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Pašková B, Marešová K, Schreiberová Z, Malušková M, Karhanová M. Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:146-153. [PMID: 38413224 DOI: 10.31348/2024/10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. MATERIAL AND METHODS 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. RESULTS mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. CONCLUSION TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.
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Wang Y, Yang F, Lou X, Qian S, Hu B, Zhao Y, Chang P. Efficacy of Toric Intraocular Lens Implantation in Patients Older Than 80 Years with Cataracts and Corneal Astigmatism. Ophthalmol Ther 2023; 12:1583-1594. [PMID: 36856976 PMCID: PMC10163995 DOI: 10.1007/s40123-023-00683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION This study analyzed the visual outcome following cataract surgery with toric intraocular lenses (IOLs) in patients older than 80 years with corneal astigmatism. METHODS A total of 159 patients (159 eyes) older than 80 years with corneal astigmatism (≥ 0.75 D) were included. Fifty-three eyes received Acrysof IQ® toric IOLs (SN6AT2-5), while the others received non-toric IOLs: 51 eyes received Acrysof IQ® IOLs (SN60WF) and 55 eyes received A1-UV IOLs. The uncorrected distance visual acuity, corrected distance visual acuity, and refraction (spherical equivalent, refractive cylinder) were assessed at 3 months postoperatively. The prediction error of refractive outcome and percentages of eyes within ± 0.50 D and ± 1.00 D in the toric IOL group obtained using five toric IOL formulas (Barrett predicted posterior corneal astigmatism (PCA), Barrett measured PCA, Kane, EVO 2.0 and Næser-Savini) were compared. RESULTS At 3 months postoperatively, the average uncorrected distance visual acuity was better in the toric IOL group than the non-toric IOL group (p < 0.001). The mean residual refractive cylinder was lower in the toric IOL group than the non-toric IOL group (p < 0.001). The Næser-Savini formula achieved the lowest mean absolute error (0.39 D) and had the highest percentages of eyes within an absolute error of 0.50 D and 1.00 D (72% and 98%) compared to the other formulas. CONCLUSION The results demonstrate the efficacy of toric IOL implantation in patients older than 80 years with corneal astigmatism and provide strong evidence for cataract surgeons to encourage such patients to choose toric IOLs.
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Affiliation(s)
- Yalan Wang
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Fuman Yang
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xicong Lou
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shuyi Qian
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Bin Hu
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yune Zhao
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Pingjun Chang
- The Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, Hangzhou, 310000, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Bellucci C, Panico A, Tedesco SA, Carta A, Gandolfi S, Bellucci R, Mora P. One-dioptre toric IOL versus spherical IOL in eyes with low preoperative corneal astigmatism. Int Ophthalmol 2022; 43:1711-1719. [PMID: 36418805 PMCID: PMC10149477 DOI: 10.1007/s10792-022-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
To investigate the advantages/disadvantages of a 1.0 D toric IOL vs spherical IOL after regular phacoemulsification in eyes with preoperative astigmatism ≤ 1 D.
Methods
Retrospective comparative series involving pseudophakic eyes with preoperative topographic astigmatism ≤ 1.0 D implanted either with monofocal 1.0 D Toric IOL (T-group), or with spherical IOL (S-group). The postoperative refractive astigmatism (PRA, i.e. surgically induced + corneal) was the main outcome; also considered in the analyses were the uncorrected and best-corrected distance visual acuity (VA). The data were referred to the last postoperative follow-up visit, 2 to 4 months after surgery.
Results
A total of 60 eyes were included: 30 in the T-group and 30 in the S-group, matched for patient’s age, laterality, and axial length. Before surgery, the mean corneal astigmatism was 0.62 ± 0.39 D in the T-group and 0.54 ± 0.33 D in the S-group (p = 0.4). In the S-group, PRA was 0.73 ± 0.37 D, higher than the corresponding preoperative corneal astigmatism (p = 0.040). In the T-group, PRA was 0.58 ± 0.31 D; the variation was not statistically significant. Uncorrected VA was significantly better in the T-group vs the S-group (p = 0.007), and the best-corrected VA was comparable in the two groups.
