Moderate Corneal Astigmatism Research Articles

Femtosecond laser-assisted open astigmatic keratotomy versus non-open astigmatic keratotomy for astigmatism correction in cataract surgery

Objective: To compare the effects of femtosecond laser-assisted astigmatic keratotomy (FSAK) with and without a manual opening for correction of low to moderate corneal astigmatism at the time of cataract surgery. Methods: It was a prospective cohort study. Patients undergoing cataract surgery from June 2021 to June 2022 at the Army Specialty Medical Center were consecutively enrolled. To correct low to moderate astigmatism, they had combined FSAK with the corneal epithelium manually opened or not according to their own decisions. Pentacam HR corneal topography was performed at 3 months after surgery. The main indicators were target induced astigmatism, surgically induced astigmatism, difference vector, correction index and angle of error. The independent samples t-test was used for continuous variables conforming to a normal distribution, the Mann-Whitney U-test for those not conforming to a normal distribution, and the Chi-square test for categorical variables. Results: There were 51 patients (61 eyes), including 27 patients (31 eyes) receiving combined open FSAK and 24 patients (30 eyes) with non-open keratotomy. No statistical difference was found between the two groups of patients in terms of age, gender and mean follow-up time (P>0.05). The target induced astigmatism was 1.10(0.80, 1.50) D in patients with open keratotomy and 1.30(0.98, 1.73) D in patients with non-open keratotomy (Z=1.729, P=0.084). The surgically induced astigmatism was 0.70 (0.59, 1.25) D and 0.42 (0.20, 0.66) D (Z=-3.571, P<0.001), the difference vector was (0.51±0.31) D and (1.21±0.44) D (t=-7.238, P<0.001), the correction index was 0.78±0.32 and 0.38±0.25 (t=5.386, P<0.001), and the angle of error was -1.08°±10.76° and 5.93°±46.98° (t=0.809, P=0.422) in the two groups, respectively. Conclusion: Open FSAK can achieve better astigmatism correction and less postoperative residual astigmatism than non-open FSAK in cataract surgery.

Levator palpebrae superioris function and corneal astigmatism in university students with normal eyelid morphology

Background: Eyelids have been shown to influence corneal shape. The effects of eyelid pathologies on corneal astigmatism have been widely investigated. This study aimed to determine the correlation between levator palpebrae superioris (LPS) muscle function and with-the-rule (WTR) corneal astigmatism in university students with normal eyelid morphology.Methods: This was a cross-sectional study with a sample of 58 university students of Chinese origin selected by simple random sampling at the University College Sedaya International (UCSI) University Optometry Clinic, Kuala Lumpur, Malaysia. We included participants aged 18 to 30 years, regardless of sex, with normal eyelid morphology, normal LPS function, and WTR corneal astigmatism. For LPS muscle function, the distance of the upper eyelid margin from the maximal downgaze to the upgaze was measured, while the frontalis function was negated by the thumb of the examiner. Corneal astigmatism was measured using a manual Keratometry (Topcon OM-4; Topcon Corporation, Tokyo, Japan). Results: Of the 58 participants, 23 (39.7%) were men and 35 (60.3%) were women. The mean ± standard deviation (SD) age was 23.22 ± 1.77 years. For all participants, the means ± SDs for LPS muscle function and corneal astigmatism were 14.72 ± 1.74 mm and - 1.16 ± 0.47 D, respectively. Of the 58 participants, 25 and 33 had low and moderate WTR corneal astigmatism, respectively. The mean LPS muscle functions were not significantly different between the low and moderate WTR corneal astigmatism groups (P &gt; 0.05). A positive but statistically insignificant correlation (r = + 0.14; P &gt; 0.05) was found between LPS muscle function and WTR corneal astigmatism. Conclusions: We found no significant difference in the mean LPS muscle function between low and moderate WTR corneal astigmatism groups in young university students of Chinese origin with normal eyelid morphology. Furthermore, no significant correlation was found between LPS muscle function and low-to-moderate WTR corneal astigmatism.

Toric intraocular lens implantation vs femtosecond laser-assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery.

To compare toric intraocular lens (TIOL) implantation and femtosecond laser-assisted arcuate keratotomy (FSAK) during phacoemulsification surgery in correction of moderate astigmatism. Clinical research study. Prospective randomized comparison study. Patients with age-related cataract and moderate preoperative corneal astigmatism of 1.25 to 3.0 diopters (D) were randomized into a TIOL implantation group and an FSAK group with symmetrical paired corneal arcuate keratotomies. The preoperative evaluation included corrected distance visual acuity (CDVA), corneal topography, autokeratometry, and ocular biometry. Postoperative examinations were performed at 1 month and 3 months and included CDVA and uncorrected distance visual acuity, manifest refraction, autokeratometry, and corneal topography. Vector analysis of astigmatic changes was performed using the Alpins vector method. This study comprised 75 eyes from 67 patients. The mean residual refractive astigmatism at 3 months was -0.63 ± 0.55 D in the TIOL group and -0.90 ± 0.53 D in the FSAK group ( P = .037) and was ≤1.00 D in 32 eyes (84%) and 25 eyes (64%), respectively. There were no statistically significant differences between the 2 groups in difference vector, angle of error, magnitude error, or correction index in the 3-month follow-up. The index of success was 0.32 ± 0.33 D in the TIOL group and 0.48 ± 0.29 D in the FSAK group ( P = .029). TIOL implantation showed better results in correcting moderate astigmatism. Despite this, FSAK is shown to be a safe technique for reducing astigmatism.

Do limbal relaxing incisions during cataract surgery still have a role?

BackgroundThough Limbal Relaxing Incisions (LRI) were used widely to correct pre-existing corneal astigmatism during cataract surgery, they have been replaced recently with the more expensive methods like the use of toric Intra Ocular Lenses (IOL) and femtosecond during cataract surgery. We conducted our study to re-evaluate the role of (LRI) in correcting pre-existing moderate corneal astigmatism during cataract surgery in settings where other options are neither available nor affordable.MethodsRetrospective analysis of all consecutive cases of LRI performed by a single surgeon at the time of cataract surgery to correct moderate corneal astigmatism (1.5-3D) in a community hospital over a period of 6 months. Corneal astigmatism, uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) were recorded pre-operatively, 4 weeks and 3 months post-operatively. Data on age, intraocular lens (IOL) power, predictive refraction and post-operative spherical equivalent was also collected and analyzed. The number and position of LRI was determined based on the pre-existing corneal astigmatism using online calculator.Results29 eyes of 25 patients with the mean age of 73.6 years (range: 46 to 90 years) and corneal astigmatism between 1.5 to 3D were included. Statistically significant reduction in the mean corneal astigmatism was recorded from 2.05 ± 0.45D preoperatively to 0.85 ± 0.56D postoperatively (P < 0.0001). All eyes showed reduction in astigmatism; 83% of eyes had < 1.0D post-operatively and 66% of eyes had < 0.75D. UDVA of 6/9 or better was recorded in 80% of eyes post-operatively (CDVA of 6/9 or better in 100%). The spherical equivalent was within 1.0D of the predictive refraction postoperatively in nearly all eyes (97%) and within 0.5D in 86% of the eyes. There were no peri-operative or post-operative complications were recorded in any case.ConclusionCombining LRI and cataract surgery to address moderate degrees of corneal astigmatism is a safe, reliable and predictable option especially in areas where more expensive methods such as toric IOL or excimer laser are not available or affordable. LRI has no significant effect on the spherical equivalent and is an excellent tool in reducing patient’s spectacle dependence.

Lasting Effects: Seven Year Results of the Castrop Nomogram for Femtosecond Laser-Assisted Paired Corneal Arcuate Incisions

ABSTRACT Purpose Long-term results of arcuate incisions are rarely reported. This is unfortunate as long-term stability of astigmatic correction is of great interest to surgeons performing astigmatic correction. This study investigates the 7 year stability of results after application of femtosecond laser-assisted arcuate incisions with the Castrop nomogram. Methods Prospective interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Single site, single surgeon study. Seven year results of cataract patients with low to moderate corneal astigmatism receiving femtosecond laser‐assisted arcuate incisions using a TechnolasVictus SW 2.7 (Bausch & Lomb Inc, Dornach, Germany) were assessed and compared to 1 year results. Outcome evaluation was based on astigmatic vector analysis, manifest refraction, and visual acuity. Results The study analyzed 19 eyes of 19 patients 7 years after surgery. Ocular residual astigmatism changed from −0.26 to −0.39 D. Preoperative corneal astigmatism was −1.51 D. Correction Index changed from 1.0 to 1.16. The magnitude of difference vector changed from 0.26 to 0.39 D. The index of success changed from 0.20 to 0.29. Spherical equivalent remained stable. A slight tendency to change toward astigmatic overcorrection was mainly observed for patients with preoperative with the rule astigmatism, but not with patients with against the rule astigmatism. Conclusions The Castrop nomogram showed stable results 7 years after surgery. Similar to toric IOL surgery, it is advisable to be less aggressive when correcting with the rule astigmatism, to avoid overcorrection over a long period.

Efficacy comparison between toric intraocular lens and aspheric intraocular lens plus steep-axis incision in cataract patients with low corneal astigmatism.

The present study aimed to evaluate and compare the efficacy of toric intraocular lens (IOL) implantation and aspheric IOL implantation with steep-axis incision for correcting mild to moderate corneal astigmatism in cataract patients. A prospective, single-center, open label, randomized, two-arm study was designed. Cataract patients with corneal astigmatism of 1.0-2.0D were enrolled and divided into test and control groups. The test group had the AcrySof® IQ Toric IOL implanted and the control group had the AcrySof® IQ IOL implanted with a steep-axis corneal incision. All patients underwent examinations of uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), subjective refraction, and corneal astigmatism before surgery and at the 1-day, 1-month, and 3-month follow-ups. Vector astigmatism analysis was evaluated using the Alpins method. We enrolled 26 eyes of 20 patients in the study, with 13 eyes in each group. The test group had better vision than the control group at the 3-month follow-up and had more cases with a UCDVA of 20/20 (10/13 vs. 4/13). The surgically induced astigmatism (SIA) vector of the test group was higher than that of the control group (1.22±0.64 vs. 0.84±0.45). The correction index of the test group was closer to 1 compared to that of the control group (0.7 vs. 0.46). Approximately 85% of patients in the test group had an angle of error within -15° to 15°. However, only 23% of patients in the control group were within that range. Though steep-axis corneal incision was cost-saving and easy-to perform, its astigmatismcorrecting efficacy was not as good as the Toric IOL implantation for cataract patients with low to moderate corneal astigmatism.

Precision and refractive predictability of a new nomogram for femtosecond laser-assisted corneal arcuate incisions.

PurposeValidating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium‐ and Bowman‐penetrating femtosecond laser‐assisted arcuate incisions.MethodologyProspective, interventional case series at the Augen‐ und Laserklinik, Castrop‐Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser‐assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity.ResultsThe study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was −0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D.ConclusionThe Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism.

Objective visual quality one year after toric IOL implantation for correction of moderate and high corneal astigmatism.

To compare the objective visual quality after implantation of a toric intraocular lens (IOL) in order to correct moderate or high corneal astigmatism at the one year postoperative follow-up. From December 2017 to June 2018, 66 patients (90 eyes) with simple age-related cataract with regular corneal astigmatism greater than 1.5 D were enrolled in this prospective self-control study. The patients were implanted with Proming® toric IOL (model: AT3BH-AT6BH). The subjects were divided into moderate astigmatism group (46 eyes, 1.5-2.5 D) and high astigmatism group (44 eyes, >2.5 D). The uncorrected distance visual acuity, residual astigmatism and axial position of IOL were observed before operation, 3, 6mo and 1y after operation. Modulation transfer function cutoff (MTF cutoff), Strehl ratio (SR), object scatter index (OSI) were observed by OQAS II to evaluate the objective visual quality of patients. There was no significant difference in UCVA, residual astigmatism, axial deviation, MTF cutoff, SR and OSI between moderate and high astigmatism group (all P>0.05). After 3mo, UCVA, MTF cutoff and SR were significantly increased (all P<0.05), residual astigmatism and OSI were significantly decreased (all P<0.05). After 3mo, all the indexes remained stable. Proming toric IOL can effectively treat age-related cataract patients with moderate-to-high regular corneal astigmatism, correcting corneal astigmatism, improving UCVA, ensuring long-term stability in the capsule, and providing patients with better visual quality.

Preliminary Clinical Study of a LenSx Femtosecond Laser-Assisted Limbal Relaxing Incision for the Correction of High Myopia with Low to Moderate Astigmatism in Posterior Implantable Collamer Lens Implantation

Purpose. To evaluate the safety, efficacy, and predictability of implantable collamer lens (ICL) implantation combined with a LenSx femtosecond laser-assisted limbal relaxing incision (LRI) for the correction of corneal astigmatism. Methods. This prospective study enrolled 64 eyes (54 patients) with high myopia with low to moderate regular corneal astigmatism. They were divided into an ICL group with ICL implantation (18 patients, 20 eyes), a TICL group with toric ICL implantation (17 patients, 23 eyes), and a LenSx + ICL group with a LenSx femtosecond laser-assisted LRI and an ICL implantation (19 patients, 21 eyes). Visual acuity, astigmatism correction ability, and visual quality were measured before and 1, 3, and 6 months after surgery. Results. The postoperative visual acuity of the 3 groups was higher than the preoperative visual acuity ( P &lt; 0.01 ), and the improvements in the LenSx + ICL group and the TICL group were greater than those in the ICL group ( P &lt; 0.01 ). The LenSx + ICL and TICL groups had less residual astigmatism and a higher astigmatism correction index (CI) than the ICL group ( P &lt; 0.01 ). There was no significant difference among the three groups in total high-order aberrations (HOAs) before and after surgery ( P &gt; 0.05 ). Conclusion. LenSx femtosecond laser-assisted LRI can effectively correct low to moderate corneal astigmatism during ICL implantation surgery. It can achieve similar clinical effects in the short term compared with TICL implantation.

Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery.

To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P<0.01). The surgically-induced astigmatism was 1.02±0.54 D. The correction index (ratio of target induced astigmatism and surgically-induced astigmatism: 0.72±0.36) as well as the magnitude of error (difference between surgically-induced astigmatism and target induced astigmatism: -0.29±0.51) represented a slight under correction. For angle of error, the arithmetic mean was 1.11±13.70, indicating no significant systematic alignment errors. Femtosecond-assisted steepest-meridian clear corneal incision is a fast, customizable, adjustable, precise, and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

Comparison of Toric and Spherical Orthokeratology Lenses in Patients with Astigmatism.

Purpose This retrospective study aimed at comparing the efficacy and safety of toric and spherical orthokeratology lenses in the treatment of patients with moderate to high astigmatism. Methods Fifty adolescents with myopia and moderate to high astigmatism (≥1.50 D) who underwent consecutive orthokeratology treatment for at least 1 year were included in this study. The toric group comprised 25 subjects (25 eyes, 11 M, 14 F; age, 10.67 ± 1.46 years) who were fitted with toric orthokeratology lenses. The spherical group comprised 25 subjects (25 subjects, 11 M, 14 F; age, 11.45 ± 1.63 years) who were fitted with traditional spherical orthokeratology lenses as a control. Corneal topography, visual acuity, axial length, and slit-lamp examinations were performed to determine the differences between these two groups. The corneal tangential difference mapping was conducted between baseline and every subsequent visit to calculate the magnitude of lens decentration. The corrective effect of ortho-K lens was measured by using the corneal axial difference map. Results The mean decentration and its vertical vector were significantly less in the toric group than in the spherical group after 1 month of lens wear. In toric group, the corneal astigmatism decreased from 1.85 ± 0.31 D at baseline to 1.45 ± 0.85 D after the first month of wear. There was a significant linear correlation between the change in corneal astigmatism and lens decentration in the toric group from 1 month to 1 year (Y = 3.268 ∗ X + 0.9182, R2 = 0.5035, p < 0.0001 (X: lens decentration; Y: astigmatic changes)). There were no significant differences in the post-OK uncorrected visual acuity, myopia control, or ocular health between the toric and spherical groups. Conclusion The toric orthokeratology lens design can effectively reduce the lens decentration magnitude and CJ180 from 1-month visit to 12-month visit of patients with high or moderate corneal astigmatism. Meanwhile, there was no significant difference in visual acuity, myopia control, and ocular health throughout 12 months. However, the effect of toric lenses on corneal morphology may be susceptible to lens positioning.

