Outcomes of toric intraocular lens realignment surgery done using slit-lamp method and wavefront aberrometry method

Purpose: To compare the slit?lamp method and wavefront aberrometry method based on outcomes of toric realignment surgeries. Settings: Tertiary care ophthalmic hospital. Design: Retrospective study. Methods: This study included all eyes undergoing toric intraocular lens (TIOL) realignment surgery between January 2019 and December 2021 for which TIOL axis assessment by slit?lamp method and wavefront aberrometry method was available. Data were retrieved from electronic medical records, and we documented demographics, uncorrected visual acuity (UCVA), subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods on postoperative day 1 and day 14. In patients with misalignment, TIOL was realigned to the original position in group 1 (27 patients) and to an axis based on calculations provided by wavefront aberrometer in group 2 (25 patients). Post?realignment surgery, UCVA, subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods were assessed and analyzed. Results: We analyzed 52 eyes and found that the mean preoperative misalignment with the slit?lamp method (44.9° ±20.0°) and wavefront aberrometry (47.1° ±19.5°) was similar. The corresponding degrees of misalignment post?TIOL repositioning surgeries were 5.2° ±5.2° (slit?lamp method) and 4.7° ±5.1° (wavefront aberrometry) (P = 0.615). Both groups showed significant improvement in median log of minimum angle of resolution (logMAR) UCVA and reduction in median refractive cylinder. Conclusions: Slit?lamp method is as good as wavefront aberrometer method to assess TIOL axis. Toric realignment surgery is found to be safe, and realigning TIOL based on either slit?lamp method or wavefront aberrometer method equally improved UCVA and decreased residual refractive cylinder.

Refractive outcomes of toric intra-ocular lens implantation in cases of high posterior corneal astigmatism

Purpose: To evaluate whether the toric intra?ocular lens (IOL) power calculation based on total corneal astigmatism (TCA) in eyes with high posterior corneal astigmatism (PCA) could result in a systematic over?correction or under?correction after operation. Methods: The present study included a mono?centric retrospective study design. The data were collected from 62 consecutive eyes during uncomplicated cataract surgery by a single surgeon with a measured PCA of 0.50 diopters (D) or higher. Toric IOL calculations were made using TCA measurements. The eyes were grouped as either “with?the?rule” (WTR) or “against?the?rule” (ATR) on the basis of the steep anterior corneal meridian. The post?operative refractive astigmatic prediction error was analyzed 1 month post?operatively using the vector analysis by the Alpins method and double?angle plots method. Results: The correction indexes were 1.14 ± 0.29 in the ATR eyes and 1.25 ± 0.18 for the WTR eyes, indicating a tendency toward over?correction. The mean over?correction was 0.22 ± 0.52D in the ATR group and 0.65 ± 0.60D in the WTR group. The magnitude of error (ME) values were significantly different from the ideal value of zero in both groups (ATR: P = 0.03; WTR: P = 0.00). No significant difference in mean absolute error (MAE) in predicted residual astigmatism was found between ATR and WTR groups (0.61 ± 0.42 D versus 0.64 ± 0.39 D; P = 0.54). The ATR group yielded better results, with 48% <0.50D prediction error in the main analysis. Conclusions: The results suggested that in cases of high PCA, the toric IOL calculation, which was performed using TCA, may cause a potential over?correction in the ATR and WTR eyes. For ATR eyes, over?correction led to slight disruption of post?operative visual quality because of the “with?the?rule” residual astigmatism after operation. Therefore, we suggested using TCA for toric IOL calculation in ATR eyes.

A new intraocular lens marker to guide the implantation of toric intraocular lenses in small and mid-dilating pupils

Insufficient pupillary dilatation is a significant challenge during cataract surgery, as it increases the risk of various intraoperative complications. Implantation of toric intraocular lenses (TIOL) is particularly difficult in eyes with small pupils, as the toric marks are provided in the periphery of the IOL optic, making the visualization of the same difficult for proper alignment. Attempts at visualizing these marks using a second instrument such as a dialler or iris retractor lead to additional manipulations in the anterior chamber resulting in increased chances of postoperative inflammation and intraocular pressure rise. A new intraocular lens (IOL) marker to guide the implantation of TIOLs in eyes with small pupils is described, which can potentially be beneficial in achieving accurate alignment of toric IOLs in small pupils, without the need for additional manipulations, thus improving safety, efficacy, and success rates of TIOL implantation in these eyes.

