Toric Intraocular Lens Research Articles

Comparison of Primary Duet Lens Procedures: In-The-Bag Monofocal with Sulcus Multifocal, and Standard Single Multifocal Lens for Cataract Surgery

To assess the safety and efficacy of primary duet intraocular lens (IOL) procedure using an in-The-bag monofocal IOL and a sulcus-based multifocal reversible platform for cataract surgery. The visual outcomes were compared with a single in-The-bag multifocal IOL. Retrospective cohort study. Consecutive patients who underwent primary duet IOL procedures were compared with consecutive patients who underwent single multifocal IOL surgery. Primary outcomes were uncorrected distance and near visual acuities (UDVA and UNVA), refraction and spherical equivalent data. Secondary outcomes included surgical complications. The study group consisted of 32 eyes (22 toric IOLs) whilst the control group had 57 eyes (29 toric IOLs). There were no statistically significant differences between the two groups on post-operative 1-month and 1-year UDVA (p=0.1522 and 0.4926, respectively) and UNVA (p=0.1248 and 0.2738, respectively). There were no statistically significant differences in the postoperative 1-month spherical equivalent within ± 0.5 diopter (p=0.1891). Postoperative intraocular pressure spikes were observed on day-1 in both groups, with most returned to their baseline at 1-month and all were normal at 1-year post surgery. There were no statistically significant differences in intraocular pressure between the two groups on day-1, 1-month and 1-year after surgery (p=0.6421). There were no statistically significant differences in the IOL axis deviation from the intended axis in the toric subgroup analysis (p=0.5843). Primary duet IOL procedure is equally effective and safe in correcting distance and near vision when compared with single multifocal IOL in the capsular bag.

Non-Diffractive Wavefront-Shaping Intraocular Lens with Extended Depth of Focus: First Implantation Experience

Purpose. Analysis of short-term clinical and functional results of implantation of a new non-diffractive IOL with expanded depth of focus.Patients and methods. The study included 27 patients (35 eyes) after bilateral (8 patients) or monolateral (19 patients) AcrySof IQ Vivity IOL implantation (Alcon, USA) with mean follow-up of 3.8 ± 0.3 (3–5) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. Women accounted for 63 % (n = 17) and men for 37 % (n = 10). AcrySof IQ Vivity DFT015 IOLs were implanted in 24 eyes and toric AcrySof IQ Vivity DFT315, DFT415 and DFT515 IOLs in 11 eyes with clinically significant (more than 1.0 D) astigmatism.Results. There was a significant (p < 0.05) increase in distance and intermediate uncorrected and best corrected visual acuity starting from the 1st day after surgery. An increase from 0.31 ± 0.09 to 0.58 ± 0.12 at the 1st day after the operation, and further up to 0.63 ± 0.13 at the follow-up period of 3 months (p < 0.05) was also registered while assessing near uncorrected visual acuity. In spite of some increase of best corrected near visual acuity in the follow-up period of 3 months in comparison with preoperative period (0.68 ± 0.19 and 0.57 ± 0.16, respectively), these differences were not statisticallysignificant (p > 0.05). After IOL implantation, the spherical refractive index was shown to decrease from –2.75 ± 1.4 in the preoperative period to –0.10 ± 0.73 in the follow-up period of 3 months. Permanent or periodic optical phenomena were detected in 4 patients out of 27 (14.8 %), of them 2 patients (7.4 %) had glare and 2 (7.4 %) — halo. Patients did not complain of difficulties in driving in the dark. In 11 oof 27 cases (40.7 %), patients required spectacle correction for reading. In spite of the need for spectacle correction for near vision in 40 % cases, the vast majority of patients (n = 24; 88.9 %) rated the result of surgery as “excellent” and three (11.1 %) as good.Conclusion. This work presents the first experience in Russia of implantation of a new non-diffractive intraocular lens with an expanded depth of focus forming a wavefront in 35 eyes. The presented data testify to the high efficacy of this IOL for medium distance and far distance vision correction and to the possibility of providing functional near vision. Implantation of the investigated IOL was associated with a low incidence of adverse optical phenomena, such as halo, glare, and discomfort when driving in the dark. The use of this IOL in clinical practice may be an option to achieve the desired outcome in cataract surgery.