Conclusion
The present study indicated that in eyes with very low preoperative astigmatism, 1.0 D toric IOLs were able to limit the increase of the PRA instead of those observed with the spherical IOLs. This could support the better uncorrected VA recorded in the T-group.
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Affiliation(s)
- Carlo Bellucci
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy.
| | - Angela Panico
- San Giuseppe E Melorio Hospital, Santa Maria Capua Vetere, Italy
| | - Salvatore A Tedesco
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | - Arturo Carta
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
| | | | - Paolo Mora
- Ophthalmology Unit, Department of Medicine and Surgery, University of Parma - Via Gramsci 14, 43126, Parma, Italy
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Goggin M. Toric intraocular lenses: Evidence‐based use. Clin Exp Ophthalmol 2022; 50:481-489. [PMID: 35584257 PMCID: PMC9543206 DOI: 10.1111/ceo.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
Uncorrected refractive astigmatism degrades visual acuity. Spherical intraocular lenses (IOLs) leave astigmatic errors resident in the cornea manifest in refractive astigmatism. Toric IOLs, correcting for this corneal astigmatism, contribute to spectacle‐free vision in the pseudophakic eye. This review provides information to assist surgeons in a rational choice of eyes suitable for toric IOL implantation, methods of IOL cylinder power calculation, surgical techniques for toric IOLs and management of complications. With appropriate application of this information, correction of visually detrimental astigmatism can be achieved routinely.
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Affiliation(s)
- Michael Goggin
- The Queen Elizabeth Hospital University of Adelaide Woodville South South Australia Australia
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Röggla V, Schartmüller D, Schwarzenbacher L, Chbib RA, Leydolt C, Menapace R. Comparison of Axis Determination With Different Toric Intraocular Lens Power Calculation Methods. J Refract Surg 2021; 37:642-647. [PMID: 34506242 DOI: 10.3928/1081597x-20210712-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the axis position of the measured total corneal astigmatism (TCA) with the axis of the anterior keratometry and the calculated axis position of different toric intraocular lens (IOL) calculators. METHODS A total of 163 astigmatic eyes of 163 patients were retrospectively analyzed. The axis of the actual TCA, measured with anterior segment optical coherence tomography, was compared to the anterior keratometric value (Group I) and three different methods of TCA calculation for toric IOL power determination: Abulafia-Koch regression formula (Group II), Barrett Toric Calculator V2.0 (Group III), and Barrett Toric Calculator V2.0 including measured posterior keratometric value (Group IV). Eyes were assigned to three subgroups: with-the-rule, against-the-rule, and oblique astigmatism. RESULTS The mean deviation calculated from measured TCA was +0.56° (Group I), -0.32° (Group II), -0.37° (Group III), and -1.00° (Group IV). For with-the-rule astigmatism, the TCA axis agreed most with Group I (6.5% outliers > 5° deviation). For against-the-rule astigmatism, Group IV and Group II were closest to the measured TCA axis (1.5% and 3% outliers with > 5° deviation). CONCLUSIONS The means of the calculated axis were similar to the measured TCA, but the proportion of outliers with an axis deviation of greater than 5° showed remarkable differences. Isolated anterior keratometric value measurements showed the fewest outliers in with-the-rule astigmatism. In against-the-rule astigmatism, Abulafia-Koch calculation should be used for axis determination. [J Refract Surg. 2021;37(9):642-647.].