Comparative evaluation of intraoperative aberrometry and Barrett’s toric calculator in toric intraocular lens implantation

Purpose: Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real?time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation. Methods: This was an institution?based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar?LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version?21 was used; P < 0.05 considered significant. Results: Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (?0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (?0.14 ± 0.32D) than IA (0.001 ± 0.33D) (?0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one?month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, ?0.57 ± 0.26D, and ?0.18 ± 0.27D, respectively. Conclusion: Both IA and BTC give reliable and comparable refractive results for tIOL implantation.

Comparison of the clinical outcomes of Eyecryl™ and Tecnis® toric intraocular lenses: A real-world study

Purpose: To compare the postoperative uncorrected distance visual acuity (UDVA) and refractive outcomes of cataract patients with astigmatism following implantation of Eyecryl™ and Tecnis® toric intraocular lenses (IOLs). Methods: We conducted a single?center, retrospective study including patients who had undergone phacoemulsification and implantation with either Eyecryl™ toric (Group 1) or Tecnis® toric (Group 2) IOL. The primary outcome measures included postoperative UDVA and residual astigmatism at 3 months. The secondary outcome measure was IOL misalignment >10° throughout the follow?up period. Results: One hundred and eight eyes of 76 patients (44 males and 32 females) were analyzed. Twenty?nine patients (38 eyes) received Eyecryl™ toric IOL (Group 1), and 47 patients (70 eyes) received Tecnis® toric IOL (Group 2). Groups 1 and 2 showed a mean postoperative logMAR UDVA of 0.09 ± 0.11 and 0.06 ± 0.09, respectively, at 3 months (P = 0.114). In both groups, all the eyes achieved a postoperative UDVA of ?0.3 logMAR. The postoperative residual astigmatism of group 1 and group 2 was ?0.29 ± 0.34 D and ?0.16 ± 0.27 D, respectively (P = 0.038). Postoperative astigmatism was within ± 1.00 D in all the eyes. No eyes had an IOL misalignment >10° throughout the follow?up period. Conclusion: Both Eyecryl™ and Tecnis® toric IOLs provided significant improvement in uncorrected visual acuity and astigmatism correction postoperatively. The Tecnis® toric IOL provided statistically significant lower residual astigmatism than Eyecryl™toric IOL. However, the difference in postoperative astigmatism between the two IOLs was clinically insignificant

Comparing IOLM700 TK, Berdahl and Hardten astigmatism fix calculator and Barrett Rx formula in managing residual astigmatism due to toric intraocular lens misalignment

Purpose: To compare the accuracy in astigmatism reduction by using IOLM 700 steep total keratometry (TK) axis, Berdahl and Hardten astigmatism fix, and Barrett Rx formula following misaligned toric intraocular lens (IOL). Methods: Ten patients with residual refractive astigmatism due to misalignment following toric IOL implantation were included in this retrospective study. They were analyzed at days 4, 7/8, and 10/11 following primary cataract surgery on the platform of Berdahl and Hardten astigmatism fix, Barrett Rx formula, and IOLM 700 to determine the optimum axis of repositioning, and underwent IOL realignment on the steep TK axis of IOLM 700 assisted by the Callisto eye. The final outcome parameters were subjective refraction and orientation of toric IOL assessed 22 ± 1 days following repositioning surgery. These parameters were fed in the Barrett Rx formula and its vector analysis graph was utilized to determine the predicted ideal axis with the least residual astigmatism and the estimated residual astigmatism if the toric IOL was realigned according to the axis suggested by Berdahl and Hardten astigmatism fix and Barrett Rx formula. Results: Realigning the toric IOL on IOLM 700 steep TK axis along with the Callisto eye reduces the residual refractive astigmatism significantly (P = 0.003) from 2.00 ± 0.78 D to 0.18 ± 0.12 D (90.5 ± 7.6%) in comparison to the estimated 0.57 ± 0.31 D (68.4 ± 21.9%) by Berdahl and Hardten astigmatism fix and 0.61 ± 0.33 D (66.4 ± 23.5%) by Barrett Rx formula. Conclusion: Realigning the misaligned toric IOL on the IOLM 700 steep TK axis gives a better reduction in the residual refractive astigmatism in comparison to Berdahl and Hardten astigmatism fix and Barrett Rx formula

