Toric Implantation Research Articles

Comparison of Toric Implantable Collamer Lens and Toric Artiflex Phakic IOLs in Terms of Visual Outcome: a Paired Contralateral Eye Study

This study sought to compare the postoperative visual outcomes of toric implantable collamer lens (T-ICL) with toric Artiflex (T-Artiflex) lenses. Alternating treatment, contralateral eye matched clinical study. This study compared 82 eyes of 41 patients with T-ICL lenses in one eye and toric Artiflex implantation in the contralateral eye to correct myopic astigmatism. Safety, efficacy, predictability, astigmatic vector changes, contrast sensitivity, endothelial cell count, and possible adverse events were assessed at least 12months postoperatively. After a mean follow-up of 12months, the safety index was mean 1.40 ± 0.70 in the T-ICL group and 1.20 ± 0.21 in the T-Artiflex group. Furthermore, their mean efficacy indexes were 1.24 ± 0.42 and 1.08 ± 0.23, respectively (P= .029). A total of 39 eyes (95%) in the T-ICL group and 41 eyes (100%) in the T-Artiflex group were within ±1.00 diopter (D) of emmetropia and 33 eyes (80%) and 34 eyes (83%) were within ±0.5 D of emmetropia, respectively. Vector analysis revealed mean index of success as large as 0.25 ± 0.22 in the T-ICL group and 0.24 ± 0.15 in the T-Artiflex group. Postoperative contrast sensitivities were equal in both groups under mesopic conditions for any given spatial frequency. There was an endothelial loss of 2.18% and 1.95% in the T-ICL and T-Artiflex groups, respectively. There were no significant complications in any of the groups. Both lenses showed promising results in terms of safety, efficacy, and predictability for correction of myopic astigmatism. As shown in this paired-eye study, most outcomes were almost identical, and neither of these lenses were clinically superior to the other.

Intracorneal ring segments followed by toric pseudoaccomodating IOL for treatment of patients with corneal ectasia and cataract

PurposeSurgical management of keratoconus aims to improve corneal curvature, prevent progression of corneal ectasia, and manage refractive error. In older individuals with concurrent cataracts, management can be challenging due to topographic irregularity and difficult-to-interpret IOL calculations. We describe a sequential combination of two surgical techniques—intrastromal corneal ring segments (e.g. intacs) insertion and toric pseudoaccomodating lens implantation—to successfully manage concurrent keratoconus and cataracts. ObservationsIn this case series, we present three eyes with corneal ectasia in two cataractous patients successfully managed by (1) Intacs placement to normalize corneal contour/asymmetry and enable more regular keratometry measurements, followed by (2) correction of astigmatism and presbyopia by placement of toric pseudoaccommodating IOL (Trulign) after cataract extraction. Conclusions and ImportanceThis is the first description, to the authors’ knowledge, of the use of intraocorneal ring segments + toric pseudoaccommodating intraocular lenses for the management of concurrent keratoconus, cataract, and presbyopia.

Bilateral phacoemulsification and toric extended depth of focus intraocular lens implantation in Alport's syndromes

Alport syndrome is a hereditary disorder characterized by sensorineural deafness, renal disease, and ocular abnormalities, including anterior lenticonus with high refractive errors. We report a case of Alport's syndrome with bilateral anterior lenticonus that was submitted to phacoemulsification and toric extended depth of focus (EDOF) intraocular lens (IOL) implantation. A 49-year-old male patient presented with progressive bilateral visual loss for 10 years. His past medical history included a diagnosis of Alport's syndrome, with renal transplantation 20 years ago. The best-corrected visual acuity was 20/80 in the right eye and 20/63 in the left eye. Examination showed anterior lenticonus and anterior subcapsular opacities. Phacoemulsification and toric EDOF-IOL implantation were performed in both eyes. Capsulorhexis was challenging because of a highly elastic anterior capsule, which was aided by the use of a viscoadaptive ophthalmic viscosurgical device. The postoperative period was uneventful, with good refractive and visual outcomes.

Toric implantable collamer lens implantation in a patient with keratoconus: September consultation #1

Toric implantable collamer lens implantation in a patient with keratoconus: September consultation #1

Visual and refractive outcomes of posterior chamber phakic IOL in stable keratoconus.

