Toric IOL Implantation Research Articles

Astigmatism Management with Astigmatism-Correcting Intraocular Lens Using Two Toric Calculators - A Comparative Case Series.

BackgroundTo compare refractive outcomes after phacoemulsification and toric IOL implantation using two different toric calculators for initial astigmatism assessment in a real-world setting.MethodsThis was a retrospective, comparative, interventional case series. Patients over 30-year-old who underwent phacoemulsification and toric IOL implantation (AcrySof® Toric IOL) by the same surgeon between 2017 and 2018 were included. Eyes with irregular astigmatism, previous corneal refractive surgery, intraocular surgery, corneal pathology, macular pathology and pupil abnormalities were excluded. IOL toricity was determined by using a calculator provided by the AcrySof Toric calculator before 2018 and Barrett Toric Calculator after 2018. Patient demographics, corneal topography, vector and preoperative and postoperative refraction were collected and analyzed at three months postoperative.ResultsThirty-two eyes of 32 patients were included in the final analysis. 0.1D for surgically induced astigmatism was used. Group 1 included 14 eyes assessed with the original (AcrySof) toric IOL calculator, and group 2 included 18 eyes assessed with the Barrett toric IOL calculator. In group 1, postoperative astigmatism less than −1.00D, −0.75 D, and −0.5D was achieved in 88.2%, 76.1% and 53.7% of eyes, respectively, while, in group 2, 89% eyes achieved postoperative residual astigmatism less than 0.5D and all eyes achieved postoperative residual astigmatism less than 0.75D. The proportion of patients with lower postoperative astigmatism was significantly higher in Group 2 (p< 0.05 by chi-square test), a pattern that still held when we divided patients into multiple groups. Vector analysis with the Alpins methods also supported better outcomes in the Barrett group (0.71 D vs 0.35 D).ConclusionThe Barrett Toric calculator resulted in better results in the prediction of residual astigmatism than original (AcrySof) toric calculators.

Outcomes of toric IOL implantation guided by iris-registered femtosecond laser capsulotomy markings

To assess the accuracy and stability of iris-registered femtosecond laser-assisted anterior capsule axis markings (compensating cyclotorsion) along with refractive and visual outcomes after toric IOL implantation. This prospective case series included eyes with visually significant cataracts and regular corneal astigmatism ranging from 1.25D to 4.0D, which received FLACS and toric IOL implantation, at The Eye Institute of West Florida, Largo, Florida, USA. Preoperative iris registration was used in conjunction with a femtosecond laser platform to create cyclotorsion corrected axis marks at the capsulotomy edge to facilitate toric IOL axial alignment. Patients were examined one, seven and thirty days after surgery to assess capsulotomy marks axis, toric IOL axis along with visual and refractive outcomes. Eighteen eyes of 13 patients aged 74.35 ± 8.65years were included. Mean pre-op CDVA was 0.24 ± 0.16 LogMAR, while mean post-op UDVA was 0.09 ± 0.09 LogMAR. Mean pre-op corneal astigmatism was 1.85 ± 0.41 D, decreasing to 0.24 ± 0.41 D of refractive astigmatism postoperatively (p < 0.001). The capsular toric axis markings were visible in 100% of eyes throughout the follow-up; the mean difference between intended capsulotomy mark axis and measured capsulotomy mark axis was 1.6°, 1.7° and 1.3 o at the 1, 7 and 30 day intervals (p > 0.05), respectively. No capsule-related or any other type of complications was noted. Iris-registered femtosecond laser-assisted anterior capsule axis markings are safe and may be considered as an alternative option to the known axis marking techniques for toric IOL axial alignment at the time of cataract surgery.

Clinical outcomes, predictability and rotational stability following implantation of Eyecryl toric versus TECNIS toric intraocular lenses-A comparative study.

To compare the visual outcomes, predictability and rotational stability following implantation of Eyecryl toric versus TECNIS toric intraocular lenses. This retrospective study included 100 eyes of 78 eligible patients who underwent phacoemulsification followed by implantation of either Eyecryl Toric IOL or TECNIS Toric IOL (n = 50 eyes in each group), using an intraoperative image-guided marker less system. All toric IOL implantations were performed under balanced salt solution. At 2weeks, 3months and 6months, uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent refraction, residual astigmatism, and rotational stability of the toric IOL was evaluated and compared. Rotational stability was assessed using ray tracing. Mean age of the participants was 67.8 ± 9.26years in Eyecryl toric group and 64 ± 11years in TECNIS toric group. The mean pre-op corneal astigmatism was 1.75 ± 0.62 D and 2.00 ± 0.71 D in the Eyecryl and TECNIS group, respectively (p = 0.07). At 2weeks and at 6months post-op, there was no statistically significant difference between the UDVA, CDVA, and residual astigmatism between the two groups (p < 0.05). Mean post-operative toric IOL rotation was 3.94 ± 2.27 degrees in the Eyecryl Toric group, and 4.44 ± 2.77 degrees, in the TECNIS Toric group, respectively, the difference was not statistically significant (p = 0.32). One IOL in the Eyecryl group and two IOLs in the TECNIS group required re-positioning for significant post-op rotation at 1week post-op. At 6months, both Eyecryl toric and TECNIS toric IOLs showed comparable post-operative outcomes in terms of UDVA, CDVA, residual astigmatism and rotational stability.

Trifocal toric intraocular lens implantation for cataract in a young patient with congenital nystagmus

We report a case of Trifocal Toric IOL implantation in a patient having cataract with congenital nystagmus. A detailed ocular assessment for pre- and postoperative uniocular and binocular visual acuity, nystagmus characteristics, abnormal head posture, fundus examination, IOP measurement, and biometry was carried out. Preoperative visual acuity was 6/12p and 6/18p in right and left eye, respectively, with binocular visual acuity of 6/12p. Postoperative visual acuity was 6/12 in right and 6/9 in the left eye, respectively. Binocular visual acuity was 6/9 for far and N6 at 40 cm for near after implantation of a trifocal toric IOL. No change in nystagmus characteristics was observed.

PMD3 The Current Burden of Cataract Surgery and Outcomes of Image-Guided Systems: A Targeted Literature Review

To conduct a targeted literature review evaluating the current burden of traditional cataract surgery (with manual marking) and the outcomes associated with digital image-guided systems (DIGS). A targeted review of the literature was undertaken using MEDLINE. The review targeted: 1) publications quantifying the burden of traditional cataract surgery (with manual marking) for Toric IOL implantation, and 2) publications evaluating the outcomes of cataract surgery with DIGS. There were seven studies included in this study, six prospective studies and one meta-analysis. Transcription errors, manual marking inaccuracies, and variabilities from incision size and implantation location were the biggest drivers of burden of traditional cataract surgeries. Transcription errors included incorrect measurement transcription, errors in handwritten results, and illegible writing. Measurement inaccuracies were found to be attributable to movement by the patient, marking pens, and experience of the marker. Additionally, difficulties in accounting for cyclotorsion when making corneal incision and aligning the IOL were observed. Use of DIGS was found to be safe, as or more effective, and more efficient alternative to manual marking. Of the five head-to-head prospective studies, three studies observed significant improvement in accuracy, IOL alignment, and/or visual quality (Strehl Ratio and Modulation Transfer Function). The DIGS significantly reduced Toric IOL misalignment, post-operative astigmatism, and difference vector compared to manual marking in the meta-analysis. This review found a significant burden associated with traditional cataract surgery, and DIGSs to be safe and effective, while also providing surgeons and practices with increased efficiency.

Evaluation of toric IOL implantation in different degrees of astigmatism

Background: correction of the pre-existing regular corneal astigmatism during phacoemulsification.Purpose: Evaluation of the toric IOL rotational stability and efficacy in patients with cataract with pre-existing astigmatism.Patients and methods: 30 eyes of 30 patient of age ranged from 45-75 years old had phacoemulsification surgery with pre-existing regular astigmatism ranged from 1.5-4.5 D without any corneal of ocular abnormality. The patients were examined one week, one month, and third month postoperative. The stability and efficacy were evaluated by the slit lamp against a dilated pupil and by the auto refractometer to measure the postoperative refraction.Results: The IOL axis of orientation is evaluated against the red reflex and calculation of any rotation No need to readjust the IOLs were made. A stable refraction is obtained by the first month with no changes in the follow up period.Conclusion: The toric IOL was much stable, effective and predictable way in correction of astigmatism.

Prevention method of toric intraocular lens rotation after phacoemulsification of cataract using a standard capsule ring

At the same time, phacoemulsification of cataracts remains the most popular surgery. But the problem among phacosurgeons is the correction of existing corneal astigmatism. According to studies, about 30% of the world's population have corneal astigmatism with a strength of 0.75D and above, which leads to a decrease in visual acuity after phacoemulsification of cataracts in the absence of its correction.The most commonly used method to correct corneal astigmatism is the implantation of toric intraocular lenses (TIOL). The main condition for obtaining high visual acuity after TIOL implantation is the location of the astigmatic component of the artificial lens in accordance with the strong meridian of the cornea. The aim of this study was to evaluate the effectiveness of the proposed method of preventing the toric intraocular lens rotation after phacoemulsification of cataracts in the eyes with corneal astigmatism by implantation of a standart capsule ring.Material and methods. The article presents the results of a comprehensive examination of 43 patients (59 eyes) who underwent surgery by phacoemulsification of cataracts with implantation of toric IOL to correct concomitant corneal astigmatism. Corneal astigmatism according to keratometry ranged from 0.5D to 4.25D (average 1.96 ± 0.1 D). Patients were divided into 2 groups. The first group consisted of 26 patients (31 eyes). Patients in this group underwent phacoemulsification with toric IOL implantation according to standard techniques without the use of techniques that prevent rotation of the artificial lens in the postoperative period. The second group included 18 patients (28 eyes) who were operated on according to our proposed prevention method of TIOL rotation. As a result of the study, it was found that rotation of TIOL was detected 6 months after surgery in the I group without the use of developed method in 22 eyes (70.9%), in the II group, where the capsule ring was implanted, rotation occurred in 12 eyes (42.85%). In the II group in all cases, the deviation of the TIOL axis did not exceed 6 degrees. The proposed method of prevention of rotation of TIOL allows to increase the efficiency of phacoemulsification of cataracts.Conclusions. Developed a method of preventing the rotation of the toric intraocular lens using a standard capsule ring, which is implanted and located on top of the haptic support elements of the artificial lens can increase the efficiency of phacoemulsification of cataracts in the eyes with corneal astigmatism, contributes to the rotational stability of the toric lens and provides long-term results of visual functions, reduces the need for repeated surgery due to reposition of the rotated lens and can be recommended for implementation in the practice of ophthalmic surgeons.The use of implantation of a standard capsule ring according to the proposed in this study method prevents the rotation of the toric intraocular lens by more than 6 degrees in all cases, which does not significantly reduce visual acuity and does not require reposition of the artificial lens. This method of preventing rotation of the toric intraocular lens allows to achieve visual acuity of 0.7 and above in 85.6% of cases.

Clinical outcomes and rotational stability following implantation of Eyecryl toric intraocular lens - Results of a 12-months prospective study.

Purpose:To evaluate the clinical performance and rotational stability after implantation of Eyecryl Toric monofocal IOL following cataract surgery.Methods:Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria were implanted with Eyecryl Toric IOL. All implantations were done under balanced salt solution. A marker-less system Callisto Eye (Carl Zeiss Meditec, Germany) was used to guide the intra-operative alignment of the toric IOL.Results:A total of 50 eyes from 39 patients with mean age of 68.2 ± 8.7 years were included in the study. At 12 months, 82% (41) eyes had cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ± 0.50 D for 94% (n = 47) eyes and refractive cylinder accuracy was within ≤0.50 D in 98% (n = 49) eyes. Average post-op rotation at 1 year was 4.06 ± 2.15 degrees. Eighty-four percent of eyes were within 5 degrees and 16% were within 6-10 degrees of intended axis. Two eyes required IOL re-positioning due to significant rotation of the toric IOL (>10 degrees), identified within the 1st week after surgery.Conclusion:Eyecryl toric IOL demonstrated the ability to achieve a significant reduction in astigmatism, improved UDVA outcomes, high levels of spectacle independence, low rates of intra-operative injector related complications and good rotational stability at 12 months post-op.

Long-term refractive outcomes in patients with cataracts and keratoconus after phacoemulsification with toric intraocular lens implant.