Iris-registration capsulotomy marking for the implantation of Toric intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the accuracy of Toric intraocular lens(IOL)alignment and visual outcome using the femtosecond laser-assisted capsulotomy markings(FLACM)versus a conventional slitlamp-assisted manual marking(SAMM)procedure. <p>METHODS: Totally 50 patients required cataract surgery and Toric IOL implantation were assigned to the FLACM group(25 eyes)or the SAMM group(25 eyes). The uncorrected distant visual acuity(UCDVA), best corrected distant visual acuity(BCDVA), residual astigmatism(RA), IOL rotation, MTF Total were measured 1mo after surgery. <p>RESULTS: The UCDVA(LogMAR)was significantly lower in the FLACM group than in the SAMM group 1mo postoperatively(0.15±0.09 <i>vs</i> 0.22±0.11, <i>P</i><0.05). The RA and IOL rotation were significantly lower in the FLACM group than in the SAMM group(0.30±0.18D <i>vs</i> 0.64±0.28D, <i>P</i><0.05; 3.64°±1.68° <i>vs</i> 5.40°±3.44°, <i>P</i><0.05). There was no statistical difference between the two groups in the BCDVA and MTF total value(<i>P</i>>0.05). The UCDVA(LogMAR)was positive correlative to the RA(<i>r</i>=0.350, <i>P</i><0.05)and IOL rotation(<i>r</i>=0.369,<i> P</i><0.05), and was negative correlative to the MTF total value(<i>r</i>= -0.290, <i>P</i><0.05); the RA was positive correlative to the IOL rotation(<i>r</i>=0.431, <i>P</i><0.05). <p>CONCLUSION: The accuracy of the axis alignment was significantly higher in the FLACM group, which results in lower residual astigmatism and better visual outcome.

Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation

Purpose: To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation. Methods: In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement. Results: We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique). Conclusion: Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.

Comparative study on the evaluation of Toric intraocular lens axial position using OPD scanⅢ and traditional slit lamp method / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the consistency and accuracy of the axial position of the astigmatism correction intraocular lens(Toric IOL)measured by OPD scan Ⅲ(optical path difference analyzer)and the traditional slit lamp method.<p>METHODS: A prospective observational control study. A total of 118 patients with 156 eyes who underwent phacoemulsification combined with Toric IOL implantation in our hospital from July 2018 to October 2019 were selected. The residual astigmatism was followed up at 1wk, 1mo and 3mo after the operation, and the axial position of Toric IOL was measured with OPD scan Ⅲ under the small pupil(Axial intraocular astigmatism method)and after dilated pupils(Axial OPD method), while using traditional slit lamp method to measure Toric IOL axis position(Axial Slit method). Analyze the difference and consistency of the measurement results of the three methods, and calculate the Lens axis deviation(LAD)between the measurement results of the three methods and the target axis. <p>RESULTS: The residual astigmatism of the patients in this group was significantly lower than that before the operation at 1wk, 1mo and 3mo after operation(<i>P</i><0.05). The proportion of residual astigmatism ≤ 0.75D at 3mo after surgery was 73.7%. Three months after the operation, the axial position of the Toric IOL measured by the axial Slit method, the axial OPD method, and the axial intraocular astigmatism method were: 111.0°(10, 178)°, 113.5°(12, 180)°, and 113.0°(15, 178)°. Consistency analysis showed that the average value of the difference between the axial OPD method and the axial Slit method, the axial intraocular astigmatism method and the axial slit method, the axial OPD method and the axial intraocular astigmatism method at 3mo after the operation, they were -0.58°, -0.19°, 0.40°, which were all close to 0°, with high consistency. 95% <i>LoA</i> were(-7.01-5.84)°,(-12.44-12.07)°,(-10.69-11.49)°. At 3mo postoperatively, the proportions of patients with LAD ≤5° measured by axial Slit method, axial OPD method, and axial intraocular astigmatism were 82.0%, 80.1%, and 59.0%, respectively.<p>CONCLUSION: OPD scan Ⅲ can directly measure Toric IOL axial position after dilated pupils. It was an objective and accurate measurement method, which can replace the traditional slit lamp method to measure axial position and avoid subjective limitations. The Toric IOL axial position can also be measured by intraocular astigmatism under the small pupil, which has certain practical application value in ophthalmology clinical work.