Сравнительная оценка точности расчета торических интраокулярных линз

Purpose. To assess the refractive error of toric IOL calculation using Holladay IOL Consultant program with Holladay II formula, Verion navigation system using Holladay II and Barrett formulas. Methods. A retrospective analysis of the records of patients who underwent phacoemulsification with Acrysof IQ Toric (Alcon, USA) IOL implantation was carried out in IRTC Eye Microsurgery Ekaterinburg Center. The IOL was calculated using Holladay IOL Consultant program with Holladay II formula and Verion navigation system with the Holladay II and Barrett formulas. Results. Average refractive error of calculating IOL optical power on Verion diagnostic system using Holladay II formula was 0.20±0.83 diopters, using Barrett formula 0.26±0.76 diopters. IOL optic power calculation using Hicsoap Professional software using Holladay II formula showed refractive error of 0.07±0.76 diopters. Conclusions. The best result for refractive error was demonstrated by Holladay IOL Consultant Professional calculator (Holladay II formula). The difference in errors using Holladay II and Barrett formulas in Verion navigation system turned out to be insignificant. The best refractive result was demonstrated in correction of straight astigmatism by toric IOL implantation. Key words: IOL optical power calculation; toric IOL; IOL calculation formulas.

Building prediction models of clinically significant intraocular lens tilt and decentration for age-related cataract.

To explore the risk factors and construct nomogram models to predict the risks of clinically significant intraocular lens (IOL) tilt and decentration after cataract surgery in patients with age-related cataract. Zhongshan Ophthalmic Center, Guangzhou, China. Prospective cohort study. 207 patients (207 eyes) who underwent phacoemulsification combined with IOL implantation were enrolled in the study. Casia2 was used to measure the tilt and decentration of crystalline lenses and IOLs before and 3 months after surgery. Univariate and multivariate logistic regression analyses were used to determine the risk factors of clinically significant IOL tilt and decentration, and nomogram prediction models were constructed according to the results of the multivariate logistic regression analysis. Two hundred and seven patients were included in analysis. 24 eyes (11.59%) and 16 eyes (7.73%) had clinically significant IOL tilt and decentration at 3 months after cataract surgery. Multivariate logistic regression analysis revealed that preoperative crystalline lens tilt and decentration were the risk factors for clinically significant IOL tilt (odds ratio [OR], 3.519, P < .001) and decentration (OR, 410.22, P = .001), respectively. Axial length was another association factor for clinically significant IOL decentration (OR, 2.155, P = .019). The risk models demonstrated good calibrations and discriminations for the predictions of clinically significant IOL tilt (receiver operating characteristic [ROC] area = 0.833, cutoff value = 6.5) and decentration (ROC area = 0.757, cutoff value = 0.08). The good performances of our models suggested that they may be useful risk prediction tools for postoperative IOL tilt and decentration. The measurement of preoperative crystalline lens tilt and decentration should be one of the routine examinations before cataract surgery, especially for toric and multifocal IOLs.

Сравнительная оценка хирургической коррекции роговичного астигматизма торическими ИОЛ с использованием различных кератометрических данных и методов расчета

Purpose. Compare the effectiveness of regular corneal astigmatism correction with toric monofocal IOL using various keratometric data and calculation methods. Material and methods. The study included 28 patients (31 eyes) with age-related cataracts and regular corneal astigmatism who underwent phacoemulsification (n=31) with implantation of a monofocal toric IOL (EnVista Toric). Two groups were formed according to the type of calculation and possible options of keratometric data: 1) keratometric data of IOL-master 500 + online manufacturer's calculator; 2) keratometric data of the anterior and posterior corneal surfaces (Pentacam HR) + Barrett's toric calculator. Results. The mean absolute deviation of the predicted residual astigmatism from the actual one was distributed as follows: 1st group – 0.62±0.62 D, 2nd group – 0.41 ± 0.71 D. The values of the mean absolute vector and mean centroid error in diopters were: 0.80±0.59 D and 0.06 D in 1st group, 0.48±0.65 D and 0.02 D in 2nd group, respectively. Conclusion. When using the measured astigmatism of the anterior and posterior surface of the cornea, Barrett's toric calculator showed the best result. The most accurate forecast of residual astigmatism was obtained using the Barrett calculator in combination with Pentacam keratometry data (Axial\Sagittal (Front), Axial\Sagittal (Back)). Key words: corneal astigmatism, posterior corneal astigmatism, toric IOL, centroid analysis, keratometry, cataract surgery