We evaluated the visual and refractive outcomes after phakic visian toric implantable collamer lens (ICL) insertion in stable keratoconus (KC). This retrospective study investigated toric ICL implantation in 14 eyes of 8 patients with stable KC. After 6mo, the mean uncorrected distance visual acuity improved significantly from 0.77 to 0.15 logMAR. The mean best corrected distance visual acuity (BCDVA) improved from 0.18±0.1 to 0.15±0.1 logMAR. Fifty percent of eyes maintained their preoperative BCDVA; 42.8% gained one line. There was no statistical difference in high order or coma aberration. The mean refractive manifest spherical equivalent (MSE), mean refractive manifest spherical error, mean manifest astigmatism decreased significantly postoperatively. At 6mo postoperatively, our achieved mean spherical equivalent was approximately 74%. No intraoperative or postoperative complications occurred. Toric ICL implantation was effective, predictable and safe to correct refractive error and improve visual acuity in patients with stable KC.

Clinical and Refractive Outcomes of Toric Phakic Implantable Collamer lens Implantat for correction of myopic astigmatism

Background: Currently there are four general approaches to correct refractive errors: refractive corneal surgery, crystalline lens surgery and implantation of an intraocular lens in anterior or posterior chamber.
 Objective: To evaluate the predictability, safety and stability of toric phakic implantable collamer lens implantation to correct moderate to high myopic astigmatism. in Eye Specialty Private Hospital, Baghdad, Iraq.
 Type of the Study: a prospective non randomize intervention study.
 Methods: 60 eyes of 40 patients underwent implantation of a toric implantable collamer lens (V4c design).Mean spherical refraction was ₋11.32 diopter (D) ±3.17 (SD) with range from ₋6.00 to ₋18.00D and the mean cylinder was -2.61(D) ±1.16 with range from ₋1.00 to ₋5.50D .The outcome measures that evaluated during a 12 months follow-up period include UDVA, refractive outcomes, CDVA, vault and adverse events.
 Results: At 12 months postoperatively the mean Snellen decimal UDVA was 0.77±0.23 and mean CDVA was 0.80±0.21, with an efficacy index 1.16. Twenty nine eyes (48.33%) showed gain in CDVA with safety index
 
 
 1.21.The treatment was highly predictable for spherical equivalent and astigmatic component .The mean SE dropped from (₋12.63D ±3.11) to ( ₋0.11 D±0.20) with 58 eyes within ±0.50 D and 60 eyes with ± 1.00D of target correction . For achieved cylinder 60 eyes (100%) had ≤0.50D and 51 eyes (85%) had ≤0.25D with strong positive linear correlation between achieved and expected cylinder(r=0.94)
 Conclusions: The results of the present study support safety, efficacy, predictability of toric implantable collamer lens implantation to treat moderate to high myopic astigmatism.

Implantation torique : comparaison du marquage horizontal manuel versus automatique, à propos de 50 cas

The main objective of our study is to evaluate the contribution of automated conjunctival recognition in the alignment of toric implants by comparing the automatic alignment optimized with Callisto™ to the manual marking of the horizontal axis. We performed a prospective, descriptive, and monocentric study on patients undergoing cataract surgery with toric implantation (Asphina 709Zeiss), operated by a surgeon with good experience in toricity, between September 2016and March 2017. We analyzed the agreement between the manual marking of the 0°-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1month. We included 50eyes of 26patients. The corrected mean astigmatism was 1.9D. The mean difference between the 2axes was 4.7° [0°-12.3°]. Only 50% of the preoperative manual markings were consistent with the automatic measurement (<5°). At one month, the average rotation recorded was 4.3° [0°-29°]. The alignment was identical for 70% (n=35) of the IOL (≤5°). As for residual subjective astigmatism, it was on average 0.58D. The mean visual acuity without correction was 8/10and 55% had 10/10without correction. The refractive performance depends on the preoperative measurement, the correct alignment of the IOL and its stability in the bag. Our study shows the value of automatic conjunctival recognition in the determination of the axis of peroperative alignment, even in an experienced operator. This precision is essential for a good refractive result, especially since the residual astigmatism in case of misalignment will increase with the power of the implant. Our study shows excellent refractive results, whatever the initial astigmatism, using the automatic alignment. The precision of the toric implantation opens the way to the toric multifocal implantation under the best conditions.