Application of two kinds of cataract surgeries combined with Toric IOL implantation in patients with long ocular axis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical observations of patients with cataract axis longer than 24mm who underwent either femtosecond laser or traditional cataract surgery combined with Toric intraocular lens.<p>METHODS: Prospective study. The subjects were patients with cataract eyes with axis length longer than 24mm who underwent ocular cataract surgery and toric IOL implantation in our hospital. They were divided into femtosecond phaco groups. Clinical observations included uncorrected visual acuity, best corrected visual acuity, and changes in corneal and intraocular high-order phase difference.<p>RESULTS: The best corrected visual acuity of the two groups 3mo after surgery(0.092±0.089, 0.131±0.096)was significantly higher than that before surgery(0.855±0.213, 0.948±0.135)(<i>P</i><0.05). The difference between the high-order cornea and the entire eye of the two groups was not significant(<i>P</i>>0.05). In the femtosecond group, the strchl values were negatively correlated with 4s3, 4s4, and 4Total in the 4mm pupil diameter of the entire eye and with the 6s5 at 6mm pupil diameter. The strchl values were also negatively correlated with 4s3 and 4Total in the 4mm pupil diameter of the entire eye in the traditional group and with 6s3, 6s3+s5, and 6Total under the 6mm pupil diameter.<p>CONCLUSION: Implantation of Toric IOL in patients with cataract greater than 24mm can effectively correct corneal regular astigmatism. Both FLACS and conventional phacoemulsification can maintain intraocular rotational stability and significantly improve postoperative visual quality.

Clinical observation of femtosecond laser capsulorhexis with toric intraocular lens implantation / 眼科新进展

Objective To evaluate the clinical effect of femtosecond laser assisted cataract surgery with Toric IOL implantation on correcting astigmatism and IOL rotating stability.Methods A prospective,nonrandomized,controlled study was conducted in 68 patients (82 eyes) diagnosed as age-related cataract with more than 1.0 diopter (D) regular astigmatism,including 41 eyes undergoing Toric IOL implantation with femtosecond laser assisted cataract surgery,and the other eyes receiving Toric IOL with phacoemulsification.And observation was performed for the uncorrected visual acuity (UCVA) before operation and 6 months after operation,preoperative corneal astigmatism,anticipated and postoperative residual astigmatism 6 months after operation.Then,comparison was performed for the degree of Toric lens axis rotation,as well as the horizontal and vertical movement of the IOL and the degree of vertical deflection in the capsule at 1,3,and 6 months after operation.Results In the observation group,preoperative UCVA (logMAR),preoperative corneal astigmatism,postoperative BCVA and the residual astigmatism at 6 months after operation was 1.03 ± 0.32,(2.09 ± 0.73) D,0.13 ± 0.11 and (0.33 ± 0.27) D,respectively,while the corresponding data in the control group was 0.92 ± 0.40,(1.69 ± 0.64) D,0.13 ± 0.09,(0.26 ± 0.22) D;the postoperative visual acuity in both groups was significantly improved,and residual astigmatism was significantly decreased at 6 months after operation (all P ＜ 0.001).There was no significant difference in Toric lens axis after femtosecond laser assisted surgery and phacoemulsification at 1 month,3 months,6 months after operation (all P ＞ 0.05),but the differences in the IOL movement in horizontal and vertical direction were statistically significant at the different time-points (all P ＜ 0.05),and there was significant differences in the degree of vertical deflection (all P ＜ 0.05).Conclusion Both femtosecond laser assisted cataract surgery and phacoemulsification combined with Toric IOL can achieve a better stability and predictability.

Clinical observation of residual astigmatism and surgically induced astigmatism (SIA) after Toric intraocular lens implantation / 眼科新进展

Objective To investigate the residual astigmatism and surgically induced astigmatism (SIA) after implantation of Acrysof Toric intraocular lens (IOL).Methods Totally 52 patients (62 eyes) who underwent phacoemuisification with Acrysof Toric IOL implantation from February 2016 to June 2017 were retrospectively reviewed.Observation of the variables including the uncorrected visual acuity,best corrected visual acuity,refraction,corneal curvature was performed,and individual SIA,mean SIA plus centroid SIA were calculated before surgery and one month after surgery.Results There was significant difference between postoperative anticipated astigmatism and postoperative actual astigmatism [(0.17 ± 0.15) D vs.(0.492 ± 0.37) D] (P ＜ 0.05).Preoperative corneal astigmatism was (1.94 ± 0.75) D,ranging from 0.93 D to 3.70 D,and postoperative corneal astigmatism was (1.95 ± 0.80) D,ranging from 0.68 D to 3.80 D.The individual SIA was 0.08-1.39 (0.44 ± 0.25) D,the mean SIA of 0.44 D,and centroid SIA of 0.12 D@126°.Conclusion It is precise and stable for Barrett Toric formula and centroid SIA to calculate the degree of Toric IOL,but there is still residual astigmatism after IOL implantation,so further optimization of SIA is still needed.