A Case Exhibiting Late, Postoperative, Toric Intraocular Lens Rotation

Purpose: We present a case of spontaneous toric intraocular lens (IOL) rotation in the late postoperative period (after 10 months).Case summary: A 44-year-old male underwent phacoemulsification and placement of an IOL (AcrySof IQ Toric, Alcon Laboratories Inc., Fort Worth, FL, USA) in the right eye. The preoperative best corrected visual acuities (BCVAs) were 0.2 in the right eye and 0.3 in the left eye, and the corneal astigmatisms -2.25 × 175° and -2.25 × 178°. Ten months later, the astigmatic IOL axis was 85° (the initial [correct] value). The BCVA after surgery was 1.0. At 11 months postoperatively, the patient presented with a sudden decrease in visual acuity in the right eye. The IOL had rotated 50° clockwise; we decided to reposition it. A capsular tension ring had been placed during surgery. The IOL was re-aligned but rotated again 1 week later. We replaced the IOL with a monofocal non-toric IOL (enVista MX60, Bausch &amp; Lomb, Rochester, NY, USA).Conclusions: Severe toric IOL rotation is a late postoperative complication.

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

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

Roles of Toric intraocular Lens implantation on visual acuity and astigmatism in glaucomatous eyes treated with iStent and cataract surgery

BackgroundTo assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and minimally invasive glaucoma surgery (MIGS), visual and refractive outcomes were compared between eyes implanted with non-toric and toric IOLs during iStent triple procedures.MethodsIn this retrospective study, open angle glaucoma eyes with preexisting corneal astigmatism of -1.5 diopter (D) or more and implanted with non-toric (n = 9) or toric (n = 9) IOLs were included. The main outcome measures were the intergroup difference in the uncorrected visual acuity (UCVA) and refractive astigmatism at 3 months postoperatively.ResultsPreoperatively, the logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism were equivalent between the groups. Postoperatively, the logMAR UCVA (non-toric, 0.45 ± 0.31; toric, 0.14 ± 0.15; P = 0.021) was significantly better and the refractive astigmatism (non-toric, -2.03 ± 0.63 D; toric, -0.67 ± 0.53 D; P = 0.0014) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (-0.21, P = 0.020) and refractive astigmatism (+ 1.72 D, P = 0.0039). Vector analyses showed the postoperative centroid magnitude and confidence eclipses of refractive astigmatism was less in the toric group (0.47 D at 173°±0.73D) than the non-toric group (1.10 D at 2°±1.91D). Postoperatively, 78% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 11% in the non-toric group. Surgically induced astigmatism (non-toric, 0.18 D at 65°; toric, 0.29 D at 137°) did not differ between groups.ConclusionUse of toric IOLs is a reasonable option for better visual outcomes when the combined cataract and iStent surgery is performed in glaucomatous eyes with corneal astigmatism.

Visual and Refractive Efficacy of Panoptix Toric Intraocular Lens in a Clinical Setting.

Trifocal Intraocular Lenses (IOLs) were developed to provide patients with effective near, intermediate and distance vision, thus minimizing spectacle dependency. Residual astigmatism has previously been shown to impact unaided visual acuity across all distances; therefore, to optimise the expected outcomes, consideration of preoperative corneal astigmatism is essential. The purpose of this study was to provide a real-world, multi-site review of visual and refractive outcomes in eyes undergoing implantation with the Panoptix Trifocal toric IOL platform. This study represents a two-fold approach. Patients who had previously undergone routine cataract removal and IOL insertion with the Panoptix Toric IOL were retrospectively analysed for routine efficacy and safety endpoints ("Retrospective Cohort"). Data was retrieved from the preoperative, surgical and postoperative visits (range 2-6 weeks). A further subset of patients undergoing lens removal and bilateral Panoptix Toric IOL insertion were identified at surgery ("Qualitative Cohort"). These patients underwent additional testing inclusive of quality of vision questionnaire and bilateral defocus curve. A total of 466 eyes of 254 patients were included in the retrospective cohort. Between 91% and 98% of eyes, respectively, were within 0.50D and 1.00D of target. Mean absolute difference from Spherical Equivalent (SE) target was 0.22 ± 0.24Ds. Following surgery, 94% of eyes demonstrated a refractive astigmatism of 0.50D or less. Further, 61% eyes achieved uncorrected distance visual acuity (UDVA) of 20/20 or better, increasing to 94% achieving 20/32 or better. Seventy percent of eyes unilaterally achieved N5 unaided and 66.0% achieved N8 or better at intermediate. In the qualitative cohort, no patient described any symptom as significant or requested explant. In a real-world setting, the PanOptix toric trifocal IOL continues to demonstrate refractive accuracy and good visual performance at all focal distances. This IOL also exhibited good quality of vision, with minimally bothersome visual disturbances or photic phenomena.