Toric intraocular lens outcomes with a new protocol for IOL selection and implantation

The published literature on toric intraocular lenses (IOL) reports postoperative refractive cylinder less than or equal to 0.5 D in anywhere from 25% to 100% of implantations with both the Acrysof® Toric and Tecnis® Toric IOL, depending upon the article. However, the majority of articles tend to cite rates between 70% and 80%. The purpose was to evaluate my personal outcomes for both models of toric IOL, in terms of one-month postoperative refractive cylinder, after implementation of new methods of IOL selection, calculation and implantation. The new protocol included measurement of centroid surgically induced astigmatism by vector analysis; calculations using only the Barrett toric calculator, for which the keratometry values were obtained by optical biometry, while the keratometric axes were chosen by visual inspection of the axial topographic map; preoperative marking with the toriCAM cell phone appliance; and corneal incisions performed either manually or with a femtosecond laser. A prospective, observational study was conducted of all consecutive monofocal toric IOL implantations from September 2016 through April 2017. One-month postoperative refractive cylinder was recorded for each eye. Seventy eyes were implanted with monofocal toric IOL, 31 Acrysof® Toric and 39 Tecnis® Toric. Mean postoperative refractive cylinder was 0.48 D (0.00-1.50) for the Acrysof® Toric group and 0.46 D (0.00-1.00) for the Tecnis® Toric group. There were no statistically significant differences in postoperative refractive cylinder between IOL models or methods of incision. The percentage of eyes achieving postoperative refractive cylinder ≤0.50 D ("success") was 77% for the Acrysof® Toric group (82% for laser-assisted and 75% for manual) and 72% for the Tecnis® Toric group (80% for laser-assisted and 69% for manual). The implementation of the new protocol resulted in an overall surgical success rate of 77% for Acrysof® Toric IOL and 72% for Tecnis® Toric IOL (P=0.7702). Femtosecond laser-assisted surgery resulted in higher success rates than manual surgery (82% vs. 75% for Acrysof® Toric and 80% vs. 69% for Tecnis® Toric), but these differences were not statistically significant (Acrysof® Toric P=0.7336; Tecnis® Toric P=0.8862).

Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases

The main objective of our study was to evaluate the contribution of automated conjunctival registration in the alignment of toric intraocular lenses by comparing automated registration optimized with Callisto® to manual marking of the horizontal axis. We performed a prospective, descriptive, monocentric study on patients undergoing cataract surgery with a toric intraocular lens (Asphina 709Zeiss), performed by a surgeon with good experience in toric implants, between September 2016and March 2017. We analyzed the agreement between the manual marking of the 0-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1month. We included 50eyes of 38patients. The mean corrected astigmatism was 1,9D.The mean difference between the 2axes was 4,7° [0-12.3°]. Only 50% of the preoperative manual markings were consistent with the automated measurement (<5°). At one month, the mean rotation recorded was 4,3° [0-29°]. The alignment was identical for 70% (n=35) of the IOLs (≤5°). As for residual subjective astigmatism, the mean was 0.58D.The mean visual acuity without correction was 8/10and 55% saw 10/10without correction. Refractive performance depends on preoperative measurement, correct alignment of the IOL and its stability in the bag. Our study shows the value of automated conjunctival registration in the determination of the intraoperative axis of alignment, even with an experienced surgeon. This precision is essential for a good refractive result, especially since residual astigmatism in the case of misalignment will increase with the power of the implant. Our study shows excellent refractive results, regardless of the initial astigmatism, using automated alignment. Precision of toric implantation opens the way to toric multifocal implantation under the best conditions.

