Comparison of clinical efficacy and stability of Toric implantable collamer lens implantation in different orientations / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the clinical efficacy, vault, and rotational stability of horizontal, oblique, and vertical implantation of Toric implantable collamer lens(TICL).METHODS: Retrospective cohort study. A total of 92 cases(120 eyes)who underwent TICL implantation from July 2018 to March 2022 and had regular follow-up for at least 1 a postoperatively(1 d, 1 wk, 1, 3, 6 mo, and 1 a)at Wuhan Bright Eye Hospital were collected. The patients were divided into three groups, with 34 cases(45 eyes)in horizontal implantation group, 25 cases(29 eyes)in oblique implantation group(29 cases), and 33 cases(46 eyes)in vertical implantation group. Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), diopters, vault, and rotation angle(deviation of the actual axis of TICL from the expected axis).RESULTS: All surgeries were uneventful, and there were no complications such as infection, secondary glaucoma, or cataract opacity. Safety and efficacy of the surgery: the CDVA of the three groups of patients was better than or equal to the preoperative CDVA at 1 a postoperatively, and there was no statistically significant differences in postoperative UDVA and CDVA of the three groups(P>0.05). The safety index at 1a postoperatively was 1.34±0.21, 1.34±0.17, and 1.31±0.18 for the horizontal, oblique, and vertical groups, respectively. The efficacy index was 1.26±0.21, 1.33±0.18, and 1.27±0.16 for the three groups, respectively, both with no statistically significant differences(P>0.05). Vault: there was a significant difference in postoperative vault among the three groups(P=0.003), with the vertical group having the lowest vault, followed by the horizontal group and the oblique group. The vaults at different follow-up time points within each group showed significant differences(P<0.001), and all decreased over time. Residual astigmatism: there was no significant difference in residual astigmatism among the three groups(P=0.130), but there were differences at different follow-up time points within each group(P<0.001). Rotation angle: no significant differences in rotation angle were observed among the three groups(P=0.135), but there were differences at different follow-up time points within each group(P<0.001).CONCLUSION: The implantation of TICL in different orientations has good safety and efficacy, the postoperative rotational stability is good, and the appropriate angle can be selected to implant TICL according to the clinical situation.

Novel custom designed toric piggyback intraocular lens for the correction of residual postoperative astigmatism

We report the outcomes of a custom-designed toric piggyback intraocular lens in a patient with high postoperative residual astigmatism. A 60-year-old male patient underwent customized toric piggyback IOL for postoperative residual astigmatism of 13 D, with follow-up examinations for IOL stability and refractive outcomes. The refractive error stabilized at two months and remained stable at one year, with a correction of nearly 9 D of astigmatism. The IOP remained within normal limits, and there were no postoperative complications. The IOL remained stable in the horizontal position. To our knowledge, this is the first case report of correction of unusually high astigmatism by a novel smart toric design of piggyback IOL.

Influencing factors of Toric intraocular lens postoperative rotation and its principles of treatment / 国际眼科杂志(Guoji Yanke Zazhi)

Correcting astigmatism safely and effectively has become a crucial part of modern cataract surgery due to the transformation of the surgery into a refractive procedure. The increased predictability and enhanced safety of Toric intraocular lens(IOL)implantation has made it the preferred method of correcting corneal regular astigmatism above 0.75D in cataract surgery. Toric IOL needs to be implanted in a precise axis position to achieve good astigmatism correction. A major cause of toric misalignment is postoperative rotation, which typically occurs soon after surgery. However, large axis misalignment will eliminate the astigmatism corrective effect of Toric IOL, even cause astigmatism in a new axis position. The factors responsible for IOL postoperative rotation are diverse. As a result, profound understanding of the factors is crucial for clinicians to minimize the rotation. Repositioning procedure is generally selected in case of significant rotation and the timing of the procedure is vital. This paper reviewed the influencing factors of IOL rotation postoperatively and its principle of treatment.