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Lindsay RG, Connell BJ, Snibson GR. Contact lens management of keratoconus in a patient with residual astigmatism resulting from implantation of a toric intraocular lens. Clin Exp Optom 2021; 96:238-41. [DOI: 10.1111/cxo.12036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Grant R Snibson
- Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia,
- Centre for Eye Research Australia, The University of Melbourne, Melbourne, Victoria, Australia,
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Stanojcic N, Roberts H, Wagh V, Zuberbuhler B, O'Brart D. A randomised, prospective study of 'off-the-shelf' use of toric intraocular lenses for cataract patients with pre-existing corneal astigmatism in the NHS. Eye (Lond) 2020; 34:1809-1819. [PMID: 32728226 PMCID: PMC7608256 DOI: 10.1038/s41433-020-0919-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/28/2020] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare visual and refractive outcomes of monofocal intraocular lenses (IOLs) with limbal relaxing incisions (LRI) with 'off-the-shelf' use of toric IOLs (TIOLs), with a fixed 2-dioptre cylinder (DC) correction, for cataract patients with pre-existing corneal astigmatism in a public-sector setting. SUBJECTS/METHODS Seventy-seven patients (77 eyes, first treated eye) with visually significant cataract and pre-operative corneal astigmatism ≥2.00 DC were randomised to receive either 'off-the-shelf' TIOLs, with a fixed 2.00 DC cylinder correction (39 eyes), or monofocal IOLs (38 eyes) with LRIs. The concept of fixing the cylindrical correction was to minimise costs, allow a full TIOL bank to be available and eliminate the need for individual TIOL ordering. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and refraction. Astigmatic changes were evaluated using the Alpins vector method. RESULTS Mean UDVA improved from logMAR 0.88 (SD 0.56)[~20/150] pre-operatively to 0.18 (SD 0.19)[~20/30] post-operatively in TIOL group, versus 0.82 (SD 0.55)[~20/130] to 0.27 (SD 0.15)[~20/40] in monofocal/LRI group (P = 0.02; 95% CI: -0.17, -0.01). Mean CDVA improved from logMAR 0.40 (SD 0.26)[~20/50] to 0.01 (SD 0.12)[~20/20] in TIOL group, and 0.41 (SD 0.38)[~20/40] to 0.06 (SD 0.12)[~20/25] in LRI group (P = 0.07; 95% CI: -0.11, 0.01). Average post-operative refractive cylinder in TIOL group was 1.35 DC (SD 0.84 DC) and in LRI group 1.91 DC (SD 1.07 DC) (P = 0.01; 95% CI: -1, -0.12). Mean difference vector magnitude was 1.92 DC (SD 1.08 DC) in LRI group and 1.37 DC (SD 0.84 DC) in TIOL group (P = 0.02; 95% CI: 0.11, 0.99). CONCLUSIONS TIOLs with a fixed 2.00 DC correction during cataract surgery may improve UDVA, reduce post-operative cylinder and result in a more reliable astigmatic correction compared with monofocal IOLs with LRIs.
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Affiliation(s)
- Nick Stanojcic
- Department of Ophthalmology, King's College London Frost Eye Research Unit, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK. .,King's College, London, UK.
| | - Harry Roberts
- Department of Ophthalmology, King's College London Frost Eye Research Unit, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK.,King's College, London, UK
| | - Vijay Wagh
- Department of Ophthalmology, King's College London Frost Eye Research Unit, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK
| | | | - David O'Brart
- Department of Ophthalmology, King's College London Frost Eye Research Unit, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH, UK.,King's College, London, UK
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Hao J, Tan LZ, Li L, Bu SC, Ren XJ, Tian F, Zhang H. Comparison of visual quality in cataract patients with low astigmatism after ART2 or ReSTOR intraocular lens implantation. Int J Ophthalmol 2019; 12:424-428. [PMID: 30918811 DOI: 10.18240/ijo.2019.03.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare visual quality in cataract patients with low corneal astigmatism who underwent intraocular lens (IOL) implantation, and evaluate effects of low levels of astigmatism on visual outcomes in multifocal pseudophakic eyes. METHODS This retrospective review of clinical records comprised patients with preoperative regular corneal astigmatism of 0.75-1.0 diopters (D) with-the-rule or 0.5-0.75 D against-the-rule who had uneventful cataract surgery and AcrySof IQ ReSTOR Toric-2 IOL (ART2) or AcrySof IQ ReSTOR IOL (ReSTOR) implantation. Retrospective data collection included postoperative ART2 axis rotation, uncorrected astigmatism, uncorrected entire visual acuities, distance corrected entire visual acuities, average modulation transfer function (aMTF), Strehl ratio (SR), spectacle independence, and patient satisfaction between groups. RESULTS Mean ART2 axis rotation was 3.12°±0.70°. No secondary surgery was required to realign IOL axis. Residual astigmatism values were -0.18±0.07 D and -0.91±0.25 D in groups ART2 and ReSTOR (P<0.05). Three months postoperatively, the mean uncorrected distant, intermediate, and near visual acuities of group A were 0.01±0.05, 0.05±0.07, 0.02±0.07 logMAR, respectively; these were better than those of group R, which were 0.08±0.06, 0.15±0.12, and 0.09±0.08 logMAR, respectively (P<0.05). aMTF, SR, and spectacle independence rates were not significantly different. All patients were satisfied with postoperative results. CONCLUSION ART2 is more suitable than ReSTOR for cataract patients with regular corneal astigmatism 0.75-1.0 D with-the-rule or 0.5-0.75 D against-the-rule.