Therapeutic effectiveness of toric implantable collamer lens in treating ultrahigh myopic astigmatism

With a rapid increase in the prevalence of Ultra-High Myopic Astigmatism (UHMA), especially in the youth, there have been many studies on visual correction. In our study, we investigated the clinical value of the Toric Implantable Collamer Lens (TICL) in UHMA. We conducted a retrospective study between 2011 and 2013. TICL implantation was performed on fifteen UHMA patients (30 eyes), and all these patients were regularly followed up for 12 months. The preoperative and postoperative data, including Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), and corneal endothelial counts, were all analysed using the paired-sample t-test. The 12-month spherical mirror (SPH) of the surgical eye was -0.25~+0.25 D, and the Cylinder mirror (CYL) was 0~-0.50 D. Twenty patients exhibited an increase in UCVA by one level in comparison to the preoperative BCVA, amounting to a 66.7% increase; 20.0% of patients exhibited an increase in UCVA by two levels. A comparison between the preoperative and postoperative IOP showed no statistically significant difference. No difference was also found in mean corneal endothelial counts before and after the operation. A decrease in visual acuity was observed in one eye at the 3rd-month of review; this was corrected by TICL position adjustment. Precisely measuring the preoperative parameters, selecting the appropriate TICL, more thoroughly aspirating sodium hyaluronate intraoperatively, and maintaining a stable IOP were important for maintaining the effectiveness, safety and stability of TICL in treating UHMA.

Toric ICL Implantation After Sequential Intracorneal Ring Segments Implantation and Corneal Cross-linking in Keratoconus: 2-Year Follow-up.

To evaluate 6-month and 2-year safety and clinical outcomes of Visian toric Implantable Collamer Lens (toric ICL) (STAAR Surgical, Monrovia, CA) implantation for the treatment of residual refractive errors after sequential intracorneal ring segments (ICRS) insertion and cross-linking (CXL) in keratoconus. This consecutive case series included the results of a three-step ICRS-CXL-toric ICL procedure in 16 eyes of 13 patients with moderate to severe keratoconus (stages II and III of Amsler-Krumeich classification). The ICRS and CXL procedures were performed sequentially with an interval of 4 weeks and the toric ICL implantation was performed at least 6 months after CXL. Data were collected preoperatively, at 6 months after sequential ICRS-CXL, and at 6 and 24 months following toric ICL implantation. All 16 eyes were evaluated at the 2-year follow-up. There was a significant decrease in keratometry (steep, flat, and maximum) and refraction (sphere and spherical equivalence, but not cylinder) and a significant increase in both uncorrected (UDVA) (from 1.06 to 0.76 logMAR, P = .004) and corrected (CDVA) (from 0.42 to 0.26 logMAR; P = .002) distance visual acuity 6 months following sequential ICRS-CXL, whereas UDVA and refraction significantly improved 6 months after ICL insertion (UDVA reached 0.33 logMAR, P = .001). At the 24-month follow-up, UDVA and keratometric readings were stable, whereas CDVA, sphere, and cylinder showed a significant improvement. Implantation of Visian toric ICL following sequential ICRS insertion and CXL is an effective and safe option for correcting high residual refractive error and improving visual acuity in patients with moderate to severe keratoconus in the long term. [J Refract Surg. 2017;33(9):610-616.].

Toric lens implantation in cataract surgery: risk factors of post‐operative lens rotation, analysis of 50 cases

PurposeToric lens implantation in cataract surgery has improved with the help of automatic alignment methods, which can determine the immediate postoperative angle with great precision. However, unpredictable misalignment sometimes occurs in the following days. The goal of our study is to identify risk factors of toric lens rotation within the first month of implantation.MethodsWe conducted a prospective, monocentric, descriptive study of 50 eyes in 26 patients operated for cataract by a surgeon experienced in toricity, and implanted a Zeiss Asphina709 implant, during September and October 2016. The intraoperative lens alignment was determined by conjunctival recognition with the Callisto system (Zeiss), coupled with the IOL Master 700 (Zeiss). Lens alignment at one month was determined by blinded double reading on slit lamp photographs using EyeSuite (Luneau). Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and white to white (WTW) distance were measured with the IOL Master 700.ResultsAll implants were aligned as planned at the end of surgery. The average postoperative lens rotation at one month was 4.4° (+/‐4.85). There was no statistically significant correlation between implant rotation at one month and AL (p = 0.46), ACD (p = 0.18), LT (p = 0.75), WTW (p = 0.67), Age (p = 0.57), or Gender (p = 0.11).ConclusionsOur study was not able to identify significant risk factors for postoperative toric implant rotation. Our low average rotation and small sample size may explain why statistical significance was not reached. A larger prospective study is underway. Our study underlines the difficulty to predict which patients will show toric implant rotation and highlights the importance of viscoelastic management at the end of surgery. Understanding and controlling those risk factors may help achieve better refractive results in the future.