EE140 The Opportunity Cost of Managing Toric IOL Rotation Cases for a Private Cataract Surgery Centre in India: A Decision-Analytic Model Comparing Three Toric IOLs

Toric IOL rotation post-surgery could impact patient’s visual outcomes leading to unplanned office visits and may require performing Toric IOL repositioning surgery in some cases. The purpose of the analysis is to compare overall clinical workload (post-operative chair-time and operating room time for Toric IOL rotation cases requiring repositioning surgeries) with three hydrophobic acrylic Toric IOLs and estimate opportunity cost for a private Cataract surgery centre in India.

Outcomes of Toric Intraocular Lens Implantation After Radial Keratotomy

Purpose: To report high toric intraocular lens (IOL) implantation in a patient with previous radial keratotomy and significantly flat corneal powers. Methods: Case report. Results: A 64-year-old woman with previous bilateral 8-incision radial keratotomy was referred for cataract surgery. Corrected distance visual acuity was 20/70 in the right eye and counting fingers in the left eye (could not be refracted). The power of the flat meridian was below 30.00 diopters (D) bilaterally, so no IOL power predictions were reported by standard biometric devices. Calculations were run with the American Society of Cataract and Refractive Surgery (ASCRS) IOL Calculator for Eyes with Prior Radial Keratotomy using data from biometry, tomography, and topography. Toric cylinder and meridian were calculated with the ASCRS Barrett Toric Calculator. Given reasonable agreement in corneal cylinder and meridian between imaging modalities, toric IOLs (3.75 D IOL cylinder) were implanted. Postoperatively, spherical equivalent was −0.50 D in the right eye and plano in the left eye. Cylinder was reduced from 3.24 to 1.00 D in the right eye and from 4.13 to 1.00 D in the left eye. Conclusions: Toric IOLs offer an opportunity to reduce postoperative astigmatism in radial keratotomy cases with high cylinder, significantly flat corneal powers, and no classic bowtie pattern on topography. Pre-cataract refractions are useful in these cases after radial keratotomy, because corneal imaging modalities may underestimate astigmatism after radial keratotomy. [ Journal of Refractive Surgery Case Reports. 2022;2(4):e68–e71.]

Post-Market Evaluation of Rotational Stability and Visual Performance of a New Toric Intraocular Lens with Frosted Haptics.

To evaluate 3-month rotational stability, and visual and refractive outcomes of a toric intraocular lens (IOL) with frosted haptics. A post-market, prospective, multi-center, single-arm, open-label study conducted at seven clinical sites in the United States. Two hundred and two eyes of 133 subjects with unilateral or bilateral cataracts and corneal astigmatism were implanted with the Tecnis Toric II IOL, Models ZCU150 to 600 (Johnson & Johnson Surgical Vision, Inc.). Lens axis misalignment/rotation, visual acuity, manifest refraction, and surgeon and patient satisfaction were evaluated 3 months postoperatively. Lens rotation was determined with operative and postoperative visit photographs and was analyzed by two independent masked analysts. Mean absolute lens rotation was 0.82° ± 1.00° and 0.94° ± 0.71° at 1 day (n = 189 eyes) and 3 months (n = 185 eyes), respectively. Absolute lens rotation was ≤5° in 98.9% and 100% of eyes at 1 day and 3 months, respectively. At 3 months, postoperative monocular uncorrected and corrected distance visual acuities were 0.004 ± 0.115 LogMAR (20/20) and -0.066 ± 0.092 LogMAR (20/17), mean spherical equivalent was -0.25 D ± 0.35 D and residual refractive cylinder was +0.27 D ± 0.33 D. Surgeons were satisfied/very satisfied with overall clinical outcomes and rotational stability in 99% of eyes, and with uncorrected distance vision in 98.5% of eyes. The study results demonstrate that the Tecnis Toric II IOL has excellent rotational stability with a high percentage of study eyes being within 5° of intended orientation. The study lens demonstrated excellent uncorrected distance visual acuity, reduction of cylinder, and exceptional patient and surgeon satisfaction.

PENTACAM STUDY OF ANTERIOR AND POSTERIOR CORNEAL ASTIGMATISM IN PATIENTS WITH KERATOCONUS AND HEALTHY CONTROLS

Keratoconus is a chronic, noninflammatory, progressive, ectatic corneal disorderthat degrades vision due to myopia and irregular astigmatism. Recently, the priority of posteriorcorneal astigmatism has been identified when toric IOL is considered. The aim of the study wasto assess and correlate the power and axis orientation of anterior and posterior corneal astigmatism in keratoconus patients and healthy controls.

Cataract surgery with toric lens. Assessment through tomography and intraoperative aberrometry ORA

AbstractPurpose: Nowadays, cataract surgery not only aims at the extraction of the opacified lens. Promoted by advances in the last decade, this medical procedure has evolved into a refractive technique whose purpose is emmetropia. The current intention, from an optical point of view, is to obtain a residual refractive error within ±0.50 diopters of spherical equivalent, and &lt;0.75 diopters in the residual cylinder. Consequently, a prospective single‐center cross‐sectional study was performed at the Ophthalmology Department of the Lozano Blesa University Hospital of Zaragoza, which was conducted from July 2021 to February 2022.Methods: Including a total of 42 eyes of 34 patients (38% male, 62% female), with astigmatism greater than 2.00 keratometric diopters undergo cataract surgery. The surgical procedure is carried out using FLACS femtosecond laser‐assisted surgery, altogether with implantation of toric intraocular lenses (Alcon SN6AT2‐9). Inclusion criteria pursued uncomplicated interventions, performed by a single surgeon and with a NRR (No Rotation Recommended) outcome.Results: The mean ages were 69.5 ± 11.89 years (39–90), the mean axial length was 23.61 ± 2.38 mm. The corneal dioptric power was 3.10 ± 1.22 D anterior surface contribution, and 0.58 ± 0.40 D posterior surface contribution. It is worth highlighting that the contribution or the posterior surface in ATR eyes (against the rule) was only 0.21 ± 0.15 D. Using vector analysis, mean (standard deviation) and median (interquartile range) from a vector of astigmatism we obtained the following results: ORA's IOL recommendation and the preoperative prediction coincided in 50% of the cases (final astigmatism mean 0.76D ± 0.47 D). In the 50% remaining cases where they did not match, the biometer‐recommended IOL was inserted (final astigmatism mean 0.84 D ± 0.77 D).Conclusions: To sum up, compared with standard methods, we show that the use of ORA intraoperative aberrometry system increases predictability and safety during the intervention, improving efficacy and giving better outcomes. The use of FLACS femtosecond laser‐assisted surgery and intraoperative guidance systems make phacoemulsification surgery a more reproducible technique.

Case report: simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Case report: simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting

ObjectifÉvaluer l’astigmatisme réfractif résiduel postopératoire après l'implantation bilatérale de lentilles intraoculaires (LIO) trifocales toriques dans un contexte réel où évoluent plusieurs chirurgiens. NatureÉtude prospective regroupant plusieurs chirurgiens (6 chirurgiens dans 2 établissements). MéthodesOn a procédé à l'implantation bilatérale de LIO trifocales toriques (LIO AcrySof PanOptix; Alcon Vision LLC, Fort Worth, Texas, États-Unis) dans 140 yeux de 70 patients. Les patients ont été évalués au jour 1 et 3 mois après l'intervention. Le principal paramètre de mesure consistait en la présence d'astigmatisme résiduel. Au nombre des paramètres secondaires, mentionnons l'erreur de prédiction absolue, la rotation des LIO, l'acuité visuelle binoculaire non corrigée, l'acuité visuelle corrigée de près (40 cm), à distance intermédiaire (60 cm) et de loin (6 m) de même que l'indépendance aux lunettes évaluée par un questionnaire validé de satisfaction envers les LIO. RésultatsLe cylindre préopératoire moyen se chiffrait à 1,25 ± 0,72 D pour atteindre 0,39 ± 0,28 D 3 mois après l'intervention. Lors de l’évaluation à 3 mois, l'astigmatisme résiduel moyen était de 0,39 ± 0,28 D (fourchette : 0–1,25 D); l'astigmatisme postopératoire s’élevait à 0,5 D ou moins dans 118 yeux (84,3 %). Pour sa part, l'erreur de prédiction absolue moyenne était de 0,25 ± 0,21 D (fourchette : 0–1,13 D); l'erreur de prédiction absolue se chiffrait à 0,5 D ou moins dans 124 yeux (88,6 %). La rotation moyenne absolue était de 2,0 ± 2,7 degrés, comparativement aux valeurs de départ (fourchette : 0–15 degrés); 133 LIO (95,0 %) se situaient à ≤ 5 degrés de l'axe d'implantation. Enfin, 55 patients (79 %) ont signalé ne jamais porter de lunettes ou affirmé ne les porter que rarement pour la vision de près, au même titre que 66 patients (94 %) pour la vision à distance intermédiaire et que 67 patients (96 %) pour la vision de loin. ConclusionsSi l'on en croit les résultats de notre étude, l'implantation de LIO toriques PanOptix peut donner d'excellents résultats réfractifs et visuels qui s'accompagnent d'un astigmatisme résiduel peu marqué.

One-dioptre toric IOL versus spherical IOL in eyes with low preoperative corneal astigmatism

PurposeTo investigate the advantages/disadvantages of a 1.0 D toric IOL vs spherical IOL after regular phacoemulsification in eyes with preoperative astigmatism ≤ 1 D.MethodsRetrospective comparative series involving pseudophakic eyes with preoperative topographic astigmatism ≤ 1.0 D implanted either with monofocal 1.0 D Toric IOL (T-group), or with spherical IOL (S-group). The postoperative refractive astigmatism (PRA, i.e. surgically induced + corneal) was the main outcome; also considered in the analyses were the uncorrected and best-corrected distance visual acuity (VA). The data were referred to the last postoperative follow-up visit, 2 to 4 months after surgery.ResultsA total of 60 eyes were included: 30 in the T-group and 30 in the S-group, matched for patient’s age, laterality, and axial length. Before surgery, the mean corneal astigmatism was 0.62 ± 0.39 D in the T-group and 0.54 ± 0.33 D in the S-group (p = 0.4). In the S-group, PRA was 0.73 ± 0.37 D, higher than the corresponding preoperative corneal astigmatism (p = 0.040). In the T-group, PRA was 0.58 ± 0.31 D; the variation was not statistically significant. Uncorrected VA was significantly better in the T-group vs the S-group (p = 0.007), and the best-corrected VA was comparable in the two groups.ConclusionThe present study indicated that in eyes with very low preoperative astigmatism, 1.0 D toric IOLs were able to limit the increase of the PRA instead of those observed with the spherical IOLs. This could support the better uncorrected VA recorded in the T-group.

Influence of Ocular Surface Hydration on Intra-Operative Aberrometry Measurement and Toric Intraocular Lens Recommendation.

The purpose of this study was to examine the effect of intra-operative live refraction stability as a surrogate marker of ocular surface hydration on intra-operative aberrometry (IA) results and to quantify the minimum duration of stable refraction needed to achieve accurate intraocular lens (IOL) selection. In this nonrandomized consecutive retrospective chart review, 18,000 data points from 45 live refraction runs of 15 patients were digitized and analyzed. An objective automated moving average method of frames lengths of 88ms, 110ms, and 132ms with less than 0.5 diopters (D) of fluctuation was compared to raw IA capture data. The difference-vector (DV) of the predicted toric powers was compared among these groups. Subjectively, traces were classified as stable or unstable if the live refraction fluctuated less than 0.5D for 5 seconds. The DV based on the stable period was compared with the IA capture data. The DVs for all frame intervals showed no significant difference when compared with IA readings. In 15 of 45 (33.3%) cases, IA active refraction traces were stable and the DV (0.27D ± 0.15D) was significantly less than unstable traces (0.49D ± 0.28D). IOL recommendations from 14 (93.3%) of stable runs led to a <0.5D of postoperative cylinder compared to 14 (47.7%) in unstable runs. Intra-operative live refraction stability is affected by ocular hydration. Surgeons should look for periods of refractive stability for at least 5 seconds to better assess measurement quality. This can be facilitated by capturing and including the active refraction trace, which is currently unavailable for review. Graphing live refractive IA readings and determining refractive stability translates to more accurate IOL selection.

Efficacy of a One-Piece Aberration Neutral Hydrophobic Acrylic Toric Intraocular Lens.

To assess the refractive outcomes, intraocular centration and rotational stability of the enVista toric intraocular lens (IOL). This study was a prospective, multi-centre, double-masked, partially randomized and partially controlled clinical trial. A total of 191 participants were implanted with toric IOL (1.25, 2.00, or 2.75D) or non-toric IOL (control). The lowest range of corneal astigmatic eyes were randomized to 1.25D toric or control. Higher astigmatic powers were allocated to the treatment arm. Subjects were assessed immediately postoperatively, 1-2 (V1), 7-14 (V2), 30-60 (V3) and 120-180 (V4) days postoperatively. Unaided (UDVA) and distance corrected visual acuity (CDVA), manifest refraction and corneal curvature were assessed. Vector analysis was used to calculate surgically induced refractive correction (SIRC), correction ratio (CR), error magnitude (EM) and error vector (EV). Slit-lamp photography was used to measure centration and rotational stability. UDVA was better in the low toric IOL group in comparison with the control group at V4 (p<0.001). There was an undercorrection in the control group, whereas the average CR for all toric subjects was 1.00 ± 0.32: V2, 0.98 ± 0.34: V3 and 0.98 ± 0.35: V4. The absolute IOL rotational stability in comparison to the position of the IOL at V1 was 1.35° ± 0.97°: V2, 1.35° ± 1.07°: V3 and 1.38° ± 1.25°: V4. Decentration was generally inferior (V1: 0.04 ± 0.22mm, V2: 0.05± 0.20mm, V3: 0.08 ± 0.22mm, V4: 0.04 ± 0.21mm) and nasal (V1: 0.19 ± 0.23mm, V2: 0.20 ± 0.20mm, V3: 0.20 ± 0.21mm, V4: 0.17 ± 0.22mm). Participants with low levels of corneal astigmatism achieved superior vision and refractive outcomes in the low toric group over the control. Moderate and high levels of astigmatism achieved excellent refractive outcomes. The toric IOL demonstrated high levels of both rotational and centrational stability.

Comparison of Astigmatism Prediction Accuracy for Toric Lens Implantation from Two Swept-Source Optical Coherence Tomography Devices.

To compare the astigmatism prediction accuracy for toric intraocular lens (IOL) implantation between two swept-source optical coherence tomography (SS-OCT) devices: Argos (Movu, a Santec Company) and the IOLMaster 700 (Carl Zeiss Meditec). This was a retrospective chart review of 59 eyes (44 patients) with corneal astigmatism and cataract that underwent cataract surgery or refractive lens exchange surgery with a toric IOL. Biometry was performed on all patients prior to cataract surgery and the Barrett toric IOL calculator was used. Visual acuity was measured postoperatively. Manifest refraction was measured at 1 month and compared to the predicted postoperative residual refraction. Preoperative K measurements between devices were also compared. Mean cylinder prediction error was -0.17 ± 0.43 for Argos and 0.12 ± 0.56 for IOLMaster 700. The cylinder prediction error 0.5 D or less was not significantly different between the devices, with 83.1% (49 eyes) for Argos and 76.3% (45 eyes) for IOLMaster 700 (p = 0.206). Spherical equivalent prediction error was 0.13 ± 0.39 for Argos and 0.25 ± 0.50 for IOLMaster 700. The mean spherical equivalent prediction error 0.5 D or less was significantly different between the devices, with 79.7% (47 eyes) for Argos and 61.0% (36 eyes) for IOLMaster 700 (p = 0.016). The prediction accuracies were similar between the devices, except for spherical equivalent, where a higher percentage of eyes were 0.5 D or less of the prediction with the Argos compared to the IOLMaster.