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Purpose: To compare the accuracy of isolated manual marking and smartphone-assisted manual marking with the Verion image-guided system for toric intraocular lens (IOL) implantation. Methods: In this prospective observational study, 42 eyes of 36 patients planned for phacoemulsification with toric IOL implantation with corneal astigmatism >1D as measured on Lenstar LS 900 optical biometer were included. Patients were preoperatively registered and photographed on the Verion image-guided system. In the operating room, the patient's eye was manually marked at the 6 o? clock limbus (Manual axis-90°) on slit-lamp in sitting position. Next, using the smartphone android app—iToric Patwardhan, the exact mark axis was confirmed (Smartphone axis). Following this, the patient was taken on the operation table where the mark axis was confirmed with Verion digital overlay on an external screen (Verion axis). The absolute angular deviation of manual axis from Verion was compared with the absolute angular deviation of the smartphone axis from Verion as the primary outcome measure. Results: The mean absolute angular deviation between the smartphone axis and the Verion axis was 2.62°, which was significantly lower (P < 0.05) than that between the manual axis and Verion axis (4.60°). Moreover, the intraclass correlation coefficient between the smartphone axis and Verion axis was 0.88 indicating a strong agreement between the two. Conclusion: Smartphone-assisted manual marking significantly improves the accuracy of manual marking alone when comparing with the Verion Digital Marker system for toric IOL implantation.
ABSTRACT
Resumo Objetivo: Avaliar o astigmatismo induzido pela cirurgia de catarata através da técnica de facoemulsificação (FACO) guiada pelo planejador cirúrgico VERION®, em um serviço oftalmológico do Paraná. Métodos: O estudo tem caráter observacional com avaliação individualizada de prontuários de forma retrospectiva, analisando 37 olhos de 20 pacientes operados de catarata pela técnica de FACO com a utilização do VERION® e implantação de lente não-tórica no Hospital de Olhos de Cascavel - PR no período de maio de 2016 a novembro de 2018. Resultados: Dentro de nossa amostra composta por 37 olhos abordados com assistência do VERION®, 43% dos participantes do estudo (n=16) apresentaram redução do astigmatismo inicial, inclusive com eliminação de graus mais graves de astigmatismo (≥2.5 D). Conclusão: O impacto do VERION® foi significativo uma vez que permitiu a correção do astigmatismo prévio de uma parte da amostragem. Em olhos que ocorreram astigmatismo induzido cirurgicamente essa complicação foi menos relevante clinicamente em comparação com incisões corneanas da técnica convencional.
Abstract Objective: To evaluate the astigmatism induced by cataract surgery through the phacoemulsification (PHACO) technique guided by the VERION® surgical planner, in an ophthalmological service of Paraná. Methods: This is an observational study with retrospective individualized evaluation of medical records, analyzing 37 eyes of 20 patients who underwent cataract surgery using the PHACO technique using VERION® and non-toric intraocular lens implantation at the Hospital de Olhos de Cascavel - PR in May 2016. Results: Within our sample of 37 eyes approached with VERION® assistance, 43% of study participants (n=16) had reduced initial astigmatism, including elimination of more severe degrees of astigmatism (≥2.5 D). Conclusion: The impact of VERION® was significant as it allowed the correction of previous astigmatism of a part of the sample. In eyes that had surgically induced astigmatism, this complication was less clinically relevant compared to conventional technique corneal incisions.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Astigmatism/complications , Astigmatism/epidemiology , Cataract Extraction/adverse effects , Phacoemulsification/methods , Surgery, Computer-Assisted , Retrospective Studies , Corneal Topography/methods , Observational StudyABSTRACT
Objective To evaluate the accuracy and validity of Toric intraocular lens (IOL) alignment by VERION image guided system.Methods In this retrospective study,75 eyes of 75 patients who underwent phacomulsification combined with Toric IOL implantation were enrolled from June 2016 to May 2017.Before operation,anterior segment images of all patients were collected using VERION image guided system,and target axis of IOL implantation was set.Horizontal axis was marked using 1 mL syringe needle under the slit lamp.During the procedures,the IOL was implanted referring to the target axis under VERION system or the slit lamp randomly,and there were 42 eyes with IOL implantation guided by VERION system (VERION group),and 33 eyes guided by slit lamp (slit lamp group).The best corrected visual acuity (BCVA) of each patient was recorded at day 1,1 week,1 month,and 3 months after operation.Anterior segment images were taken after mydriasis,and all the images were analyzed by Photoshop software.Finally,the BCVA at various time points after operation and the deviation value of actual axis and target axis was compared in both groups.Results The proportion of eyes with BCVA ≥ 0.8 at day 1,1 week,1 month,and 3 months after operation was 61.9％,78.6％,71.4％ and 76.2％ in VERION group,respectively,and 69.7％,78.8％,81.8％ and 75.8％ in slit lamp group,respectively,and there was no statistical significance between VERION group and slit lamp group (all P ＞ 0.05).The difference value of target axis marked by VERION system and by slit lamp was (3.04 ± 1.99) °.No significant differences were seen in the IOL actual axis and target axis between the two groups at various time points (all P ＞ 0.05).Conclusion It is accurate and stable of VERION image guided system for toric IOL axis marking.