Refractive Outcomes of 20 Eyes Undergoing ICL Implantation for Correction of Hyperopic Astigmatism.

To analyze 1-week, 1-month, and 12-month postoperative refractive outcomes of eyes that under-went ICL implantation to correct hyperopic astigmatism. The study enrolled 20 eyes of patients with an average age of 32 years (range: 21 to 40 years). The outcomes of spherical and cylindrical refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), vault, and angle parameters were evaluated 1 week, 1 month, and 12 months postoperatively. The preoperative mean UDVA was 0.15 ± 0.11 (decimal) (20/133 Snellen) and increased to 0.74 ± 0.25 (20/27 Snellen) postoperatively, with a change of 0.59 (decimal) (20/33.9 Snellen) (P < .0001), which was statistically significant. The preoperative mean CDVA was 0.74 ± 0.25 (decimal) (20/27 Snellen) and increased to 0.78 ± 0.21 (20/25 Snellen), with a change of 0.03 (decimal) (20/666 Snellen) (P < .052), which was not statistically significant. The mean preoperative sphere was 6.86 ± 1.77 diopters (D) and the mean preoperative cylinder was -1.44 ± 0.88 D. The mean 12-month postoperative sphere decreased to 0.46 ± 0.89 D (P < .001) and cylinder decreased to -0.61 ± 0.46 D (P < .001), with a change of 6.40 D, both of which were statistically significant. The mean 1-month postoperative vault was 0.65 ± 0.13 mm and decreased to 0.613 ± 0.10 mm at 1 year postoperatively, with a change of 0.44 mm (P < .003). The preoperative/12-month and 1-month/12-month trabecular-iris angle (TIA), trabecular-iris space area 500 mm from the scleral spur (TISA500), and angle opening distance 500 mm from the scleral spur (AOD500) values were analyzed nasally, temporally, and inferiorly. All differences were statistically significant between preoperative/12-month analysis. The only differences between 1- and 12-month analysis were on TISA500 inferior (P < .002) and AOD500 nasal (0.031) values. ICL hyperopic toric implantation is a safe method and provides stable refractive outcomes in patients with high hyperopia (up to 10.00 D) and astigmatism (up to 6.00 D). [J Refract Surg. 2017;33(9):604-609.].

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism

BackgroundTo compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism.MethodsThis study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years.ResultsPreoperatively, the mean manifest spherical equivalent (SE) was −14.14 ± 2.12 D in the TICL group and −14.83 ± 2.79 D in the AK + ICL group (P = 0.28), and the mean manifest refractive cylinder, −2.87 ± 1.09 D and −2.58 ± 0.85 D, respectively (P = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group (P = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively (P = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group (P = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups.ConclusionsBoth TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.Trial registrationNCT03202485

Anterior segment optical coherence tomography angle and vault analysis after toric and non-toric implantable collamer lens V4c implantation in patients with high myopia

ObjectiveTo assess anterior segment changes, including iridocorneal angle and vault, after toric and non-toric implantable collamer lens (ICL) V4c (STAAR Surgical AG) implantation under different lighting conditions.MethodsLongitudinal, prospective, case series....