Comparison of clinical outcomes of astigmatic correction using Toric intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical effects of two brands of Toric intraocular lens(IOL)used in surgical correction of cataract with corneal astigmatism.<p>METHODS: Totally 35 patients(50 eyes)with corneal astigmatism who underwent ophthalmic surgery from April 2019 to July 2019 were retrospectively analyzed. Among them, 25 eyes of 20 patients were implanted with Rayner 623T, while 25 eyes of 15 patients with Alcon AcrySof Toric IOL. Three months after surgery, the uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), residual astigmatism, rotational degree of intraocular lens, contrast sensitivity, objective visual quality and the National Eye Institute 25-Item Visual Function Questionnaire(NEI VFQ-25)scale score were compared. Vector analysis was performed using the Alpins method.<p>RESULTS: The mean postoperative UCDVA(LogMAR)and BCDVA(LogMAR)in the Rayner group were 0.17±0.20 and 0.08±0.15, respectively(<i>P</i>>0.05), while those in the Alcon group were 0.21±0.16 and 0.10±0.11, respectively(<i>P</i>>0.05). The mean residual astigmatism in the Rayner group was(-0.57±0.24)D while that in the Alcon group was(-0.50±0.28)D(<i>P</i>>0.05). There was no statistically significant difference between the two groups in IOL rotational stability, vector analysis parameters, contrast sensitivity and objective visual quality(<i>P</i>>0.05). The NEI VFQ-25 scale score was 85.16±5.91 in the Rayner group while it was 82.08±6.16 in the Alcon group(<i>P</i>>0.05).<p>CONCLUSION: The two brands of Toric IOL-Rayner 623T and Alcon AcrySof Toric showed no significant difference in their clinical outcomes.

Rotational stability of Toric intraocular lens and its influencing factors / 国际眼科杂志(Guoji Yanke Zazhi)

@#With the development of refractive cataract surgery,Toric intraocular lens(Toric IOL)has been widely used in the treatment of cataract patients with regular astigmatism. And the rotational stability of Toric IOL has been paid more and more attention. This article reviewed the evaluation method of the rotation stability, and analyzed various related influencing factors.

Comparative evaluation of two toric intraocular lenses for correcting astigmatism in patients undergoing phacoemulsification

Purpose: To compare the efficacy of AT-TORBI plate haptic toric intraocular lens (IOL) (Carl Zeiss Meditec AG, Jena, Germany) and AcrySof loop haptic toric IOL (Alcon Laboratories, Inc., Fort Worth, TX, USA) for correcting preexisting astigmatism of ?1 diopters (D) in patients undergoing phacoemulsification and to compare the rotational stability of these two toric IOLs. Methods: In this prospective randomized controlled trial. Forty-two eyes of 42 cataract patients with preexisting astigmatism of 1 D or more were randomized to receive plate haptic toric (AT TORBI) or loop haptic toric (AcrySof) IOLs, with 21 in each group. Postoperative evaluation was done at day 1, 1 week, 1 month, and 3 months. Uncorrected distance visual acuity (UDVA), best corrected visual acuity (VA), and IOL position were noted in both the groups. Results: At 3 months postoperatively, the mean log MAR UDVA was 0.23 ± 0.20 and 0.20 ± 0.13 in Groups I and II, respectively (P = 0.7), the mean residual cylindrical refractive error in plate haptic toric group was 0.40 ± 0.31 D and in loop haptic group was 0.45 ± 0.33 D (P = 0.64). The mean IOL rotation at 3 months follow-up in plate haptic group was found to be 3.52 ± 3.84° and in loop haptic group was 2.05 ± 2.56° (P = 0.25). Conclusion: Both types of toric IOLs were equally efficacious for attaining good uncorrected VA and correcting preexisting astigmatism between 1–5 D. Both of them were rotationally stable at 3 months follow-up.

Rotational Stability after Toric Implantable Collamer Lens Implantation

PURPOSE: To evaluate rotational stability of Toric Implantable Collamer Lens (ICL) implantation to correct myopic astigmatism. METHODS: We estimated the degree of Toric ICL rotation together with change in visual acuity and astigmatism in 118 eyes of 66 patients who underwent Toric ICL implantation and had a long-term mean follow-up period of 37 months. RESULTS: After Toric ICL implantation, 107 (91%) out of 118 eyes showed uncorrected visual acuity of 0.8 or better. The mean postoperative astigmatism decreased to -0.64 +/- 0.61 D from a mean preoperative astigmatism of -2.96 +/- 1.13 D. The mean axis change of Toric ICL was 2.4 +/- 3.8 degrees during follow-up period. Two (1.7%) out of 118 eyes showed the axis change of more than 10 degrees. These two eyes had a decrease in visual acuity, rotational axis change of 18 degrees and 30 degrees, respectively, and increases in astigmatism of 1.50 D and 1.00 D, respectively. The remaining 116 eyes (98.3%) showed excellent rotational stability without visual acuity decreasing Toric ICL rotation during the follow-up period. CONCLUSIONS: Toric ICL implantation to correct high myopia with astigmatism rarely has axis rotation and maintains excellent rotational stability for long-term follow-up.