A novel nomogram for the treatment of astigmatism with femtosecond-laser arcuate incisions at the time of cataract surgery.

PurposeThe purpose of this study was to determine an arcuate incision (AI) nomogram to treat astigmatism during femtosecond laser-assisted cataract surgery.MethodsThis is a retrospective, cohort study. Femtosecond laser (FSL)-assisted transepithelial AIs were created at a 9.0 mm optical zone, 80% depth, centered on the limbus. We modified the manual Donnenfeld limbal relaxing incision nomogram to 70% for with-the-rule (WTR), 80% for oblique (OBL), and 100% for against-the-rule (ATR) astigmatism. The correction index (CI) equaled AI-induced astigmatism/target-induced astigmatism. Measures included preoperative keratometric corneal cylinder (Pre Kcyl), postoperative Kcyl (Post Kcyl), and postoperative residual refractive astigmatism (Post RRA).ResultsMean Pre Kcyl and 1–2 months Post RRA in 161 eyes of 116 patients were 0.626±0.417 diopters (D) (range 0.5–2 D), and 0.495±0.400 D (range 0–1.5 D), respectively. Mean absolute astigmatic changes (Pre Kcyl–Post Kcyl) without accounting for axis change in the WTR, ATR, and OBL groups were 0.165±0.383 D (P<0.001), 0.374±0.536 D (P<0.001), and 0.253±0.416 D (P=0.02), respectively. Mean absolute astigmatic changes using RRA as the postoperative measurement (Pre Kcyl–Post RRA) without accounting for axis change were 0.440±0.461 D (P<0.001), 0.238±0.571 D (P<0.05), 0.154±0.450 (P=0.111) in WTR, ATR, and OBL groups, respectively. CIs for WTR, ATR, and OBL were 0.53, 1.01, and 0.95, respectively. There were no intraoperative or postoperative complications related to the AIs.ConclusionTransepithelial FSL-AIs using the modified Donnenfeld nomogram show potential for management of mild to moderate corneal astigmatism. An increase in the magnitude or reduction of the optical zone size for the treatment of WTR and ATR astigmatism for this nomogram may further improve refractive accuracy.

Evaluation of Opposite Clear Corneal Incision in Controlling Astigmatism in Cataract Patients Undergoing Phacoemulsification Surgery

Aim: To evaluate the role of clear corneal incision combined with opposite clear corneal incision in controlling astigmatism in patients undergoing phacoemulsification surgery for cataract. Design: Prospective clinical study. Methods: 45 consecutive patients planned for phacoemulsification were divided into three equal groups of fifteen patients each: Group 1 presenting without corneal astigmatism, Group 2 having WTR (with-the-rule) and Group 3 having ATR (against-the-rule) astigmatism. All underwent phacoemulsification through 2.8mm clear corneal incision. In Group 1 the temporal clear corneal incision (CCI) was enlarged to 3.2mm before IOL insertion along with 2.2mm superior CCI to neutralise the astigmatism induced by main cataract incision. In Group 2 the superior CCI was enlarged to 3.2mm before IOL insertion, followed by 3.2mm inferior opposite CCI. In Group 3 the temporal CCI was enlarged to 3.2mm before IOL insertion followed by 3.2mm nasal opposite CCI. Results: In Group 1, the overall mean postoperative astigmatism observed was 0.28 ± 0.2D WTR, with 4 out of 15 patients (26.66%) continuing to have nil astigmatism. In Group 2, the mean postoperative astigmatism was reduced from 1.16 ± 0.32D WTR preoperatively, to 0.46 ± 0.28D WTR at 3 months postoperatively. In Group 3, the preoperative astigmatism of -1.25 ± 0.32DATR reduced to -0.38 ± 0.31D ATR, 3 months postoperatively. The reduction in astigmatism was statistically significant in both WTR and ATR astigmatism groups (p < 0.001). Conclusion: More than 50% reduction in astigmatism was achieved in both groups with astigmatism. Thus opposite clear corneal incision (OCCI) is a simple, predictable, safe and effective procedure in reducing mild to moderate preexisting corneal astigmatism in cataract surgery.