Comparison of Visian toric collamer lens and toric acrylic intraocular lens implantation for the treatment of myopia with astigmatism

PurposeTo compare the efficacy and outcome of phakic toric implantable collamer lens (TICL) and refractive clear lens extraction with AcrySof Toric intraocular lens (TIOL) implantation for the treatment of myopic astigmatism.Patients and methodsThis study assessed eyes with myopic astigmatism >−1 D and ≤−4 D with a spherical equivalent >10 D or <10 D if the patients were unsuitable for corneal refractive surgery. These eyes were divided into group A, in which Visian Toric ICL™ Phakic TICL was implanted, and group B, which involved clear lens extraction with implantation of an AcrySof IQ toric SN60T3-9™ IOL. The outcome and complications were evaluated.ResultsThis study enrolled 63 eyes of 38 patients with a follow-up period of at least 6 months. The mean postoperative spherical equivalent was −0.19±0.31 D in group A and −0.21±0.28 D in group B (P=0.69). The mean postoperative cylinder value was −0.46±0.53 D in group A and −0.32±0.41 D in group B (P=0.35). Postoperative cylinder was <1 D in 76.47% and 79.31% of eyes in groups A and B, respectively. The mean endothelial cell count was reduced by 4.32% in group A and by 5.32% in group B (P=0.003). The mean postoperative intraocular pressure increased insignificantly in group A (P=0.22) and reduced significantly in group B (P=0.004). The complication rate was 11.76% in group A and 6.90% in group B.ConclusionBoth procedures showed predictable results and good visual results. However, the loss of accommodation and risk of retinal complications in the TIOL group suggest that the use of TICL for myopic astigmatism is a better choice in younger patients.

Toric markers-assisted implantation of the scleral-fixated intraocular lens.

To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens (SFIOL). From October 2010 to December 2013, all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2, in group 1 SFIOL was performed with the assist of radial keratotomy (RK)-marker, and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers (T-and axis markers). Patients' demographic data and information on baseline preoperative visual acuity, indication for surgery and latest postoperative visual acuity were collected and analyzed. The haptic and optic positions were determined by ultrasound biomicroscopy. The optic tilt angle and decentration distance were measured. The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66y. Group 1 comprised 24 eyes (24 patients) and group 2, 19 eyes (19 patients). Uncorrected reoperative acuity was improved on all the eyes postoperatively. The improved postoperative acuity was significantly more in group 2 than that in group 1 (1.11±0.38 vs 0.82±0.45 logMAR; F=4.85, P=0.03). Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1 (42%, 10/24) than that in group 2 (11%; 2/19) (Chi square=3.68, P=0.04). The mean tilted degree in group 1 was significantly higher than that in group 2 (P=0.04). Mean decentration distance in group 1 was greater than that in group 2 (P=0.03). During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

How to calculate pseudophakic and phakic toric implants?

SummaryDifferent calculation modalities for pseudophakic and phakic toric lens implants are discussed: what are the benefits and drawbacks of formula‐based and raytracing techniques? How could we set‐up our own calculation sheet in a standard PC software package? A step‐by‐step calculation is shown in a clinical example. When do we need customized software? How can we evaluate residual refractive error after axis displacement of the toric lens implant? A list of commercial and non‐commercial online calculators for toric lenses is shown.

Surgical aspects of toric lens implantation and complication management

SummaryIn this contribution we would like to give an overview in the spectrum of pseudophakic and phakic toric lenses currently on the market. The audience will be guided how to select the proper lens for the indivual patient. Perioperative marking, surgical technique, intraoperative positioning and validation of lens alignment will be addressed in detail. Techniques are shown how to prevent postoperative rotation, decentration or tilt of the lens. In a last step, we will demonstrate how and when to re‐position or re‐align (in axis) the pseudophakic or phakic toric lens implant in case of decentration, tilt or axis rotation. The add‐on value of modern intraoperative assistance / guidance functions for proper positioning of the toric lens implant or re‐positioning in terms of complication management is shown.

Instrument assisted diagnostics – biometry, topography and wave‐front analysis

SummaryWe start with an overview on biometric, tomographic, topographic and other complimentary examination techniques and instruments. Criteria and indicators are presented to tailor out whether measurements qualify for an appropriate calculation of pseudophakic and phakic toric lens implants. As a hot topic we show how to discriminate between regular and irregular portion of astigmatism in a tomographic or topographic measurement and how to use this information for calculation. We will address the issue, which data from the large set of information provided by the instrument software should be used for toric lens calculation. We will provide hints where to look at the printouts from the devices. Finally, we provide a compact workflow for device assisted examination for toric lens planning.