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Affiliation(s)
- Jing Hao
- Tianjin Medical University Eye Hospital, Tianjin 300384, China.,North China University of Science and Technology, Tangshan 063000, Hebei Province, China
| | - Liang-Zhang Tan
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Lin Li
- Tangshan Gongren Hospital, Tangshan 063000, Hebei Province, China
| | - Shao-Chong Bu
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xin-Jun Ren
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Fang Tian
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Hong Zhang
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Power B, Murphy R, Leccisotti A, Moore T, Power W, O'Brien P. Maximising Refractive Outcomes with an Extended Depth of Focus IOL. Open Ophthalmol J 2018; 12:273-280. [PMID: 30369992 PMCID: PMC6174614 DOI: 10.2174/1874364101812010273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/13/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the impact of the magnitude of preoperative and postoperative corneal astigmatism on refractive outcomes in patients undergoing cataract surgery or lens exchange with an extended depth of focus intraocular lens. To compare visual outcomes of steep and temporal on-axis corneal incisions. Setting Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland. Design Prospective cohort analysis. Methods Fifty-three consecutive adult patients (94 eyes) undergoing routine phacoemulsification with Symfony IOL implantation were analysed. Exclusion criteria: targets for mini-monovision, incomplete data, other ocular pathology. Data were prospectively collected on pre- and postoperative refraction, keratometry, distance vision, near vision, surgical wound site and Surgically Induced Astigmatism (SIA). Results The average postoperative monocular Uncorrected Distance and Near visual acuities (UDVA and UNVA) were 0.12 LogMAR (± 0.1) (6/7.5+1) and 0.34 LogMAR (± 0.09) respectively. The average binocular UDVA and UNVA were 0.05 (± 0.07) and 0.29 LogMAR (± 0.06) respectively. Low levels of preoperative corneal astigmatism (0-0.99 D) were associated with better LogMAR UDVA and UNVA when compared with higher levels (> 0.99 D): 0.11 (CI 0.103-0.107) vs. 0.206 (CI 0.122-0.290) (p =0.015, CI 95%) and 0.33 (CI 0.316 - 0.356) vs. 0.39 (CI 0.34-0.43) (p =0.034, CI 95%) respectively. When patients with steep on-axis corneal incisions were compared with temporal on-axis corneal incisions, no difference was detected in visual outcome or SIA. Conclusion The Symfony IOL is an effective surgical means of addressing presbyopia and reducing postoperative spectacle dependence. We stress caution when offering potential spectacle independence for patients with over 1D of preoperative corneal astigmatism as these patients achieve statistically significantly inferior and less predictable visual results.
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Affiliation(s)
- Barry Power
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Ophthalmology, Biomedical Sciences Research Institute, Ulster University, Northern Ireland
| | - Rory Murphy
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Ophthalmology, Biomedical Sciences Research Institute, Ulster University, Northern Ireland
| | - Antonio Leccisotti
- Department of Ophthalmology, Biomedical Sciences Research Institute, Ulster University, Northern Ireland.,Department of Ophthalmology, University of Siena, Siena, Italy
| | - Tara Moore
- Department of Ophthalmology, Biomedical Sciences Research Institute, Ulster University, Northern Ireland
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Raucau M, El Chehab H, Agard E, Lagenaite C, Dot C. [Toric lens implantation in cataract surgery: Automatic versus manual horizontal axis marking, analysis of 50 cases]. J Fr Ophtalmol 2018; 41:136-144. [PMID: 29426763 DOI: 10.1016/j.jfo.2017.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/15/2022]
Abstract
SUBJECT The main objective of our study is to evaluate the contribution of automated conjunctival recognition in the alignment of toric implants by comparing the automatic alignment optimized with Callisto™ to the manual marking of the horizontal axis. MATERIALS AND METHODS We performed a prospective, descriptive, and monocentric study on patients undergoing cataract surgery with toric implantation (Asphina 709 Zeiss), operated by a surgeon with good experience in toricity, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0°-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS We included 50 eyes of 26 patients. The corrected mean astigmatism was 1.9 D. The mean difference between the 2 axes was 4.7° [0°-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automatic measurement (<5°). At one month, the average rotation recorded was 4.3° [0°-29°]. The alignment was identical for 70 % (n=35) of the IOL (≤5°). As for residual subjective astigmatism, it was on average 0.58 D. The mean visual acuity without correction was 8/10 and 55 % had 10/10 without correction. DISCUSSION The refractive performance depends on the preoperative measurement, the correct alignment of the IOL and its stability in the bag. Our study shows the value of automatic conjunctival recognition in the determination of the axis of peroperative alignment, even in an experienced operator. This precision is essential for a good refractive result, especially since the residual astigmatism in case of misalignment will increase with the power of the implant. CONCLUSION Our study shows excellent refractive results, whatever the initial astigmatism, using the automatic alignment. The precision of the toric implantation opens the way to the toric multifocal implantation under the best conditions.