Comparison of the Modified Transtibial Technique, Anteromedial Portal Technique and Outside-in Technique in ACL Reconstruction

PURPOSE: To compare clinical and radiographic results of anterior cruciate ligament (ACL) reconstruction using modified transtibial technique (mTT), anteromedial (AM) portal technique and outside-in (OI) technique. MATERIALS AND METHODS: From March 2007 to December 2012, ACL reconstruction was performed using the mTT, AM portal technique and OI technique in 20 patients each. Anteroposterior and rotational stability were assessed using the GNRB arthrometer and pivot-shift test. Femoral tunnel obliquity was measured on the anteroposterior and lateral radiographs. RESULTS: Tegner score, Lysholm score, International Knee Documentation Committee score, pivot-shift test were improved at final follow-up in all three groups. However, statistical difference was not shown. Side-to-side difference in GNRB arthrometer was average of 1.4 mm, 1.0 mm and 0.9 mm in mTT, AM and OI group, showing the signicant difference between mTT and AM/OI groups (p<0.001). The mean femoral tunnel obliquity was 56.4degrees in the mTT group, 39.4degrees in the AM group and 33.6degrees in the OI group, showing significant intergroup difference (p<0.001). It showed the significant difference among three groups (p<0.001). CONCLUSIONS: Clinical results were improved in all three groups. Femoral tunnel obliquity in AM and OI were more horizontal on the coronal plane. They are thought to have more benefits in oblique positioning of the grafted ACL in rotational stability; however, there was no significant difference among three techniques in pivot-shift test to assess the rotational stability in this study.

Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by the Two Anteromedial Portal Method: The Comparison of Transportal and Transtibial Techniques

PURPOSE: The purpose of this study was to report the results of anatomic single bundle anterior cruciate ligament (ACL) reconstruction by the two anteromedial portal method. MATERIALS AND METHODS: We evaluated the clinical results in 33 patients with ACL rupture who were treated by anatomic ACL reconstruction using the two anteromedial portal technique. The control group included 33 patients with ACL rupture who were treated with the conventional transtibial non-anatomic method. We performed an objective instability test, both preoperatively and at the final follow-up. We also compared the clinical results of both groups using International Knee Documentation Committee and Lysholm scores as a subjective test. RESULTS: At the final follow up, the study showed that in the control group, the Lachman test was negative in 27 cases (81.8%), the pivot shift test was negative in 26 cases (78.8%), and the average anterior translocation was 3.1 mm on a KT-2000 arthrometer. In the group of patients who underwent anatomic reconstruction by the two anteromedial portal method, the Lachman test was negative in 28 cases (84.8%), the pivot shift test was negative in 30 cases (90.9%), and the average anterior translocation was 2.8 mm on the KT-2000 arthrometer. Results in the pivot shift showed statistically significant improvement compared to the control group. CONCLUSIONS: Anatomic ACL reconstruction by two anteromedial portals is an effective surgical technique that restores the rotational stability with excellent clinical results.

Rotary Instability after Anterior Cruciate Ligament Reconstruction with Single BTB Tendon / 대한정형외과학회잡지