Effect of Toric Intraocular Lens Implantation on Astigmatism in Cataract Surgery

PURPOSE: To evaluate the efficacy of Tecnis(R) toric intraocular lens (IOL) implantation for the correction of astigmatism and rotational stability during cataract surgery in patients with cataract and astigmatism. METHODS: We prospectively analyzed 17 eyes of 14 patients with 1 to 4 diopters (D) of corneal astigmatism who underwent phacoemulsification and Tecnis(R) toric IOL implantation at Seoul National University Hospital from June 2013 to May 2014. Informed consent was obtained from all participants before the clinical trial. We evaluated the changes in visual acuity, refraction, astigmatism, IOL axis and higher order aberration for 3 months postoperatively. Power vector analysis was used to analyze astigmatism. RESULTS: The mean uncorrected visual acuity (log MAR) significantly improved from 0.58 +/- 0.34 to 0.26 +/- 0.43 at 3 months postoperatively. The mean refractive astigmatism was significantly decreased by 77.9% from a mean value of -2.67 +/- 0.89 D to -0.59 +/- 0.48 D at 3 months postoperatively. According to power vector analysis, M, B, J0, and J45 were significantly reduced after the surgery. The mean difference between achieved and intended IOL axis was 3.26 degrees clockwise at postoperative 3 months, which was statistically insignificant. Most of the rotational changes were observed within a month after the surgery. CONCLUSIONS: Phacoemulsification and Tecnis(R) toric IOL implantation in patients with cataracts and astigmatism showed efficacy for the correction of astigmatism and rotational stability.

Comparison of the Astigmatic Power of Toric Intraocular Lenses Using Three Toric Calculators

PURPOSE: To compare the astigmatic power of toric intraocular lenses (IOLs) obtained from the AcrySof, TECNIS, and iTrace toric calculator in patients with preoperative with-the-rule (WTR) or against-the-rule (ATR) corneal astigmatism. MATERIALS AND METHODS: Fifty eyes with cataract and corneal astigmatism greater than 0.75 diopters were enrolled in each group (WTR and ATR). Keratometric values were measured using autokeratometry, an IOLMaster, and an iTrace, which incorporated corneal topography and ray-tracing aberrometry. Based on measured keratometric values, the astigmatic power of each toric IOL was calculated using three toric calculators. RESULTS: Bland-Altman plots showed good agreement between six pairwise corneal astigmatism values in both groups. The TECNIS calculator tended to suggest a higher astigmatic power of the toric IOL than the AcrySof calculator. With the higher astigmatism and keratometric values from the IOLMaster, in both groups, calculations from the AcrySof and TECNIS calculators resulted in higher calculated astigmatic powers than those from same calculators with autokeratometry-measured values, demonstrating good agreement. With the higher calculated astigmatic power values, the values from the iTrace toric calculator using keratometric values obtained from iTrace ray tracing wavefront aberrometry or iTrace simulated keratometry showed fair to moderate agreement with those from the other calculator-keratometry pairs in both groups. CONCLUSION: To achieve the best refractive outcome after toric IOL implantation, understanding the differences in keratometric values between instruments and in calculated astigmatic power among toric calculator programs is necessary. Moreover, systemic analysis of each toric calculator in conjunction with postoperative data is required.

Combined special capsular tension ring and toric IOL implantation for management of post-DALK high regular astigmatism with subluxated traumatic cataract.

We report a case of 18‑year‑old male who has undergone phacoemulsification with implantation of toric IOL (AcrySof IQ SN6AT9) after fixation of lens capsule with Cionni’s capsular tension ring (CTR) for subluxated traumatic cataract with high astigmatism after deep anterior lamellar keratoplasty (DALK). He underwent right eye DALK for advanced keratoconus four years earlier. He had history of trauma one year later with displaced clear crystalline lens into anterior chamber and graft dehiscence, which was repaired successfully. The graft survived, but patient developed cataract with subluxated lens, for which phacoemulsification with implantation of toric IOL was done. Serial topography showed regular corneal astigmatism of ‑ 5.50 diopter (K1 42.75 D @130°, K2 48.25 D @40°). At 10‑month follow‑up, the patient has BCVA 20/30 with + 0.75 DS/‑ 1.75 DC @ 110°. The capsular bag is quite stable with well‑centered IOL. Combination of Cionni’s ring with toric IOL could be a good option to manage such complex cases.