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Affiliation(s)
- M Raucau
- Service d'ophtalmologie, HIA de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - H El Chehab
- Service d'ophtalmologie, HIA de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - E Agard
- Service d'ophtalmologie, HIA de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - C Lagenaite
- Service d'ophtalmologie, HIA de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - C Dot
- Service d'ophtalmologie, HIA de Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
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11
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Raucau M, El Chehab H, Agard E, Lagenaite C, Dot C. Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases. J Fr Ophtalmol 2018; 41:e1-e9. [PMID: 29331293 DOI: 10.1016/j.jfo.2017.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/30/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
SUBJECT The main objective of our study was to evaluate the contribution of automated conjunctival registration in the alignment of toric intraocular lenses by comparing automated registration optimized with Callisto® to manual marking of the horizontal axis. MATERIALS AND METHODS We performed a prospective, descriptive, monocentric study on patients undergoing cataract surgery with a toric intraocular lens (Asphina 709 Zeiss), performed by a surgeon with good experience in toric implants, between September 2016 and March 2017. We analyzed the agreement between the manual marking of the 0-180° axis versus the one automatically generated by the Callisto™, as well as the alignment of the IOL and the refractive results at 1 month. RESULTS We included 50 eyes of 38 patients. The mean corrected astigmatism was 1,9 D. The mean difference between the 2 axes was 4,7° [0-12.3°]. Only 50 % of the preoperative manual markings were consistent with the automated measurement (<5°). At one month, the mean rotation recorded was 4,3° [0-29°]. The alignment was identical for 70 % (n=35) of the IOLs (≤5°). As for residual subjective astigmatism, the mean was 0.58 D. The mean visual acuity without correction was 8/10 and 55 % saw 10/10 without correction. DISCUSSION Refractive performance depends on preoperative measurement, correct alignment of the IOL and its stability in the bag. Our study shows the value of automated conjunctival registration in the determination of the intraoperative axis of alignment, even with an experienced surgeon. This precision is essential for a good refractive result, especially since residual astigmatism in the case of misalignment will increase with the power of the implant. CONCLUSION Our study shows excellent refractive results, regardless of the initial astigmatism, using automated alignment. Precision of toric implantation opens the way to toric multifocal implantation under the best conditions.
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Affiliation(s)
- M Raucau
- Service d'ophtalmologie, HIA de Desgenettes, Bron, 1, place du Change, 69005 Lyon, France.
| | - H El Chehab
- Service d'ophtalmologie, HIA de Desgenettes, Bron, 1, place du Change, 69005 Lyon, France
| | - E Agard
- Service d'ophtalmologie, HIA de Desgenettes, Bron, 1, place du Change, 69005 Lyon, France
| | - C Lagenaite
- Service d'ophtalmologie, HIA de Desgenettes, Bron, 1, place du Change, 69005 Lyon, France
| | - C Dot
- Service d'ophtalmologie, HIA de Desgenettes, Bron, 1, place du Change, 69005 Lyon, France
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12
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Kaur M, Shaikh F, Falera R, Titiyal JS. Optimizing outcomes with toric intraocular lenses. Indian J Ophthalmol 2017; 65:1301-1313. [PMID: 29208810 PMCID: PMC5742958 DOI: 10.4103/ijo.ijo_810_17] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery. Comprehensive literature search was performed in MEDLINE using “toric intraocular lenses,” “astigmatism,” and “cataract surgery” as keywords. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Realignment of the toric IOL is needed in 0.65%–3.3% cases, with more than 10° of rotation from the target axis. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations.
