-sutured IOL 2mm posterior to the limbus demonstrates acceptable refractive outcomes. The accuracy of IOL power calculation using the SRK/T formula for eyes needing low IOL power or high IOL power may be affected by the uncertain position of postoperative IOL and further studies are needed.

Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis.

To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. The mean age of the patients was 57.4 ± 15.1years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.

Intraocular lens implantation with flattened flanged intrascleral fixation technique in pediatric aphakia

To evaluate the clinical outcomes of flattened flanged intrascleral fixation of the intraocular lens (IOL) in cases of pediatric aphakia without adequate capsular support. The medical records of children who underwent flattened flanged intrascleral IOL implantation for aphakia with insufficient capsular support, subluxated cataract, ectopia lentis, and dislocated IOL were reviewed retrospectively. Best-corrected visual acuity, astigmatism, corneal endothelial cell loss, IOL tilt, and intra- and postoperative complications were evaluated. A total of 21 eyes of 16 patients were included. Mean patient age at time of surgery was 7.1 ± 3.8 years (range, 2-15). Mean follow-up time after surgery was 2.0 years. The mean pre- and postoperative best-corrected visual acuities were 1.03 ± 0.49 logMAR and 0.33 ±0.44 logMAR, respectively (P < 0.001). The mean preoperative astigmatism was 2.2 ± 0.9 D; and the mean postoperative astigmatism, 1.8 ± 0.8 D. The mean IOL tilt was 3.2° ± 3.1° (range, 0°-10°). The mean endothelial loss was 4.8%. Postoperatively, one of the haptics was partially visible in the scleral tunnel in one eye of a patient with Marfan syndrome. In our study cohort, the flattened flanged IOL fixation technique provided good IOL fixation, with firm haptic fixation, without use of sutures or glue.

A study on corneal astigmatism before and after pterygium excision

The prevalence of pterygium shows a substantial increase for increasing age and UV irradiation. There is paucity of available literature regarding the total area of pterygium, percentage of extension of pterygium on to the cornea and its effects on corneal astigmatism. Hence this study was undertaken to evaluate the pre and post-surgical effect of the size of the pterygium on corneal astigmatism. 100 out patients aged between 22 to 50 years diagnosed with pterygium were included in the study. Slit lamp bio microscope was used to measure the length and width of pterygium in millimetres. Slit beam was used to measure the diameter of cornea. Corneal astigmatism was measured pre and postoperatively on day 1 and 1 month follow up using keratometery. In this study 2.13±1.39 was the mean preoperative astigmatism, 1.36±1.03 was the mean post-operative astigmatism on day 1 and on 1 month follow up 0.86±0.91 was the mean post-operative astigmatism which was statistically significant(p&amp;#60;0.001)). The corneal astigmatism was directly proportional to pterygium area. As the area of pterygium increased the post-operative astigmatism significantly decreased. There was increase in corneal astigmatism with the increase in the percentage of pterygium extension onto cornea. In post-operative period the corneal astigmatism decreased with the increase in the percentage of pterygium extension onto cornea (p&amp;#60;0.001). As per our findings we draw a conclusion that surgical removal of pterygium significantly reduces pterygium induced astigmatism and also there is an improvement in visual acuity.

Comparative study of anatomic and functional changes of the corneal endothelium in cataract patients undergoing phacoemulsification and MSICS

The purpose of this study was to compare the effect of Phacoemulsification and Manual small incision cataract surgery (MSICS) on the corneal endothelium and to assess its impact on visual acuity and induced astigmatism. In this prospective randomized study, 100 cases were randomly selected with the help of lottery system. 50 cases underwent phacoemulsification (group 1) and 50 underwent MSICS (group 2) by a single surgeon. The endothelial cell count, central corneal thickness, best corrected visual acuity and induced astigmatism was measured preoperatively and postoperatively on day 1, 7, 28 and on day 42. Mean endothelial cell loss (cells/mm2) in group 1 at the end of six weeks was 538.64 (20.59%) and in group 2 was 485.66 (19.20%) which was statistically insignificant (p &amp;#62;0.05). The mean central corneal thickness was reduced in both the groups with a mean of 0.51±0.04 mm in group 1 and 0.50±0.03 mm in group 2 which was statistically insignificant. Postoperative best corrected visual acuity of more than 6/18 was found in 49 (98%) cases in each group at six weeks, and was statistically insignificant (p value &amp;#62; 0.05). Phacoemulsification group had statistically significant less mean postoperative astigmatism than MSICS group (p value &amp;#60; 0.05). Both groups gave similar statistically insignificant results in relation to endothelial cell loss, central corneal thickness and best corrected visual acuity at the end of six weeks, although the mean astigmatism was more in group 2 in comparison to group 1 with a statistically significant difference.

Phacotrabeculectomy versus Phaco with Implantation of the Ex-PRESS Device: Surgical and Refractive Outcomes-A Randomized Controlled Trial.

The aim of this study was to compare surgical and refractive outcomes between phacotrabeculectomy (P-Trab) and phaco with Ex-PRESS (P-Ex-PRESS) for glaucoma at a 6-month follow-up. This prospective randomized controlled trial included 81 eyes; 43 eyes (53%) and 38 eyes (47%) were assigned to the P-Ex-PRESS and P-Trab groups, respectively. Refraction, intraocular pressure (IOP), and best-corrected visual acuity were measured. Refractive change was analyzed using the cylinder’s magnitude, and polar analysis assessed the change in the trend of astigmatism [with-the-rule, against-the-rule (ATR), oblique (OBL)], evaluating mean astigmatism in centroid form. All patients showed a statistically significant postoperative decrease in IOP (P < 0.05). There were no differences between the groups in terms of postoperative IOP and visual outcomes or in astigmatism preoperatively or postoperatively (P = 0.61, P = 0.74). In both groups, the mean preoperative and postoperative astigmatism were ATR and OBL, respectively. Preoperative and postoperative centroids in the P-Ex-PRESS group were 0.44 ± 1.32 D at 177° and 0.35 ± 1 D at 8°, respectively, (P = 0.5) and in the P-Trab group were 0.16 ± 1.5 D at 141° and 0.39 ± 1.38 D at 29°, respectively (P = 0.38). Both P-Ex-PRESS and P-Trab showed comparable antihypertensive efficacy in treating open-angle glaucoma over 6 months. Preoperative and postoperative astigmatism did not differ between groups. The groups showed comparable results for final visual acuity.

Refractive Outcomes of Four-Point Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture.

Background/ObjectiveTo determine the refractive outcomes after 4-point scleral fixation of the Akreos AO60 intraocular lens with Gore-Tex suture.MethodsThis was a single referral center, multi-surgeon, retrospective consecutive case series. A total of 63 eyes met the inclusion criteria for having received surgical implantation of the Akreos AO60 intraocular lens with Gore-Tex suture from August 2014 to December 2018. Exclusion criteria included all ocular pathology that precluded an accurate refraction, concurrent ocular surgery, poor corrected pre-operative visual potential, among other factors. Main outcome measures included post-operative uncorrected visual acuity (VA), best-corrected VA, and spherical equivalent deviation from target.ResultsMean pre-operative BCVA was 0.67 ± 0.64 LogMAR (20/93 Snellen). Mean final post-operative BCVA was 0.17 ± 0.18 (20/28 Snellen) and mean final post-operative UCVA was 0.31 ± 0.22 (20/41 Snellen). Mean post-operative spherical equivalent was −0.57 D. Mean post-operative astigmatism was 0.85 D.ConclusionRefractive outcomes after secondary implantation with Akreos AO60 are favorable in eyes with good visual potential.

COMPARISON OF POSTOPERATIVE CORNEAL ASTIGMATISM IN PHACOEMULSIFICATION AND MANUAL SMALL INCISION CATARACT SURGERY

Objective: Globally a significant proportion of treatable blindness is caused by cataract, especially in India and southeast Asia. Treatment of cataract is surgical correction with intraocular lens implantation. The main drawback of surgical correction is induction of postoperative astigmatism in patients. The aim of this study was to compare the degree of astigmatism in manual small incision cataract surgery and phacoemulsification 3 mo postoperatively&#x0D; Methods: The study was a retrospective case study on postoperative corneal astigmatism after cataract surgery. It was conducted in a tertiary care hospital in Thandalam, Tamil Nadu. A total of 100 patients were selected and divided into two groups, group A (=50) underwent phacoemulsification and group B (=50) underwent manual small incision cataract surgery. Preoperative astigmatic status of the patients was noted from patient records. Both groups were evaluated 3 mo postoperatively using automated keratometry. The data collected was analyzed using Microsoft Excel Independent T test, p&lt;0.05 was considered statistically significant. Power of the study was 80% with an alpha error of 5%.&#x0D; Results: Mean postoperative astigmatism at 3 mo was 0.91±0.255D and 0.34±0.110D due to manual small incision cataract surgery and phacoemulsification, respectively.&#x0D; Conclusion: Postoperative astigmatism was greater in manual small incision cataract surgery than phacoemulsification. Improvement in preoperative astigmatism was seen in patients who underwent superotemporal incision phacoemulsification

Secondary intraocular lens implantation using the flanged intrascleral fixation technique in pediatric aphakia: case series and review of literature

To present a pediatric case series in which the flanged intrascleral intraocular lens (IOL) fixation technique (Yamane technique) was used to correct aphakia. The surgical database of a single tertiary children's hospital was reviewed to identify all patients who underwent secondary IOL implantation by a single surgeon from May 2018 to January 2020. The medical records and operative reports of all patients operated on using the Yamane technique were reviewed retrospectively. Intra- and postoperative complications and pre- and postoperative vision and refraction were documented to assess outcomes. A total of 12 eyes of 10 consecutive patients were included. Mean age at surgery was 10±6years. Indications for scleral fixation were ectopia lentis (secondary to Marfan syndrome [n=3] or idiopathic [n=1]), lens subluxation with intermittent pupillary block secondary to Weill- Marchesani syndrome (n=2), early childhood lensectomy with insufficient residual capsular support (n=5), and traumatic aphakia after an open globe (n=1). Mean follow-up was 8±5months. No major intraoperative complications occurred. Postoperatively 1 patient required IOL repositioning 1week after surgery. The location of one haptic was noted to be intrascleral but superficial in another patient, who did not require surgical intervention. The mean postoperative astigmatism was 2±2 D. Good visual results were achieved in all eyes. With slight modifications, the Yamane technique can be adapted to the pediatric eye. This technique has significant surgical and anatomic advantages and provides stable IOL fixation. Visual outcomes and adverse events compare favorably with older techniques.

Outcomes of Small Incision Lenticule Extraction with Dual-Incisions in Myopic Patients.

PurposeTo assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) with dual-incisions in myopic patients.SettingEbsar Eye center, Benha, Qalyopia, Egypt.DesignSingle-center, retrospective, COHORT study.Patients and MethodsThe study was conducted as a retrospective non-comparative analysis of the records of 105 eyes of 53 patients treated by the SMILE with a dual-incisions technique for a mean spherical myopic error of −5.05 ± 1.93 D (range: −1.38 to −9.0 D) with or without astigmatism and the mean astigmatism of −0.90 ± 0.83 D. The mean LogMAR corrected distance visual acuity (CDVA) was −0.04 ± 0.07.ResultsOne month after surgery, the mean refractive error was −0.03 ± 0.56 D (range: 0.88 to −1.50 D), and the mean postoperative astigmatism was 0.20 ± 0.31 D. The mean LogMAR UDVA was 0.07 ± 0.18 in the last follow-up visit, 12 months after surgery. At the end of the follow-up period, approximately 91.43% of patients had unchanged CDVA or gained one or more lines, 8.57% lost one line of CDVA, and 0.0% lost 2 lines.ConclusionSMILE with dual-incisions is effective and safe, with a stable and predictable outcome for correction of myopia and myopic astigmatism.

Clinical outcomes of Ankoris toric intraocular lens implantation using a computer-assisted marker system.

To report the clinical outcomes of patients who underwent cataract surgery with implantation of Ankoris monofocal toric intraocular lens (IOL) (PhysIOL SA, Liège, Belgium) using the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA). We conducted a retrospective case series of patients who underwent routine cataract extraction and implantation of Ankoris toric IOL using the Zeiss Callisto eye between January 2018 and December 2018 by four senior surgeons. Patients' medical records were reviewed, and clinical outcomes including postoperative refraction, visual acuity outcomes, IOL position and deviation from planned axis were collected. Fifty-six eyes of 56 patients were included, 48% were female, and the mean age was 70 ± 8years. Patients with pseudoexfoliation syndrome, glaucoma or keratoconus were excluded from the study. Pre-operative mean corneal astigmatism was 2.38 ± 0.78 diopters (D), and mean implanted IOL cylindrical power was 3.06 ± 1.07 D. IOL rotation 30days postoperatively was within 5° in 82% of eyes and between 6° and 10° in 10.8% of eyes. Mean postoperative refractive astigmatism 30days postoperatively was 0.22 ± 0.36D; in 84% of eyes the postoperative refractive astigmatism was ≤ 0.50D. IOL rotation significantly increased between day 1 to day 7 postoperatively (1.91 ± 3.15° to 3.18 ± 3.3°, P = 0.001). However, no significant rotation had occurred between day 7 and day 30 postoperatively (P = 0.093). Cataract surgery with implantation of Ankoris monofocal toric IOL using the Zeiss Callisto Eye marking system is predictable and effective in reducing refractive astigmatism.

Impact on corneal astigmatism following phacoemulsification surgery from temporal approach

Objectives: To study the change of corneal astigmatism in patients who had a cataract surgery using a temporal approach and the distribution of corneal astigmatism reference to the axis and magnitude. Methodology: Retrospective analysis of the records of 2700 patients who underwent phacoemulsification surgery at Sri Jayewardenepura General Hospital during the period of May 2011 to May 2019. Pre-operative and one-month postoperative astigmatism obtained using keratometry values. Results: Study population consisted of 2700 patients. Age ranging from 17 years to 94 years. 38% patients were male, and 62% patients were female. Mean preoperative astigmatism calculated was 0.86D. In which 63% of patients had against the rule astigmatism. Mean post-operative astigmatism obtained was 0.84D. Results shows overall reduction in post-operative astigmatism compared to pre-operative by 0.02D though this amount is not statistically significant. However, subgroup analysis of against the rule astigmatism category showed statistically and clinically significant reduction in corneal astigmatism. Conclusion: Phacoemulsification using temporal approach reduce or maintains the pre-existing astigmatism. Specially for patients having against the rule astigmatism.

Comparative effects of various types of toric intraocular lenses on astigmatism correction

BackgroundCurrently, various types of toric intraocular lenses (IOL) have been manufactured and can be divided into three types according to the location of correction component; front-toric IOL (correction on anterior IOL surface), back-toric IOL (correction on posterior IOL surface), and bi-toric IOL (correction on both anterior and posterior IOL surfaces). In this study, we aimed to investigate the effectiveness of reducing corneal astigmatism of either normal or post-penetrating keratoplasty (PKP) corneas according to the type of implanted toric IOLs.MethodsMedical records were retrospectively reviewed in 370 patients who had undergone phacoemulsification with posterior chamber toric IOL insertion (front-toric IOL, back-toric IOL or bi-toric IOL). Subjects were divided into 2 groups; subjects who had no history of corneal disease with corneal astigmatism more than 1.00 diopters (D) (G1) and subjects who received previous PKP with all corneal sutures removed and had corneal astigmatism more than 1.25 D (G2). Preoperatively intended target from SRK/T was evaluated. Refractive astigmatism and its vector analysis (J0, J45), mean numerical error (MNE) and mean absolute error (MAE) were assessed at least a month after cataract surgery.ResultsMean preoperative corneal astigmatisms were 2.2 D and 4.0 D in G1 and G2, respectively. There was significant reduction of mean postoperative refractive astigmatism to 0.89 D in G1 and to 2.33 D in G2. In G1, bi-toric IOL showed significantly more improved refractive astigmatism than back-toric IOL. In G2, no difference in refractive astigmatism according to toric IOL type was observed. While G2 showed no difference in MNE among toric IOLs, in G1, bi-toric IOL showed significant hyperopic shift compared to back-toric IOL. In both groups, there was no significant difference in MAE according to type of IOL. No postoperative complications were observed.ConclusionOur study suggests that all types of toric IOL are beneficial in correcting astigmatism of normal and post-PKP corneas. Noticeably, bi-toric IOL showed significantly better results in refractive astigmatism than back-toric IOL in normal cornea. However, bi-toric IOL showed a more hyperopic shift compared to back-toric IOL. Among post-PKP corneas, all types of toric IOL showed similar results.

A Simple Modified Way of Glueless, Sutureless Scleral Fixation of an IOL: A Retrospective Case Series

To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL). Retrospective interventional case series. A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt. Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P < 0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt. This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.