Comparison of the Clinical Outcomes of Two Types of Toric Intraocular Lens

Purpose: In this study evaluated clinical outcomes and higher-order aberrations in patients with implanted Tecnis ZCT toric intraocular lens (IOL) (Abbott Medical Optics Inc., Santa Ana, CA, USA) and the Zeiss AT TORBI toric IOL (Carl Zeiss Meditec AG, Jena, Germany) in eyes with low to moderate corneal astigmatism. Methods: We conducted a retrospective study of 32 consecutive eyes of 26 patients with a visually significant cataract and moderate corneal astigmatism (higher than 1.25 diopter [D] and lower than 4.5 D) undergoing cataract surgery with implantation of the aspheric Tecnis ZCT toric IOL (Abbott Medical Optics Inc.) and the Zeiss AT TORBI toric IOL (Carl Zeiss Meditec AG). Phacoemulsification was performed by the same experienced surgeon using 2.2 mm temporal incision. Visual, refractive and aberrometric changes were evaluated during a 3-month follow-up. Power vector analysis of Cartesian astigmatism (J0) and oblique astigmatism (J45) was performed. Results: At the 3-month follow-up, corrected distance visual acuity (CDVA) and residual astigmatism showed no statistically significant differences between groups (p = 0.203 and p = 0.364, respectively). Preand postoperative J0 were 0.71 ± 0.84 and 0.05 ± 0.39 in the Tecnis Toric group and, 0.88 ± 1.27 and -0.02 ± 0.16 in the AT TORBI group, respectively, which showed statistically significant differences (p = 0.029 and p = 0.032, respectively). Preand post-operative differences of J0 and J45 were not statistically significant (p = 0.234 and p = 0.603, respectively). No eye had IOL rotation ≥10°. Ocular aberrometry values were statistically significantly differenct between the groups, except for spherical aberration, which was higher in the AT TORBI group (p = 0.0047). Conclusions: Both IOLs showed good postoperative uncorrected distance visual acuity, CDVA and refractive results in this study. Rotational stability was excellent for both IOLs until the 3-month follow-up. J Korean Ophthalmol Soc 2016;57(2):200-207

Management of moderate and severe corneal astigmatism with AcrySof® toric intraocular lens implantation – Our experience

PurposeVisual performance following toric intraocular lens implantation for cataract with moderate and severe astigmatism. SettingCataract services, Shroff Eye Centre, New Delhi, India. DesignCase series. MethodThis prospective study included 64 eyes of 40 patients with more than 1.50 dioptre (D) of pre-existing corneal astigmatism undergoing phacoemulsification with implantation of the AcrySof® toric IntraOcular Lens (IOL). The unaided visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere and refractive cylinders were evaluated. Toric IOL axis and alignment error was measured by slit lamp method and Adobe Photoshop (version 7) method. Patient satisfaction was evaluated using a satisfaction questionnaire at 3months. ResultsThe mean residual refractive astigmatism was 0.57 D at the final follow-up of 3months. Mean alignment error was 3.44 degrees (SD=2.60) by slit lamp method and 3.88 degrees (SD=2.86) by Photoshop method. Forty-six (71.9%) eyes showed misalignment of 5 degrees or less, and 60 (93.8%) eyes showed misalignment of 10 degrees or less. The mean log MAR UCVA at 1st post-op day was 0.172 (SD=0.02), on 7th post-op day was 0.138 (SD=0.11), and on 30th post-op day was 0.081 (SD=0.11). The mean log MAR BCVA at three months was −0.04 (SD=0.76). ConclusionWe believe that implantation of AcrySof® toric IOL is an effective, safe and predictable method to correct high amounts of corneal astigmatism during cataract surgery.

Vector Analysis of Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy

To evaluate the outcomes of femtosecond-assisted arcuate keratotomy combined with cataract surgery in eyes with low to moderate corneal astigmatism. Retrospective, interventional case series. This study included patients who underwent combined femtosecond-assisted phacoemulsification and arcuate keratotomy between March 2013 and August 2013. Keratometric astigmatism was evaluated before and 2 months after the surgery. Vector analysis of the astigmatic changes was performed using the Alpins method. Overall, 54 eyes of 54 patients (18 male and 36 female; mean age, 68.8 ± 11.4 years) were included. The mean preoperative (target-induced astigmatism) and postoperative astigmatism was 1.33 ± 0.57 diopters (D) and 0.87 ± 0.56 D, respectively (P < .001). The magnitude of error (difference between surgically induced and target-induced astigmatism) (-0.13 ± 0.68 D), as well as the correction index (ratio of surgically induced and target-induced astigmatism) (0.86 ± 0.52), demonstrated slight undercorrection. The angle of error was very close to 0, indicating no significant systematic error of misaligned treatment. However, the absolute angle of error showed a less favorable range (17.5 ± 19.2 degrees), suggesting variable factors such as healing or alignment at an individual level. There were no intraoperative or postoperative complications. Combined phacoemulsification with arcuate keratotomy using femtosecond laser appears to be a relatively easy and safe means for management of low to moderate corneal astigmatism in cataract surgery candidates. Misalignment at an individual level can reduce its effectiveness. This issue remains to be elucidated in future studies.

Rotational stability and patient satisfaction after implantation of a new toric IOL.

To evaluate rotational stability, astigmatism correction, visual outcomes, and patient satisfaction after implantation of the toric intraocular lens (IOL) Torica-aA following cataract extraction over a 6-month follow-up period. This prospective observational study enrolled 40 eyes of 26 patients presenting with preexisting corneal astigmatism of 1.00 to 2.60 D. The rotational stability of the IOL was evaluated using retroillumination photographs taken within 24 hours after surgery and 1 week and 6 months postoperatively. Other main study outcomes were assessed 6 months postoperatively and included uncorrected and distance-corrected visual acuities, astigmatism correction, and patient satisfaction. Six months postoperatively, mean absolute IOL rotation was 1.99 ± 1.88° (range 0.10-7.40°) and secondary repositioning was not required. The IOL rotation was &lt;3° in 85% of eyes, ≤5° in 94% of eyes, and &lt;8° in 100% of eyes. Mean residual refractive cylinder was -0.57 ± 0.34 D. The magnitude of the J0 vector was significantly decreased postoperatively (p&lt;0.0001). The mean J45 vector was close to zero preoperatively and postoperatively (p = 0.27). Mean monocular uncorrected distance visual acuity (UDVA) was 0.09 ± 0.12 logMAR and 97% of eyes achieved UDVA of 20/40 or better including 66% of eyes having 20/25 or better. The good UDVA resulted in high levels of spectacle independence and patient satisfaction. Implantation of the Torica-aA IOL was safe and effective in reducing low to moderate preexisting corneal astigmatism and provided good rotational stability and refractive outcomes, which led to a high degree of patient satisfaction.

Management of pre-existing regular astigmatism in phacoemulsification

Objectives The objective of this study was to compare the effect of single clear corneal incision (CCI) on the steep axis with opposite clear corneal incisions (OCCIs) on pre-existing regular corneal astigmatism in cataract patients having phacoemulsification. Background Correction of pre-existing regular astigmatism in phacoemulsification. Patients and methods This randomized prospective clinical study included 30 eyes of 30 cataract patients with corneal regular astigmatism greater than 1 D. The patients were randomly divided into two groups, each group involving 15 eyes. Paired 3 mm CCI were made on the steep axis in Group A and single in Group B. Preoperative evaluation included uncorrected visual acuity, refraction, best-corrected visual acuity, applanation tonometry, fundus examination, biometry, keratometry, and corneal topography. The vertical axis was marked before peribulbar anesthesia was given and routine phacoemulsification was performed through a 3-mm CCI on the steep axis. An additional opposite 3-mm self-sealing CCI was made opposite to the first one in Group A. Patients were examined 2, 4, and 8 weeks postoperatively. Visual acuity, refraction, keratometry, and corneal topography were used to evaluate the improvement. Results The mean preoperative and postoperative topographic corneal astigmatism was 1.95 D ± 0.83 (SD), 0.59 D ± 0.47 (SD) and 1.93 D ± 0.51 (SD), 1.53 D ± 0.62 (SD), respectively, in Groups A and B. There was a significant difference between the mean values of astigmatism in the two groups postoperatively. The mean surgically induced astigmatism, measured by a vector-corrected method, was 1.2 ± 80.11 D and 1.09 ± 0.13 D in Group A and Group B, respectively ( P = 0.00). The mean values of best-corrected visual acuity were 0.11 ± 0.13 in Group A and 0.22 ± 0.15 in Group B postoperatively ( P Conclusion OCCIs on the steep axis were more effective than single CCI in the correction of mild to moderate pre-existing corneal astigmatism.

Comparison of visual and refractive outcomes after bilateral implantation of toric intraocular lenses with or without a multifocal component

To compare visual outcomes between patients with a multifocal toric intraocular lens (IOL) and those with a monofocal toric IOL. Hayashi Eye Hospital, Fukuoka, Japan. Prospective case-control series. Eyes with preoperative corneal astigmatism between 0.75 diopter (D) and 2.82 D scheduled for implantation of a diffractive multifocal toric IOL (Restor SND1T) or monofocal toric IOL (Acrysof SN6AT) were recruited. Three months postoperatively, visual acuity at various distances, contrast visual acuity, and refractive outcomes were examined. Each group comprised 66 eyes (33 patients). Postoperatively, the mean refractive astigmatism decreased to 0.71 D in the multifocal group and 0.74 D in the monofocal group. The mean monocular and binocular uncorrected and corrected near visual acuity at 0.3 m and intermediate visual acuity at 0.5 m were significantly better in the multifocal group than in the monofocal group (P≤.0011). The uncorrected and corrected visual acuities at other distances were similar between groups except at 1.0 m. Binocular photopic and mesopic contrast visual acuities at high to moderate contrasts did not differ significantly between groups; however, acuities at low contrasts were worse in the multifocal group (P≤.0429). Diffractive multifocal toric IOL implantation decreased refractive astigmatism to an acceptable range in eyes with moderate corneal astigmatism and provided useful visual acuity (≥20/40) at any distance and significantly better near and intermediate visual acuity than a monofocal toric IOL. No author has a financial or proprietary interest in any material or method mentioned.

Multifocal toric intraocular lenses versus multifocal intraocular lenses combined with peripheral corneal relaxing incisions to correct moderate astigmatism

To compare the outcomes of multifocal toric intraocular lens (IOL) implantation and standard nontoric multifocal IOL implantation combined with peripheral corneal relaxing incisions (PCRIs) in patients with moderate preexisting corneal astigmatism. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Prospective randomized controlled trial. Patients with visually significant cataract in both eyes who desired spectacle independence and had corneal astigmatism (1.00 to 2.50 diopters [D]) had multifocal toric IOL implantation in 1 eye and a nontoric multifocal IOL combined with PCRIs (Donnenfeld nomogram) in the contralateral eye. Outcome measures were visual acuity, astigmatic vector reduction, digital toric IOL axis determination, spectacle need, and patient satisfaction. Thirty patients were enrolled. Three months postoperatively, the mean residual refractive astigmatism was 0.45 D ± 0.49 (SD) in the toric IOL group and 0.72 ± 0.61 D in the PCRI group. The mean uncorrected distance visual acuity was 0.10 ± 0.14 in the toric IOL group and 0.15 ± 0.14 in the PCRI group and the mean uncorrected near visual acuity, 0.43 ± 0.11 and 0.39 ± 0.10, respectively. The mean absolute misalignment from the intended axis was 2.52 ± 1.97 degrees. The rotation was within ±3 degrees in 90.9% of all cases and within ±6 degrees in all cases. On the questionnaire, 52.9% of all patients said they required spectacles only when reading for a long time. Although refractive astigmatism decreased in both groups, multifocal toric IOL implantation was predictable with good rotational stability. No author has a financial or proprietary interest in any material or method mentioned.