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Affiliation(s)
- Manpreet Kaur
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Farin Shaikh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchita Falera
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Thomas BC, Khoramnia R, Auffarth GU, Holzer MP. Clinical outcomes after implantation of a toric intraocular lens with a transitional conic toric surface. Br J Ophthalmol 2017; 102:313-316. [PMID: 28774937 DOI: 10.1136/bjophthalmol-2017-310386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the postoperative outcomes after implantation of a hydrophilic toric intraocular lens (tIOL) with a transitional conic toric surface in patients with astigmatism undergoing refractive lens exchange (RLE) or cataract surgery. METHODS In this monocentric study, clinical outcomes following implantation of the hydrophilic Precizon toric IOL model 565 (Ophtec) were analysed. For intraoperative axis alignment, the Verion Image Guided System was used. Intended versus achieved refraction, IOL position, visual acuity outcomes and power vector analyses were evaluated 3 months postoperatively. RESULTS Forty-three eyes of 28 patients (40 eyes cataract, 3 eyes RLE) received a Precizon toric IOL with a cylindrical power between 1.0 and 7.5 D. Target refraction was emmetropia except for four eyes that had a myopic target. The median postoperative IOL rotation at slit lamp was 3° with a range from 0° to 16°. Uncorrected distance visual acuity (UDVA) increased from median 0.5 logMAR preoperatively to median 0.06 logMAR at 3 months postoperatively. Corrected distance visual acuity increased from 0.20 to -0.02 logMAR. Median preoperative subjective cylinder was 1.5 D and 3 months postoperatively 0.25 D. CONCLUSION Preoperative diagnostics, IOL selection and correct intraoperative positioning of tIOLs are essential for good outcomes and postoperative spectacle independence following cataract or RLE surgery. Visual acuities and rotational stability of the Precizon toric IOL showed very good outcomes and the subjective postoperative astigmatism could be reduced significantly.
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Affiliation(s)
- Bettina C Thomas
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, David J Apple International Laboratory of Ophthalmic Pathology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, David J Apple International Laboratory of Ophthalmic Pathology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, David J Apple International Laboratory of Ophthalmic Pathology, University of Heidelberg, Heidelberg, Germany
| | - Mike P Holzer
- Department of Ophthalmology, International Vision Correction Research Centre (IVCRC), University of Heidelberg, Heidelberg, Germany.,Department of Ophthalmology, David J Apple International Laboratory of Ophthalmic Pathology, University of Heidelberg, Heidelberg, Germany
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Lehmann R, Modi S, Fisher B, Michna M, Snyder M. Bilateral implantation of +3.0 D multifocal toric intraocular lenses: results of a US Food and Drug Administration clinical trial. Clin Ophthalmol 2017; 11:1321-1331. [PMID: 28790805 PMCID: PMC5530114 DOI: 10.2147/opth.s137413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the clinical outcomes of apodized diffractive +3.0 D multifocal toric intraocular lens (IOL) implantations in subjects with preoperative corneal astigmatism. Patients and methods This was a prospective cohort study conducted at 21 US sites. The study population consisted of 574 subjects, aged ≥21 years, with preoperative astigmatism 0.75–2.82 D, and potential postoperative visual acuity (VA) ≥0.2 logMAR, undergoing bilateral cataract removal by phacoemulsification. The intervention was bilateral implantation of aspheric apodized diffractive +3.0 D multifocal toric or spherical multifocal nontoric IOLs. The main outcome measures were monocular uncorrected near and distance VA and safety at 12 months. Results A total of 373/386 and 182/188 subjects implanted with multifocal toric and nontoric IOLs, respectively, completed 12-month follow-up after the second implantation. Toric IOLs were nonin-ferior in monocular uncorrected distance (4 m) and near (40 cm) VA but had >1 line better binocular uncorrected intermediate VA (50, 60, and 70 cm) than nontoric IOLs. Toric IOLs reduced cylinder to within 0.50 D and 1.0 D of target in 278 (74.5%) and 351 (94.1%) subjects, respectively. Mean ± standard deviation (SD) differences between intended and achieved axis orientation in the first and second implanted eyes were 5.0°±6.1° and 4.7°±4.0°, respectively. Mean ± SD 12-month IOL rotations in the first and second implanted eyes were 2.7°±5.8° and 2.2°±2.7°, respectively. No subject receiving toric IOLs required secondary surgical intervention due to optical lens properties. Conclusion Multifocal toric IOLs were noninferior to multifocal nontoric IOLs in uncorrected distance and near VAs in subjects with preexisting corneal astigmatism and effectively corrected astigmatism of 0.75–2.82 D.