To determine the refractive stability of patients with keratoconus and cataracts after the implantation of a toric intraocular lens. This is a cross-sectional, retrospectivestudy. Clinical records from patients with non-progressive keratoconus and cataracts that underwent non-complicated phacoemulsification with toric IOL implantation were reviewed. Mean keratometry (Km), refractive cylinder (RC), spherical equivalent (SE), steeper keratometry (K), and axis were evaluated at the 1-month, 6-month, 12-month, and 24-month follow-up visits. Fifty-four eyes from 41 patients were included. Thirty-seven (68.5%) female and 17 (31.5%) male patients, with a mean age of 67.52 ± 8.22. Refractive cylinder at postoperative 30 days was -1.61 ± 1.23, 6-month -1.22 ± 0.80, 12-month -1.10 ± 0.83 and 24-month visit after surgery was -1.37 ± 0.77(p = 0.290). SE at the 30-day visit was -0.82 ± 1.90, 6-month -0.64 ± 1.23, 12-month -0.78 ± 1.91 and at 24-month postoperative visit -1.02 ± 1.87 (p = 0.210). Km value at the 1-month visit was 47.23 ± 1.95, 6-month 47.87 ± 1.61, 12-month 46.39 ± 2.52 and 24-month postoperative visit 46.92 ± 1.26 (p = 0.877). The steeper K axis in the 30-day control was 78.53 ± 30.12, 6-month 77.29± 37.68, 1-year 93.13 ± 62.42, 24-month 67.31 ± 38.49 (p = 0.632). Our findings suggest a low variation in the refractive outcome for patients with mild and moderate keratoconus and cataracts, without evident progression signals, a demonstrated keratoconus clinical stability. No statistically significant postoperative changes in the refractive cylinder, SE, mean K, and steeper K axis were observed, which suggests good predictability for toric IOL implant.

Оптико-реконструктивное лечение пациента с эссенциально-мезодермальной дистрофией радужки

Essentially mesodermal dystrophy of the iris is a type of iridocorneal endothelial syndrome and has a chronic progressive course. It stems from the local fibrosis in the outer border of the iris, which subsequently leads the peripheral iris to pull up and the pupil to deform. Purpose. To evaluate outcome of the modern high-tech surgical treatment, which allows to increase visual functions, prevent decompensation of intraocular pressure and achieve the desired cosmetic effect. Material and methods. Patient R., 48 y.o., with diagnosed OU Essential-mesodermal dystrophy of the iris, low hyperopia, astigmatism, presbyopia. In order to prevent the development of secondary glaucoma and to correct refractive anomalies, phacoemulsification with implantation of a multifocal toric IOL, synechiotomy, and iris plastic surgery were performed. The calculation of MTIOL was performed using the data from the VERION™ Image Guided System navigation computing complex (Alcon, USA) and IOLMaster® 700 optical biometer (Carl Zeiss, Germany). Results. During follow-up examinations the patient noticed an increase in visual acuity with stabilization by the 6th month, a significant decrease in undesirable optical phenomena (glare, halo) and was satisfied with the postoperative cosmetic result. The level of intraocular pressure stabilized by the 6th month after surgery and was within the reference range by the 9th month. No intraoperative complications were observed. Control UBM scans showed OU transparent cornea, anterior chamber shallower than the average depth, stratified stroma of the iris, moderate anterior chamber angle, intact ciliary body, pupil in the center, IOL in capsule bag. Conclusion. The case describes outcome of successful surgical treatment of rare variety of iridocorneal endothelial syndrome, increase in visual functions, achievement of the desired cosmetic effect, and improvement in the quality of life of the working age patient.

Visual performance after bilateral toric extended depth-of-focus IOL exchange targeted for micromonovision.

To evaluate overall patient satisfaction, spectacle independence, binocular visual acuity, rotational stability, prevalence of optical phenomena, and decentration and tilt after bilateral toric extended depth-of-focus intraocular lens (EDOF IOL) implantation targeted for micromonovision. Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. Prospective case series. The study included 52 eyes of 26 patients with regular corneal astigmatism from 0.75 to 2.60 diopters (D) that were implanted bilaterally with a toric EDOF IOL targeted for micromonovision. Postoperative visual acuity, astigmatism reduction, rotation, tilt, decentration, spectacle independence, patient satisfaction, and photic phenomena were assessed. For the 52 eyes studied, binocular means expressed in logarithm of the minimum angle resolution for postoperative corrected distance, uncorrected distance, uncorrected intermediate, and uncorrected near visual acuities were -0.10 (±0.12), -0.01 (±0.13), 0.01 (±0.14), and 0.13 (±0.14), respectively. Mean refractive astigmatism reduction was 1.31 ± 0.67 D resulting in a mean refractive cylinder of 0.47 ± 0.46 D at the 3-month visit. Mean postoperative rotation was 3.5 ± 3.5 degrees, at the 3-month time point. Most prevalent dysphotopsia were halos, starburst, and glare affecting 6 (23%), 6 (23%), and 5 (19%) of 26 patients, respectively; 20 (77%) of 26 patients reported spectacle independence, with 19 (95%), 19 (95%), and 14 (70%) of 20 patients questioned being satisfied with distance, intermediate, and near vision, respectively. Toric EDOF IOL implantation targeted for micromonovision resulted in reliable reduction of preoperative astigmatism with a high degree of postoperative rotational predictability and centration, enabling functional distance, intermediate, and near vision, which manifested itself in high patient satisfaction.

Clinical outcomes after aphakic versus aphakic/pseudophakic intraoperative aberrometry in cataract surgery with toric IOL implantation.

To determine if there was a clinically significant difference in clinical outcomes after toric IOL implantation based on intraoperative aberrometry (IA), where eyes were measured either in the aphakic state only or both the aphakic and pseudophakic states. A prospective, randomized, contralateral eye study was performed at one site in Poughkeepsie, NY, USA. Subjects included patients presenting for uncomplicated bilateral cataract surgery eligible for toric lens implantation with regular corneal astigmatism in both eyes whose toric IOL implantation was based on IA. One eye was measured when aphakic and the other when both aphakic and pseudophakic. The primary outcome measure was the magnitude of residual refractive astigmatism. Secondary measures included the percentage of eyes with 0.50D or less of residual refractive astigmatism, the spherical equivalent refraction and the time for IA measurement. Mean residual refractive astigmatism was not statistically significantly different between groups (0.32D ± 0.46D IA_1 vs. 0.23D ± 0.35D IA_2, p = 0.25), nor was the percentage of eyes with a residual refractive cylinder of 0.50D or less (94% in both groups, p = 1.0). The average time to measure the pseudophakic eye was 3min, 46s. Aphakic IA measurements appeared to produce better spherical equivalent refractive results relative to preoperative calculations. Pseudophakic IA measurements took nearly 4min per case. Residual refractive astigmatism was not appreciably lower when pseudophakic IA measurements were made after aphakic IA measurements, which suggests aphakic IA measurements alone provide good clinical results with toric IOLs.

Toric intraocular lens for correction of high corneal astigmatism in cataract patients

AIM: To evaluate the efficacy of Bi-Flex toric intraocular lens (T-IOL; Medicontur, Medical Engineering, Ltd., Inc.) implantation to correct preexisting astigmatism in patients having cataract surgery. METHODS: This retrospective consecutive study included 22 eyes of 16 patients with more than 2.50 diopters (D) of corneal preexisting astigmatism having cataract. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction and keratometric and topographic cylinder were measured. Postoperative the toric IOL axis was evaluated using vector analysis. RESULTS: Postoperatively, subjective refractive cylinder was reduced significant (P&lt;0.05) from 4.05±1.53 D to 1.35±0.86 D. The component J0 reduced in magnitude from -0.81±2.02 D to -0.12±0.62 D (P&lt;0.05). Both, UCVA and BCVA improved significantly at 1mo after surgery (P&lt;0.05 in both cases). After the surgery, the UCVA and BCVA were 0.24±0.19 and 0.06±0.08, respectively. The mean toric IOL axis rotation was 2.95±5.25 degree, with rotation less than 10 degrees in 86.36% of eyes. No differences in mean keratometric values obtained before and after surgery were found (P&gt;0.05 for J0 and J45). CONCLUSION: Implantation of the Bi-Flex toric IOL is a safe and effective method to correct the preexisting regular astigmatism (greater than 2.50D).

A study on evaluation of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery- At a tertiary care hospital

The current study evaluates the results of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery. This study was done on Prospective interventional at Osmania Medical College, Sarojini Devi Eye Hospital, Hyderabad. The sample of the study is included 40 eyes of 38 consecutive patients with 1.5 D or more of pre-existing astigmatism consists of cataract surgery with toric open-loop IOL implantation (Alcon, Fort Worth, TX, USA). The pre-operative markings for the position of incisions and IOL placement were being done under the slit lamp. The visual acuity, residual keratometric and refractive cylinders, and toric IOL axis were being measured. 54.71 years was the mean age of the patients. All the 40 eyes at the final check-up had post-operative unaided visual acuity of 6/12 or better. 10 patients (25 %) had an unaided visual acuity of 6/6.37 eyes (92.5%) had best corrected post-operative visual acuity of 6/9 or better. The mean pre-operative refractive astigmatism in 40 eyes was 2.34D. 22 eyes had the Refractive astigmatism of &amp;#62;2D. No eyes had refractive astigmatism of &amp;#60;1.5D. The mean axial length was 24.22mmOut of 40 eyes in which Toric IOL was implanted, the post-operative residual refractive sphere was seen in 4 eyes. Out of 40 eyes in whom Toric IOL was implanted, a post-operative residual refractive cylinder was seen in 30 eyes. 10 patients had No post-operative refractive cylinder. The mean post-operative residual refractive cylinder was 0.58D. The mean Post-operative Keratometric cylinder was 2.24D. The mean post-operative Keratometric cylinder was 2.34D. In comparison, both pre-operative and post-operative keratometric astigmatism, it was found that there was no statistically significant difference between them.The misalignment of Toric IOL was 10 degrees or less in 36 patients (94.73%) and less than 5 degrees in 22 patients (57.89%). Misalignment of &amp;#62;10 degrees (11 degrees and 13 degrees) was seen in 2 patients. The mean IOL rotation among 38 patients was 4.55 degrees (Range 0-13 degrees, SD 3.43). None of the eyes required repositioning. The results of this study show that implantation of AcrysofTor ic IOL is a good surgical method to evaluate pre-existing corneal astigmatism in cataract surgery. Acrysoftoric IOL has shown good rotational stability.

Correlations of Corneal Spherical Aberration with Astigmatism and Axial Length in Cataract Patients.

Purpose To clarify the distribution of corneal spherical aberrations (SAs) in cataract patients with different corneal astigmatism and axial length. Setting Department of Ophthalmology and Vision Science of the Eye and ENT Hospital of Fudan University, Shanghai, China. Design Retrospective case series. Methods The axial length, corneal SAs, and other corneal biometrics were collected in cataract patients with Pentacam HR and IOLMaster 500. The statistical analysis of the corneal SAs was based on the stratification of axial length and anterior corneal astigmatism. Results In total, 6747 eyes of 6747 patients were recruited, with 2416 eyes (58.17 ± 16.81 years old) in the astigmatism group (anterior corneal astigmatism ≥1 D) and others (61.82 ± 12.64 years old) in the control group. In patients with astigmatism <2 D, the total and anterior SAs decreased as the axial length increased (P < 0.001). The total corneal SAs of patients with astigmatism of 2-3 D stabilized at around 0.29 μm, whereas those of patients with anterior corneal astigmatism ≥3 D tended to be variable. Age and anterior corneal astigmatism had positive and negative effects, respectively, on SA in the regression model. Conclusions Axial length has a negative effect on the anterior and total corneal SAs, which stabled around 0.33 μm and 0.30 μm in patients with axial length of ≥26 mm, respectively. Individualized SA adjustments are essential for patients undergoing aspheric toric IOL implantation with preoperative anterior corneal astigmatism of 1-2 D or ≥3 D. Toric IOLs with a negative SA of −0.20 μm are recommended for patients with anterior corneal astigmatism of 2-3 D if no customized therapy is warranted.

Accuracy of toric intraocular lens implantation using automated vs manual marking

BackgroundAccurate alignment of toric intraocular lens (TIOL) to steep corneal astigmatic axis is important to achieve effective postoperative results. The authors compare the accuracy of astigmatism correction using automated and manual marking in TIOL implantation during cataract surgery.MethodsOne hundred thirty-two eyes with nuclear density from Grade 2 to 4 were randomly subdivided into 2 groups (automated and manual marking). All patients underwent manual marking and the steep axis was compared to SensoMotoric Instruments (SMI). After phacoemulsification, 62 patients underwent toric IOL implantation using the SMI and 70 patients underwent toric IOL implantation using manual marking. Intraoperative measurement was the steep axis difference. Clinical measurements included preoperative and postoperative best corrected visual acuity (BCVA), and TIOL axis.ResultsThe intraoperative steep axis difference between SMI and manual marking was 7.86 ± 6.4 degrees. The difference between the preoperative steep axis and the postoperative TIOL axis using SMI (3.63 ± 1.12 degrees) was significantly lower than that using manual marking (8.29 ± 2.23 degrees) (P < 0.05).ConclusionsThe steep axis measurements may be different when using SMI vs. manual marking. The SMI is more accurate than manual marking for TIOL implantation during cataract surgery.Trial registrationCurrent Controlled Trials ISRCTN12294725, Retrospectively registered, on 20 July 2018.

Vector Analysis of Anticipated Residual Astigmatism and Actual Residual Astigmatism in Toric IOL Implantation using Callisto-Eye

&#x0D; &#x0D; &#x0D; Purpose: The aim of this study is to investigate the differences of actual residual astigmatism and anticipated residual astigmatism using Alpin’s Vector Analysis from toric IOL implantation using Image Guided System (Callisto EyeTM) and other method. Method: This was a retrospective case series study done in Jakarta Eyte Center. Data was taken consecutively from medical records of Toric IOL implantation from January 2016 to November 2017. Primary data taken were demographic data, anticipated residual astigmatism, refractive examination both subyectively and objectively. Secondary data was analized using Alpin’s Vector Analysis to substract anticipated residual astigmatism from actrual residual astigmatism. Spherical equivalent and axis shifting also taken from refractive ecamination results. Data was divided into subgrup of Toric IOL implantation using Image Guided System and subgrup of Toric IOL implantation using other method. &#x0D; Results: There was a statically significant difference of subjective refraction vector analysis result between subgroups with differnce of 0.312 dioptri (p value 0.004). Objective refraction vector analysis shows no statistically difference between two subgrups (p value 0.286). Spherical equivalent both subjectively and objectively not differ (p value 0.721 and 0,689). Axis shifting from refractive examination also not statistically significant differ between two subgrups (p value 0.432 and 0.358) &#x0D; Conclusion: Difference between actual residual astigmatism from subjective refraction and anticipated residual astigmatism is lower whrn usingCallisto EyeTM. &#x0D; &#x0D; &#x0D;

Результаты имплантации торических ИОЛ у пациентов с катарактой и стабилизированным кератоконусом

Purpose . To evaluate the clinical and functional results of phacoemulsification with toric IOL implantation in eyes with stable keratoconus. Material and methods . This study comprised 49 patients (49 eyes) with stable keratoconus and cataract post ICRS implantation and UVcrosslinking in anamnesis. Mean age was 46±1.2 years. Depending on different corneal astigmatism constant, all patients were subdivided in clinical groups. The first one was 27 patients with corneal astigmatism from 1.25 to 4.0D (2.52±1.63D) where the phaco AcrySof IQ Toric were implanted (Alcon, USA). The second group included 22 patients with corneal astigmatism from 4.0 to 10.50D (7.43±1.81D). In that group the IOL AT Torbi 709M (Carl Zeiss Meditec, Germany) was implanted, with the possibility of astigmatism corr ection up to 12.0 D. Results . Postoperative results were evaluated after 1, 3, 6 and 12 months. By the end of the first month all patients registered a significant visual acuity improvement. The UCVA and BCVA were 0.6±0.19 (from 0.4 to 0.7) and 0.8±0.1 (from 0.7 to 0.9) in the group 1. In the group 2: 0.5±0.18 (from 0.3 to 0.6) and 0.6±0.14 (from 0.5 to 0.7). The final refractive criteria stabilization was achieved 3 months after the surgery. The objective spherical and cylindrical refraction in the group 1 was –1.5±1.58 and – 0.75±0.56D; in the group 2: –1.25±2.22 and –1.25±0.56D, respectively. In refractive results estimation a hyperopic shift was found, +0.67±0.19D (from +0.53 to +0.98D) in the group 1 and +0.98±0.21D (from +0.75 to +1.21D) i n the group 2. Conclusion . Phaco with toric IOL implantation is a safe and effective option of ametropia correction in eyes with stable keratoconus, which leads to a visual function improvement in overwhelming majority of patients, however, this method needs to capture all corneal parameters. The obtained results require a deeper further i nvestigation.

