ABSTRACT
BACKGROUND: For cataract patients with astigmatism, the insertion of a toric intraocular lens is a safe and effective method to achieve emmetropia. The exact alignment of the lens along the calculated axis is essential for effective correction of astigmatism. The purpose of this study is to evaluate our own data using descriptive statistics. The primary focus is on the refractive outcome and thus the verification of the alignment accuracy of toric IOLs with the Zeiss Callisto system. PATIENTS AND METHODS: The study evaluated a total of 106 eyes of 72 patients who underwent cataract surgery with implantation of a toric intraocular lens at our hospital between January 2019 and December 2020. Preoperative biometry and intraoperative marking of the implantation axis was performed using the Zeiss Callisto system. Postoperative controls were performed after one day, one week and 4 weeks, either at our hospital or by the referring ophthalmologist. For the analysis, only the data of the 4-week control were used. RESULTS: In 64 eyes (60%), a Zeiss AT Torbi 709 M or MP and in 42 eyes (40%) a PhysIOL Ankoris toric yellow IOL were implanted. In 46 eyes, postoperative uncorrected visual acuity was not recorded. Of the remaining 60 eyes, the mean postoperative uncorrected visual acuity was 0.07 ± 0.12 logMAR. Postoperative uncorrected visual acuity ≥ 1.0 (decimal) was achieved in 48% of the eyes and visual acuity ≥ 0.6 (decimal) in 92%. The postoperative cylinder averaged - 0.65 ± 0.53 D. The cylinder of the target refraction was - 0.45 ± 0.39 D on average. The mean of the absolute value of the postoperative cylinder minus the cylinder of the target refraction was 0.42 ± 0.32 D. CONCLUSIONS: The Zeiss Callisto system is an effective tool to align toric intraocular lenses.
Subject(s)
Astigmatism , Cataract , Lenses, Intraocular , Phacoemulsification , Humans , Lens Implantation, Intraocular/methods , Astigmatism/surgery , Refraction, Ocular , Cataract/diagnosis , Phacoemulsification/methodsABSTRACT
As glaucoma specialists, we often ask ourselves why patients are referred so late for surgery. Usually the patient is referred in a far advanced stage of the disease after long-term conventional treatment with topical medications. By that time, substantial morphologic damage is present and the patient is disabled by far advanced visual field defects. In addition, decompensated intraocular pressure, despite maximal tolerated medical treatment, is seen. Delayed surgery due to late diagnosis is rather a rare event. Various reasons may be responsible for this late referral. Improved IOP-lowering medications (i.e., fixed combinations), personal aversion (fear and knowledge of lack of improvement in visual acuity) against surgery, and imperfect glaucoma procedures may play an important role. A retrospective review of the last 274 cases referred for filtering glaucoma surgery is used to describe and analyze criteria for adequate timing of glaucoma surgery. This study reveals that almost ¾ of patients are referred rather late for glaucoma surgery. Criteria for adequate timing of glaucoma surgery are given for non-glaucoma specialists in particular. They apply for all types of glaucoma surgery, and the pros and cons are discussed in detail. Trabeculectomy is still regarded as the gold standard of glaucoma surgery. Because trabeculectomy may not be an ideal glaucoma procedure, there is hope that the modern less-invasive glaucoma procedures (MIGS) will be able to extend indications for glaucoma surgery. This may also lower the hurdle of referral for glaucoma surgery for both patients and non-glaucoma specialist doctors.