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Affiliation(s)
| | | | - Bret Fisher
- The Eye Center of North Florida, Panama City, FL
| | - Magda Michna
- Department of Clinical Trial Management, Alcon Laboratories, Inc., Fort Worth, TX
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Zhang B, Ma JX, Liu DY, Guo CR, Du YH, Guo XJ, Cui YX. Effects of posterior corneal astigmatism on the accuracy of AcrySof toric intraocular lens astigmatism correction. Int J Ophthalmol 2016; 9:1276-82. [PMID: 27672591 DOI: 10.18240/ijo.2016.09.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022] Open
Abstract
AIM To evaluate the effects of posterior corneal surface measurements on the accuracy of total estimated corneal astigmatism. METHODS Fifty-seven patients with toric intraocular lens (IOL) implantation and posterior corneal astigmatism exceeding 0.5 diopter were enrolled in this retrospective study. The keratometric astigmatism (KA) and total corneal astigmatism (TA) were measured using a Pentacam rotating Scheimpflug camera to assess the outcomes of AcrySof IOL implantation. Toric IOLs were evaluated in 26 eyes using KA measurements and in 31 eyes using TA measurements. Preoperative corneal astigmatism and postoperative refractive astigmatism were recorded for statistical analysis. The cylindrical power of toric IOLs was estimated in all eyes. RESULTS In all cases, the difference of toric IOL astigmatism magnitude between KA and TA measurements for the estimation of preoperative corneal astigmatism was statistically significant. Of a total of 57 cases, the 50.88% decreased from Tn to Tn-1, and 10.53% decreased from Tn to Tn-2. In all cases, 5.26% increased from Tn to Tn+1. The mean postoperative astigmatism within the TA group was significantly lower than that in the KA group. CONCLUSION The accuracy of total corneal astigmatism calculations and the efficacy of toric IOL correction can be enhanced by measuring both the anterior and posterior corneal surfaces using a Pentacam rotating Scheimpflug camera.
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Affiliation(s)
- Bin Zhang
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jing-Xue Ma
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Dan-Yan Liu
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Cong-Rong Guo
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ying-Hua Du
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Xiu-Jin Guo
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yue-Xian Cui
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Chiam PJ, Quah SA. The refractive outcome of Toric Lentis Mplus implant in cataract surgery. Int J Ophthalmol 2016; 9:699-702. [PMID: 27275424 DOI: 10.18240/ijo.2016.05.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens (IOL) implant. METHODS This is a retrospective case series. Consecutive patients with corneal astigmatism of at least 1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter (>6 mm), poor visual potential and significant ocular comorbidity. Postoperative manifest refraction, uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), uncorrected intermediate visual acuity (UIVA) at 3/4 m and uncorrected near visual acuity (UNVA) were obtained. RESULTS There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk (range 4.0 to 15.5) from the operation date. Sixty-five percent of eyes had 6/7.5 (0.10 logMAR) or better, and 99% 6/12 (0.30 logMAR) or better postoperative UDVA. Eighty-nine percent could read Jaeger (J) 3 (0.28 logMAR) and 95% J5 (0.37 logMAR) at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D (Wilcoxon, P<0.001) after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D (keratometric) preoperatively to 0.00-1.46 D (subjective refraction transposed to corneal plane) postoperatively. CONCLUSION Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.
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Affiliation(s)
- Patrick J Chiam
- