Multifocal Toric Intraocular Lens Research Articles

Double-C loop platform in combination with hydrophobic and hydrophilic acrylic intraocular lens materials

To analyze the behavior of a new double-C-loop quadripod symmetrical intraocular lens (IOL) platform combined with a hydrophilic lens material and a new hydrophobic glistening-free acrylic lens material, Ankoris and Podeye, respectively, in silico (computer simulation), in vitro (laboratory investigation), and in vivo (rabbit model). John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA, and Physiol S.A., Liege, Belgium. Experimental study. An in silico simulation investigation was performed using finite elements software, an in vitro investigation according to the International Organization for Standardization (ISO11979-3:2012), and an in vivo implantation in a rabbit model with 4 weeks of follow-up. Postmortem data were collected by Miyake-Apple gross examination and histopathologic analyses. Biocompatibility and IOL centration were tested. Both IOLs demonstrated statistically insignificant variations in posterior and anterior capsule opacification and Soemmerring ring formation. They were well biotolerated with no signs of toxicity, inflammation, or neovascularization. Axial and centration stability were noted in vitro and in vivo as a result of significant contact between surrounding tissues and haptics and the posterior portion of the optic. The results suggest suitability of the double-C loop IOL platform for the manufacturing of premium (ie, multifocal, toric, and multifocal toric) IOLs. Drs. Bozukova, Gobin, and Pagnoulle are employees of Physiol S.A., Liege, Belgium. Dr. Pagnoulle has a proprietary interest in the tested intraocular lenses. No other author has a financial or proprietary interest in any material or method mentioned.

Complicação periférica de cirurgia macular em paciente fácico: o que fazer e qual tamponante usar?

We present a case of a 28-year-old male patient undergoing macular surgery for epiretinal membrane (ERM). The surgery was performed using Zeiss non-contact system with good peripheral and macular viewing (two-lens system). During posterior hyaloid detachment, an iatrogenic operculated tear was detected in the nasal quadrant of the retina. Macular surgery was successfully performed; however, we was left SF6 as a tamponade to block the fotcoaguladed operculated hole.. The patient progressed well, with best corrected visual acuity (BCVA) improving from 20/100 to 20/20. After 2 years, the patient complained of blurred vision (the formation of a slight posterior subcapsular cataract) that caused significant discomfort (BCVA worsened to 20/25). Therefore, a multifocal toric intraocular lens IOL (+2.50 add) was implanted in the victrectomized eye and refractive correction in fellow eye (PRK for −2.50 sph.). The patient was satisfied with the postoperative results.

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.

Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens

PurposeTo evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL).MethodsProspective, non-randomised multicentre clinical study including...

Clinical outcomes after implantation of multifocal toric intra ocular lenses.

AbstractPurpose To assess clinical outcomes and optical performances of refractive cataract surgery with mutifocal toric intraocular lens (IOL).Methods This was a monocentric, retrospective review of cases, conducted at the Ophtalmology and Refractive Unit Percy, military Hospital, Clamart, FRANCE. This study included eyes presenting preoperative regular corneal astigmatism of 1D or greater, who underwent cataract surgery with implantation of a +3,75D multifocal toric hydrophilic IOL, by 2 differents surgeons. Ten eyes of seven patients were operated between 2012 and 2014. At the one month postoperative visit, we analysed visual acuity at various distances, spherical équivalent, refractive cylinder, spectacle independance, halos perception and patients satisfaction.Results The mean spherical équivalent was ‐0,4D at one month. Mean pre‐operative réfractive cylinder increased from ‐2,89D (ranged from ‐1 to ‐6,75D) to ‐0,67D (ranged from ‐0,5 to ‐1,0D). Mean monocular uncorrected visual acuities were 7,42/10 at 4 m (Monoyer) and ‐0,28 logMAR at preferred near (40cm). Mean corrected visual acuities were 9,56/10 at 4 m and ‐0,18 logMAR at near. 8 of 10 patients reported freedom from corrective wear, and 6 of 10 complained about halos perception. The mean score that patients rated their uncorrected visual acuity was 7,3 +‐ 0,6 on a scale of 0 to 10.Conclusion One month after implantation of a multifocal toric IOL, patients had significantly reduced spherical équivalent and refractive cylindre. They achieved good visual acuity across distances permiting spectacle independance for most of them.

Visual outcomes of eyes implanted with a toric multifocal intraocular lens.

To investigate the predictability, efficacy, and safety of a ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX). This retrospective, noncomparative case study included 70 eyes of 44 patients implanted with a ReSTOR toric multifocal IOL (Alcon Laboratories, Inc., Fort Worth, TX). Patients were examined preoperatively and approximately 3 months postoperatively. Uncorrected and distance-corrected distance and near visual acuities were measured. Refractive and topographic astigmatism were recorded. Improvement, number of lines gained and lost, and correlation of attempted and achieved astigmatic correction values were also investigated as measurements of efficacy, safety, and predictability. Mean follow-up time was 2.3 ± 1.2 months. Postoperative values of uncorrected distance and near visual acuity were 0.02 ± 0.05 logMAR (20/21 ± 20/22 Snellen) and 0.01 ± 0.04 logMAR (20/20 ± 20/22 Snellen), respectively. Statistical analyses revealed a significant improvement when comparing preoperative and postoperative values of manifest refraction spherical equivalent (P < .0001), uncorrected distance visual acuity (P < .0001), and astigmatism (P < .0001); 95.7% of eyes were 20/25 or better and 100% of eyes were 20/30 or better. At the last follow-up visit, none of the examined eyes had lost any lines. One hundred percent of the eyes remained unchanged or improved after surgery. Mean postoperative manifest refraction spherical equivalent was -0.06 ± 0.27 at the last follow-up visit. The residual manifest astigmatism was 0.22 ± 0.21. There was a highly significant correlation between preoperative attempted topographic astigmatism and postoperative achieved refractive astigmatism. The study provides clinical evidence that the new toric multifocal IOL seems to be predictable, safe, and effective, providing satisfactory visual acuity for far and near and correcting astigmatism.

Multifocal Toric Intraocular Lens Implantation for Forme Fruste and Stable Keratoconus

To describe the results of multifocal toric intraocular lens implantation in two patients (one with forme fruste keratoconus and the other with frank but stable keratoconus). A 50-year-old woman with forme fruste keratoconus and positive family history of keratoconus and a 42-year-old man with frank keratoconus underwent corneal collagen cross-linking. Uncorrected distance visual acuity was 20/800 in the right eye and 20/400 in the left eye and 20/400 in the right eye and 20/100 in the left eye, respectively. Refractive lens exchange was performed using multifocal toric intraocular lenses in both cases. After phacoemulsification, uncorrected distance visual acuity, corrected distance visual acuity, binocular uncorrected distance visual acuity was 20/25 and 20/30 in cases 1 and 2, respectively, and residual refraction was within 0.5 diopters of emmetropia in both cases. Patients were subjectively satisfied. Presbyopic treatment options are scarce for patients with keratoconus and multifocal toric intraocular lenses may be useful in selected cases.

Clinical Outcomes of Diffractive Multifocal Toric Intraocular Lens Implantation

Purpose: To evaluate the clinical outcomes of patients with diffractive multifocal toric intraocular lens (IOL) implantation. Methods: Thirty-four eyes of 26 patients underwent diffractive multifocal toric IOL. Uncorrected visual acuity (UCVA) at distant, intermediate and near and residual refractive astigmatism were measured on the first day, at 2 weeks, and 1, 3 and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II), high-order aberrations (HOA) and patient satisfaction questionnaire were evaluated 3 months postoperatively. Results: At the 6 month postoperative visit, the mean UCVA at distant, intermediate (63 cm, 100 cm) and near were 0.06 ± 0.07, 0.18 ± 0.11, 0.16 ± 0.12 and 0.03 ± 0.06 (log MAR), respectively. The refractive astigmatism decreased significantly from -1.66 ± 1.04 D to -0.54 ± 0.32 D at 6 months postoperatively (p < 0.01). The means of objective scatter index, modulation transfer function (MTF) cut-off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.33 ± 0.67, 37.24 ± 9.67 cdp, 0.22 ± 0.09 and 3.08 ± 0.53 D, respectively. HOA scores for 5 mm and 6 mm were 0.30 ± 0.09 and 0.49 ± 0.15, respectively; 82.3% of the patients were satisfied with the postoperative results, 79.4% of the patients reported they would recommend the procedure to others, and 14.7% of patients reported moderate or severe visual disturbance at night. Conclusions: Implantation of a diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distant, intermediate, and near visual outcomes, good optical quality and high patient satisfaction. J Korean Ophthalmol Soc 2014;55(8):1139-1149

Clinical outcomes after bilateral implantation of an apodized +3.0 D toric diffractive multifocal intraocular lens

To assess visual outcomes after bilateral implantation of an apodized +3.0 diopter (D) addition power toric diffractive multifocal intraocular lens (IOL). Five study sites in Europe and South America. Cohort study. Patients had bilateral implantation of the AcrySof(®) IQ ReSTOR(®)+3.0 D toric multifocal IOL. Inclusion criteria were age from 21 to 70 years, need for bilateral cataract extraction or refractive lens exchange, and regular corneal astigmatism from 0.75 to 2.5 D. Six-month evaluations included spherical equivalent (SE), refractive and corneal cylinder, visual acuity at various distances, defocus testing, reading speed, and IOL rotation. Forty-four of 49 patients completed the 6-month visit. The mean SE (88 eyes) was 0.09 D ± 0.49 (SD) at 6 months (± 1.00 D in 95.2%). The mean refractive cylinder decreased from 1.07 ± 0.71 D to 0.33 ± 0.44 D (≤ 0.50 D in 78.6% and ≤ 1.00 D in 92.9%). The mean binocular uncorrected visual acuity was 0.04 ± 0.08 logMAR at preferred near (≈ 39 cm), 0.07 ± 0.09 logMAR at 40 cm, 0.09 ± 0.11 logMAR at 60 cm, and 0.05 ± 0.10 logMAR at 4 m. The mean corrected reading speed increased from 125.43 ± 33.58 words per minute (wpm) to 132.68 ± 23.69 wpm. The mean IOL rotation was 2.20 ± 4.34 degrees. Six months after implantation of the toric multifocal IOL, patients had significantly reduced SE and refractive cylinder, good visual acuity across distances, increased reading speed, and minimal IOL rotation.

Subjective Outcomes After Bilateral Implantation of an Apodized Diffractive +3.0 D Multifocal Toric IOL in a Prospective Clinical Study

To assess subjective outcomes after bilateral implantation of an aspheric apodized diffractive +3.0 diopter (D) multifocal toric intraocular lens (IOL). This was a prospective, single-arm, 6-month study conducted at five study sites in Europe and South America. Forty-nine patients requiring bilateral cataract extraction or refractive lens exchange and IOL implantation in both eyes with preoperative regular corneal astigmatism of 0.75 D or greater and 2.5 D or less received bilateral AcrySof ReSTOR +3.0 D toric IOLs (Models SND1T3, SND1T4, or SND1T5; Alcon Laboratories, Inc., Fort Worth, TX). Subjective questionnaires were administered preoperatively and 6 months postoperatively. Patient subjective experience with visual tasks at all distances improved from the preoperative visit to the 6-month visit. At the 6-month visit, 90% (36 of 40) of respondents reported complete freedom from corrective wear compared with 14% (6 of 43) pre-operatively. On a scale of 0 (worst) to 10 (best), the mean score that patients rated their uncorrected vision was 7.9 ± 1.9 at 6 months (n = 37) compared with 3.6 ± 2.0 at the preoperative visit (n = 38). Six months following bilateral implantation of the AcrySof ReSTOR +3.0 D toric IOL revealed improved subjective experience, increased spectacle freedom, and higher satisfaction when compared with the preoperative baseline.

Visual acuity and refraction with a diffractive multifocal toric intraocular lens

To evaluate clinical outcomes and optical performance of the AT Lisa 909M diffractive multifocal toric intraocular lens (IOL). Multicenter study. Cohort study. The measured outcomes included refractive error; distance, near (40 cm), and intermediate (60 cm and 80 cm) visual acuities; defocus curve; rotational stability; and monocular and binocular photopic and mesopic contrast sensitivity. Astigmatism was evaluated by Alpins vector analysis. The multifocal toric IOL was implanted in 284 eyes of 142 patients. At 6 months, 89.4% of eyes were within ±1.00 diopter (D) of emmetropia. The mean refractive cylinder decreased from -2.39 D ± 1.48 (SD) to -0.49 ± 0.53 D; it was lower than 1.00 D in 80.9% of eyes. The mean visual acuities (logMAR) were monocular uncorrected distance 0.16 ± 0.22, monocular corrected distance 0.04 ± 0.15, binocular corrected distance -0.00 ± 0.09; monocular uncorrected near 0.21 ± 0.22, monocular corrected near 0.08 ± 0.16, binocular distance-corrected near 0.07 ± 0.14; intermediate at 60 cm (80 cm): monocular uncorrected 0.16 ± 0.21 (0.09 ± 0.21), monocular distance corrected 0.13 ± 0.19 (0.07 ± 0.20), and binocular distance corrected 0.07 ± 0.17 (0.00 ± 0.18). At 3 months and 6 months, 95.8% of IOLs showed no rotation over 5 degrees. This is the largest study yet on the first commercially available diffractive multifocal toric IOL. Results confirm its efficacy, predictability, and safety in restoring distance, near, and intermediate vision and allowing patients with significant levels of corneal astigmatism to achieve spectacle independence. No author has a financial or proprietary interest in any material or method mentioned.

Comparative analysis of the visual and refractive outcomes of an aspheric diffractive intraocular lens with and without toricity

To analyze and compare the postoperative visual and refractive outcomes and patients' visual satisfaction after implantation of an aspheric or an aspheric toric multifocal diffractive intraocular lens (IOL) in eyes with equivalent biometric characteristics. Private clinic, Munich, Germany. Comparative case series. Patients having cataract surgery were assigned to 1 of 2 groups: aspheric, which had AT Lisa 809M IOL implantation, and aspheric toric, which had AT Lisa 909M IOL implantation (corneal toricity ≥0.75 diopter [D]). Visual and refractive postoperative outcomes were evaluated, as was the patient's ability to perform daily tasks related to vision and the incidence of photic phenomena. The aspheric group comprised 77 eyes (42 patients) and the aspheric toric group, 26eyes (17 patients). A significant improvement in corrected distance and near visual acuity was observed postoperatively in both groups, as was a significant reduction in the astigmatic component J0 (P<.01). The aspheric toric group had significantly better uncorrected intermediate visual acuity (P=.01). In both groups, the postoperative astigmatic power vectors and spherical equivalent were within ±0.50 D in 100% of eyes and in more than 88% of eyes, respectively. No statistically significant differences were found in any subjective patient questionnaire item. There was no difference in the incidence of photic phenomena between the groups (P≥0.16). The addition of a toric surface to the aspheric diffractive multifocal platform resulted in a comparable visual performance and ability to perform visual tasks. The author has no financial or proprietary interest in any material or method mentioned.

Do multifocal intraocular lens implants allow spectacle independence?

AbstractPurpose This study aims to evaluate the effectiveness of multifocal and toric multifocal intraocular lens implants in achieving spectacle independence when used in cataract surgery and clear lens extractions.Methods Case records were examined retrospectively for 218 eyes of 109 consecutive patients (38 male) who underwent lens extraction with multifocal intraocular lens implant by a single surgeon. If corneal astigmatism was present appropriate corrective procedures were undertaken: this included 38 eyes which received a toric multifocal lens. Data collected included: demographics, pre‐operative corrected visual acuity (with habitual correction), post‐operative unaided visual acuity for near and distance, degree of spectacle independence, and complications of surgery.Results Over 90% of patients reported spectacle independence for daily activities. Complication rates were low, with tolerable glare and haloes being the most common problem. Approximately half required laser capsulotomy for posterior capsule opacification.Conclusion In conclusion, multifocal intraocular lens implants can allow carefully selected patients to achieve spectacle independence. These results compare favourably with published data.

Outcomes and complications of a multifocal toric intraocular lens with a surface-embedded near section

To evaluate the refractive outcomes and rotational stability after implantation ofa multifocal toric intraocular lens (IOL) with a surface-embedded near section. Private center, London, United Kingdom. Case series. This study evaluated eyes with more than 1.50 diopters (D) of preexisting corneal astigmatism. After phacoemulsification, Lentis Mplus toric IOLs were implanted in all cases. The main outcome measures were refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected near visual acuity (UNVA), keratometry, and IOL position. Three-month postoperative data are presented. The study enrolled 89 eyes (58 patients). The mean monocular postoperative UDVA and UNVA were 0.03 logMAR ± 0.11 (SD) and 0.17 ± 0.14 logMAR, respectively. The mean refractive cylinder decreased from 2.90 ± 1.31 D preoperatively to 0.50 ± 0.39 D postoperatively (P<.001). The mean difference between the planned axis of implantation and the actual axis postoperatively was 2.53 ± 2.27 degrees. The multifocal toric IOL with a surface-embedded near section effectively corrected preexisting corneal astigmatism. The IOL was stable in the capsular bag, there were no visually significant complications, and there was no significant rotation out to 3 months postoperatively. Neither author has a financial or proprietary interest in any material or method mentioned.

Visual and optical outcomes of a diffractive multifocal toric intraocular lens

To evaluate the visual and wavefront outcomes after cataract surgery with implantation of a diffractive multifocal toric intraocular lens (IOL). Two clinical centers, Lisbon, Portugal. Case series. This study comprised patients with cataract and corneal astigmatism between 0.75 diopter (D) and 2.50 D who had phacoemulsification with implantation of an Acrysof IQ Restor toric IOL. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, residual astigmatism, rotational stability of the IOL, higher-order aberrations, and the presence of dysphotopic phenomena. The study included 38 eyes (19 patients). The mean UDVA was 0.07 logMAR ± 0.10 (SD), the mean UIVA was 0.16 ± 0.10 logMAR, and the mean UNVA was 0.02 ± 0.09 logMAR. Predictability of refractive results was very good, with an SE refraction within ± 0.50 D of the attempted spherical correction in 33 eyes (87%). The mean toric IOL axis rotation was 2.97 ± 2.33 degrees. One eye required a second surgery to align the IOL axis. Ocular aberrometry and dysphotopic phenomena results were similar to those published for the nontoric version of the toric IOL. Implantation of the diffractive multifocal toric IOL in patients with cataract and corneal astigmatism provided excellent distance, intermediate, and near visual outcomes; predictability of the refractive results; rotational stability; and good optical performance, allowing all patients to achieve complete spectacle independence. No author has a financial or proprietary interest in any material or method mentioned.

Long-term visual performance of AT LISA 909M multifocal toric intraocular lenses

Purpose The aim of the study was to analyze the subjective and objective visual and astigmatic effect of AT LISA 909M multifocal toric intraocular lenses (IOLs) for far and near vision after 1 year of implantation. Design This is a prospective nonrandomized interventional case series. Methods After cataract surgery with implantation of AT LISA 909M multifocal toric IOLs, the visual, refractive, and corneal topographic outcomes, lens rotation, contrast sensitivity, and patient satisfaction were evaluated over 12 months and analyzed. Refractive astigmatic changes (target-induced astigmatism, surgically induced astigmatism, difference vector, magnitude of error, and flattening effect) were analyzed using the Alpins vectorial method. Results The study enrolled 22 eyes (11 patients). Postoperatively, a significant reduction was observed in the refractive cylinder (P Conclusion The AT LISA 909M multifocal toric IOL resulted in long-term visual improvement in distance and near vision with good predictability in eyes with moderate-to-high corneal astigmatism undergoing cataract surgery.

Implantation of a multifocal toric intraocular lens with a surface-embedded near segment after repeated LASIK treatments

We report a 66-year-old patient who presented with increasing hyperopia, astigmatism, and presbyopia in both eyes 8 years after bilateral laser in situ keratomileusis (LASIK) and LASIK enhancement in the left eye aiming for spectacle independence. Bilateral multifocal toric Lentis Mplus intraocular lenses (IOLs) with an embedded near segment and individually customized cylinder correction were implanted uneventfully following phacoemulsification. The Haigis-L formula after previous hyperopia correction was chosen for IOL power calculation and provided reliable results. Emmetropia was targeted and achieved. Three months postoperatively, the uncorrected distance visual acuity had increased from 0.40 logMAR to 0.10 logMAR in the right eye and from 0.20 logMAR to 0.00 logMAR in the left eye. The patient gained 6 lines of uncorrected near visual acuity: 0.20 logMAR in the right eye and 0.10 logMAR in the left eye. This case shows that customized premium IOL implantation can provide accurate results even in challenging cases. The International Vision Correction Research Centre, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany, has received research grants, lecture fees, and travel reimbursement from Oculentis GmbH.

Residual Astigmatism Following Toric Intraocular Lens Implantation Related to Pupil Size

To present two patients with residual astigmatism following toric intraocular lens (IOL) implantation. Case reports. A 58-year-old woman underwent toric IOL implantation (spherical power 29.50 diopters [D], cylinder power 3.00 D; SN60T5, Alcon Laboratories Inc) to correct 2.33 D @ 80° of corneal astigmatism. Postoperatively, uncorrected distance visual acuity (UDVA) was 20/30 and corrected distance visual acuity (CDVA) was 20/22 (0 -1.75 × 95), indicating an overcorrection of astigmatism. Slit-lamp examination demonstrated no IOL misalignment. Wavefront aberrometry showed a large pupil diameter (>6 mm) and a lower corneal astigmatism in a 6-mm zone (-1.40 D @ 174°) compared to a 4-mm zone (-2.21 D @ 171°). The second patient, a 60-year-old man, underwent multifocal toric IOL implantation (spherical power 22.50 D, cylinder power 2.25 D; SND1T4, Alcon Laboratories Inc) to correct 1.51 D @ 173° of corneal astigmatism. Postoperatively, UDVA was 20/50 and CDVA was 20/20 (+0.25 -1.00 × 102), indicating an undercorrection of astigmatism. Slit-lamp examination showed no misalignment. Both cases indicate that unexplained residual astigmatism following toric IOL implantation may be the result of multiple factors: the effect of the spherical power and anterior chamber depth on toric IOL calculations, the effect of posterior corneal astigmatism, and the effect of a large pupil size. The first two issues may be compensated for by improving toric IOL calculations. The latter indicates that pupillometry is indicated in relatively young patients who undergo toric IOL implantation.

Bilateral implantation of toric multifocal additive intraocular lenses in pseudophakic eyes

A 41-year-old patient presented with hyperopia, astigmatism, and presbyopia for refractive treatment 6 years following cataract surgery. A toric multifocal additive intraocular lens with a near addition of +3.5 diopters (D) for sulcus implantation was chosen and implanted uneventfully. Follow-up examinations were performed from the first day until 9 months after surgery. A predictable refractive correction was seen, with a residual error of +0.125 D (spherical equivalent) in the right eye and emmetropia in the left eye. Monocular uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (40 cm) improved to 0.1 logMAR. It could not be improved further with near-add spectacles. Binocular UDVA and UNVA were 0.0 logMAR and 0.1 logMAR (80 cm), respectively. Both additive IOLs remained centered and on axis during the follow-up period. Spectacle independence was achieved, as was high patient satisfaction. The International Vision Correction Research Centre received research grants related to this publication from the following companies: Dr. Schmidt Intraocularlinsen GmbH, Rayner Intraocular Lenses, Ltd., and Carl Zeiss Meditec AG. No author has a financial or proprietary interest in any material or method mentioned.