PURPOSE: To analyze both the functional restoration and recovery of rotational and anterior-posterior stability after a single bundle ACL reconstruction using a BTB tendon. MATERIALS AND METHODS: A total of 52 patients were evaluated with an average follow up period of 32 months. A Lachman test, KT-2000 arthrometer, and Pivot shift test were performed to analyze the AP and rotational stability of the patients. The IKDC and Lysholm score was then used to evaluate the clinical results of the patients. The correlation between femoral tunnel angle and recovery of rotational stability was evaluated to determine the association between the two variables. This study also evaluated how the recovery of rotational stability affects the functional recovery of the patients. RESULTS: At the final follow up, the results indicated significant improvement according to the negative Lachman tests in 40 cases (76%), with an average of 2.92 mm anterior translation in the KT-2000 arthrometer and negative Pivot shift tests in 41 cases (79%)(p<0.05). The Lysholm and IKDC scores also showed significant improvement (p<0.05). Throughout the study, Group A was designated as those with <5 mm anterior translation and a negative Pivot shift test whereas Group B had positive test results. In Group A, the results showed 35 normal (85%), and 6 near normal (15%) cases in the IKDC score system, whereas Group B showed 2 normal (25%) and 5 near normal (62.5%) cases. Group A had an average of 89.3 in the Lysholm score system whereas Group B had a score of 60.5. On the knee tunnel view, Group A showed an average femoral tunnel angle of 49.2degrees, whereas Group B showed 63.5degrees. CONCLUSION: Decreasing the inclination of the BTB tendon using a transtibial femoral tunnel angle at either 10'30 or 1'30 will result in an excellent clinical outcome by achieving both anterior and rotational stability when operating a single bundle ACL reconstruction.

An evaluation of rotational stability in endodontic electronic motors / 대한치과보존학회지

The purpose of this study was to evaluate a rotational stability of endodontic electronic motors by comparing the changes of rotational speed, depending on the number of usages and with/without static load. Twelve new endodontic electronic motors were used in this study. Non contact type digital tachometer was used for measuring the rotational speed of handpiece. True RMS Multimeter was used for measuring the voltages and the electric currents. All measurements were recorded every 10 seconds during 10 minutes and repeated 9 times. Five repetition was done per each electronic motor. To statistical analysis, student t-test, repeated measures and Scheffe's post-hoc tests were performed. In the same motor group, there was no significant difference in all measurements. In all groups, there was no significant difference in the amount of rotational speed changes depending on the number of usages and with/without static load. In the limitation of this study, the results showed that all kinds of endodontic electronic motors in this study had an established rotational stability. Therefore they could be safely used in root canal treatment with a reliable maintenance of rotational speed, regardless of the number of usages and with/without load.

O conceito da reconstrução anatômica do LCA dupla banda / The concept of anatomic anterior cruciate ligament reconstruction

Um interesse cada vez maior na reconstrução dupla banda do LCA tem estimulado um grande avanço nesta área de pesquisa e levado a um aumento no nosso conhecimento de anatomia, cinemática e função do joelho. Estudos recentes têm melhor definido o tamanho e orientação das inserções femorais e tibiais das bandas ântero-medial e póstero-lateral do LCA. O objetivo da reconstrução anatômica do LCA é utilizar esses novos conceitos para melhorar a técnica cirúrgica e mimetizar a anatomia original do LCA. Acreditamos que a reconstrução anatômica do LCA irá resultar em uma melhora na biomecânica e, consequentemente, uma melhora no quadro funcional de cada paciente.

The Clinical Result of AcrySof Toric Intraocular Lens Implantation

PURPOSE: To evaluate the short-term efficacy of astigmatism correction and rotational stability of AcrySof Toric Intraocular lens (IOL) implants. METHOD: We analyzed 27 eyes of 23 patients who underwent microcoaxial cataract surgery (MCCS) and AcrySof Toric IOL implantation between March 2008 and July 2008. We evaluated visual acuity, keratometry, and refraction. Slit-lamp retro-illumination photographs were obtained in all patients on 1 day, 1 month and 3 months postoperatively. The change of postoperative IOL axis alignment and the presence of anterior capsular shrinkage were analyzed. RESULT: The mean unaided visual acuity (LogMAR) improved from 1.02+/-0.38 to 0.10+/-0.12. Although postoperative manual keratometric value was not different from the preoperative value, post-operative astigmatism decreased from a mean value of 1.66+/-0.42D to 0.61+/-0.38D at 3 months postoperatively. The mean difference between achieved and intended lens axis was 1.63+/-2.83 degrees at the first post-operative day, and 1.91+/-2.92 degrees on the first postoperative month, with all cases within 10 degrees. There were two cases of IOL rotation between one day and one month postoperative follow-up, and severe anterior capsule contractions were found in them. CONCLUSIONS: AcrySof Toric IOL is effective for correction of astigmatism and it has good post-operative rotational stability. Because most of misalignments were found at the postoperative day 1, the precise implantation of IOL, according to the intended axis, can be important during operation and immediately after the operation.