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Objective To analyze the reproducibility of keratometry and astigmatism measured by the VERION Digital Guidance System and the comparability of VERION with iTrace,Lenstar LS900 and manual keratometer.Methods The keratometry of 62 cataract patients were measured using four different devices.The steep keratometry (Ks),flat keratometry (Kf),astigmatic magnitude,astigmatic axis,cylinder at 0-degree meridian (vector component,J0) and cylinder at 45-degree meridian (vector component,J45) from each machine were recorded and analyzed.The three repeated measurements and the results of VERION system with other three devices were compared to analyze the reproducibility and comparability of VERION system.Results Reproducibility:Intraclass correlation coefficients and Cronbach's alpha values were higher than 0.9 for Ks,Kf,astigmatic magnitude,astigmatic axis,J0 and J45 measured by the VERION system (all P ＜ 0.001).Comparability:The results of Ks and magnitude of astigmatism of VERION were larger than the iTrace (all P ＜ 0.05) in the paired-samples t test.There was no statistical difference for the rest of parameters (all P ＞ 0.05).The Bland-Altman graphs revealed the 95％ limits of agreement (LOA) of J0,J45 and the astigmatic axis between VERION and iTrace were (-0.31-0.35) D,(-0.25-0.31) D and-13.5 °-12.3 °,respectively;There was no statistical differences for all parameters except for J45 in the paired-samples t test between the VERION and Lenstar LS900 (all P ＞ 0.05).The Bland-Altman graphs revealed the 95％ LOA of J0,J45 and the astigmatic axis were (-0.25-0.31)D,(-0.27-0.36) D and-13.5°-11.0°,respectively;There were statistical differences for the results of Kf and magnitude of astigmatism between the VERION and manual keratometer (all P ＜ 0.05).The Bland-Altman graphs revealed the 95％ LOA of J0,J45 and the astigmatic axis between VERION and manual keratometer were (-0.38-0.35) D,(-0.41-0.42) D,-12.6°-16.4°,respectively.Conclusion The VERION system is a reliable system for the measurement of keratometry and astigmatism.The keratometry and astigmatic magnitude of the VERION system have a good agreement with the iTrace,Lenstar LS900 and manual keratometer.However,the astigmatic axis measurements are significantly different among the four devices.
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PURPOSE: To compare the corneal refraction, astigmatism, and corneal marking for toric intraocular lens measured with a VERION® Image Guided System and an autorefractor in order to precisely determine the toric intraocular lens target. METHODS: The medical records of 29 eyes of 29 patients were retrospectively reviewed to compare the corneal refraction, axis, and amount of astigmatism measured with a VERION® Image Guided System and an autorefractor. We compared the difference in marked axis for toric intraocular lenses as measured by a VERION Digital Marker and a manual marker. RESULTS: The average corneal refraction and amount of astigmatism were greater with the VERION® Image Guided System than with the autorefractor. The average difference in axis of astigmatism was 9.62°. The difference in axis of astigmatism in patients with more than 1.0 D of astigmatism (18 eyes) was 2.82 ± 2.27°, while that in patients with less than 1.0 D of astigmatism (11 eyes) was 20.27 ± 28.14°. The average difference in marked axis for toric intraocular lens measured by the VERION® Digital Marker and manual marker was 2.50° (0°-9.27°). CONCLUSIONS: The corneal refraction and amount of astigmatism were significantly higher with the VERION® Image Guided System, so careful concern and comparison of surgical outcomes between the two devices is needed in biometry.