Хирургическая коррекция астигматизма в ходе факоэмульсификации катаракты с применением системы VERION

Initial corneal astigmatism is one of the leading problems affecting the refractive result after phacoemulsification of cataract (FEC). For its correction, various techniques were proposed, which were simultaneously performed with cataract surgery, in order to obtain high-quality vision without additional correction. Purpose . To perform a comparative evaluation of various surgical methods in a simultaneous correction of the initial corneal astigmatism during the phacoemulsification of cataracts using the VERION system. Material and methods . Three groups of patients aged from 40 to 75 years were formed. All patients were diagnosed with cataract with concomitant regular astigmatism: the group 1 included 15 patients (15 eyes) with concomitant astigmatism from 2.0 to 6.0D, where the Ascrysof IQ TORIC lens was implanted; the group 2 – 15 patients (15 eyes) with concomitant astigmatism from 1.25 to 2.5D, where limbal slack (arcuate)incisions using a Femto LDV Z8 femtolaser were performed during the FEC; the group 3 – 12 patients (12 eyes) with concomitant astigmatism from 1.25 to 2.5D, where an arcuate incision was performed with a diamond keratotomic knife during archaic cataract phacoemulsification. Results. All patients received a reduction in the initial astigmatism in the group 1 up to 0.75±0.11 D, in the group 2 – to 1.0±0.25 D and to 1.15±0.25 in the group 3. Uncorrected visual acuity was 0.75±0.11, 0.59±0.14 and 0.49±0.18, respectively, that indicates an efficiency of the presented methods of surgical correction of corneal astigmatism during the FEC. The fastest recovery and stable results were achieved in patients with toric IOL implantation. Conclusion. The successful outcome of surgical cataract treatment in patients with concomitant astigmatism mainly depends on the correctness of the choice of treatment method, so a differentiated approach allows to achieve the maximum refractive result after the operation.

The application of Verion system in toric intraocular lens implantation

Objective To analyze the efficacy of Verion system assisted phacoemulsification cornbined with toric intraocular lens implantation. Methods The data of 40 eyes of 40 cases with age-related cataract with more than 1.0 D of preexisting corneal astigmatism before surgery were collected and analyzed retrospectively. All cases were divided randomly into two groups. The observation group, 20 eyes, underwent Verion system assisted phacoemulsification and toric intraocular lens implantaiton. The control group, 20 eyes, underwent toric IOL implantation with application Alcon astigmatic IOL online formula for calculating the diopter and manual slitlamp-assisted preoperative marking. The visual acuity, contrst sensitivity, residual refractive cylinder and toric IOL axis were recorded. The follow-up time was 3-6 months. Results The uncorrected visual acuity after surgery was improved in both groups. In observation group, the visual acuity (log MAR) after surgery was from 0.96±0.19 to 0.07±0.08 (P=0.001) ; in control group from 0.59±0.33 to 0.18±0.11 (P=0.044). The difference was not statistically significant between the preoperative estimated residual astigmatism and the actual residual astigmatism in observation group(P=0.687), but the difference in control group was statistically significant(P=0.029). The difference in visual acuity and contrast sensitivity values between the two groups were not statistically significant at 5 spatial frequencies of noctovision (P>0.05). The mean toric lens axis rotation in observation group of 3.00°±2.12°was lower than 7.57°±2.64°in control group(P=0.010). The difference was not significant between the two groups in the preoperative estimated residual astigmatism. The actual residual astigmatism in observation group was (0.22±0.18) D and (0.64±0.24) D in control group, the difference was statistically significant(P=0.010). Conclusion The toric IOL implantation application of Verion system is better stability and less residual astigmatism.It is an effective option to correct preexisting astigmatism in cataract patients. Key words: Digital system, Verion; IOL, intraocular; Contrast sensitivity; Axis rotation