Use Of Toric Intraocular Lens Research Articles

Treatment of astigmatism during phacoemulsification.

To compare the effectiveness of limbal relaxing incisions (LRI) with that of toric intraocular lens (IOL) implantation for the treatment of astigmatism during phacoemulsification using nonvectorial (predictability, safety, and efficacy) and vectorial analyses. This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism of 0.75-2.50 diopters (D) in both eyes. Patients were randomly assigned to 2 groups: a toric IOL group, which received toric IOLs in both eyes, and an LRI group, which received spherical IOLs associated with LRI placement in both eyes. All patients were evaluated at 1, 3, and 6 months after surgery, when refractive astigmatism analysis was performed using both nonvectorial and Alpins vectorial methods. Outcomes were assessed within each group and compared between groups. The proportion of eyes within ±0.50 D of the intended correction at 3 and 6 months after surgery was 75% and 71.88%, respectively, in the LRI group and 40% and 66.67%, respectively, in the toric IOL group. In the remaining period, the proportion was greater in the toric IOL group. The safety index showed no difference at any time point. The efficacy index at 1 and 3 months after surgery was significantly higher in the toric IOL group (0.43 and 0.44, respectively) than in the LRI group (0.31 and 0.36, respectively). At 6 months after surgery, the status of eyes in the LRI group was as follows: 53.13% were undercorrected, 43.74% achieved the intended correction, and 3.13% were overcorrected. In the toric IOL group, 16.76% eyes were undercorrected, 76.67% achieved the intended correction, and 6.67% were overcorrected. The success rates for astigmatic surgery, astigmatism reduction at the intended axis, and astigmatism corrected were 43%, 62%, and 64%, respectively, in the LRI group and 57%, 81%, and 94%, respectively, in the toric IOL group. Our results suggest that the use of toric IOLs may be advantageous over the use of LRIs for the treatment of astigmatism during phacoemulsification. Although such advantages seem subtle in nonvectorial analyses, they are highlighted in vectorial analyses.

Comparison of clinical outcomes between limbal relaxing incisions and toric intraocular lenses in eyes with astigmatic corneas

Objective: To compare refractive and vectorial outcomes of limbal relaxing incisions (LRI) versus toric intraocular lenses (IOL) in the treatment of preexisting corneal astigmatism at the time of phacoemulsification. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism between 0.75 and 2.50 diopters in both eyes. Patients were randomly assorted in two groups: one assigned to receive AcrySof Toric™ IOL in both eyes, and another one assigned to have AcrySof Natural™ IOL associated with LRI, also in both eyes. All patients were re-evaluated, postoperatively, at 1, 3 and 6 months, when refractive astigmatism analysis was performed using vectorial methods proposed by Thibos. Variability of outcomes within each group and between groups were assessed and compared. Results: Manifest refractive cylinder, in diopters (D), as means ± standard deviation, in the LRI group for 1-month, 3-month and 6-month re-evalutions were respectively -0.66 ± 0.30; -0.70 ± 0.21 and -0.74 ± 0.26 when compared to -0.58 ± 0.24; -0.63 ± 0.20, and -0.62 ± 0.17 in the toric IOL group. (p value ≥ 0.06). Vectorial analysis evidenced greater astigmatism reduction in the toric IOL group in the 6th postoperative month, when postoperative mean astigmatic power vector was 0.31 D, when compared to 0.37 D in the LRI group (p value = 0.00). Conclusions: A trend of slightly better refractive outcomes favoring toric IOL group was seen, although such a trend was not statistically significant. Vectorial analysis, however, suggests that the use of toric IOL may constitute a more advantageous approach in the treatment of pre-existing corneal astigmatism, simultaneously with phacoemulsification.

Visual acuity improvements after implantation of toric intraocular lenses in cataract patients with astigmatism: a systematic review

BackgroundCataracts are a common and significant cause of visual impairment globally. We aimed to evaluate uncorrected distance visual acuity (UDVA) as an outcome in treating astigmatic cataract patients to assist clinicians or ophthalmologists in their decision making process regarding available interventions.MethodsMedline, Embase and Evidence Based Reviews were systematically reviewed to identify relevant studies reporting changes in UDVA, UIVA and UNVA after cataract surgery in presbyopic patients. Strict inclusion/exclusion criteria were used to exclude any non-relevant studies. Relevant outcomes (UDVA, UIVA and UNVA) were identified from the studies retrieved through the systematic review process.ResultsThe systematic review identified 11 studies which reported UCVA. All 11 studies reported UDVA. Four brands of toric intraocular lenses (IOLs) were reported in these studies. All studies identified in the literature search reported improvements in UDVA following surgical implant of a toric IOL. The largest improvements in VA were reported using the Human Optics MicroSil toric IOL (0.74 LogMAR, UDVA) and the smallest improvements were also reported using the Human Optics MicroSil toric IOL (0.23 LogMAR, UDVA) in a different study.ConclusionsThe results of this systematic review showed the aggregate of studies reporting a beneficial increase in UDVA with the use of toric IOLs in cataract patients with astigmatism.

Results of the AcrySof Toric intraocular lenses implantation

SummaryBackgroundThe expectations of post-removal cataract surgery patients are extremely high, and best vision acuity is expected. The best refractive results are influenced by two factors – cataract surgical removal and the corneal astigmatism correction. Currently, the two most often applied corneal astigmatism removal methods are laser surgery and toric intraocular lens implantation, with the latter method being both more stable and more reversible. This study aimed to estimate the surgical astigmatism correction efficiency after AcrySof Toric intraocular lens implantation in patients with corneal astigmatism.Material/MethodsWe used the AcrySof Toric IOL 1-part hydrophobic acrylic lenses. The retrospective research covered 30 eyeballs in 28 cataract and corneal astigmatism patients, with the AcrySof Toric lens implanted by one surgeon.ResultsIn our test group 92.31% of post-surgical patients (phacoemulsification and toric lenses implantation) gained the best uncorrected visual acuity, range 0.6–1.0; and in 7.69% of patients the acuity was 0.4–0.6. Lens rotation was examined three weeks after the surgical procedure and a 3.24±3.41 degree axial displacement was observed; however, this lens rotation was clinically unimportant.Based on the analysis of post-surgical results, the corneal astigmatism was 84.2% lower than before the procedure.ConclusionsWe noticed clinically and statistically important vision acuity improvement in the corneal astigmatism patients. The patients’ high satisfaction was conditioned by proper pre-surgery qualification. Astigmatism correction by cataract removal surgery is a safe and effective surgical solution. In the future, we expect the use of toric intraocular lenses will become widespread and significant.

Treating astigmatism at the time of cataract surgery.

An increasingly important goal of modern cataract and implant surgery is to obtain the most desirable refractive outcome for our patients, and in so doing, decrease their dependence upon spectacle correction. Refined spherical outcomes are now achieved by directing close attention to biometry technique, through the use of third generation intraocular lens (IOL) power formulae, and refinements in technology such as partial coherence interferometry. Similarly, improvements in astigmatic outcomes are now possible by focusing upon and obtaining more accurate preoperative cylinder measurements, careful surgical planning particularly in regard to incision(s) design, use of toric IOLs, and employing advanced postoperative enhancement techniques. Because of these refinements in technique and technology, the field of cataract and implant surgery has emerged as a true and recognized form of refractive surgery.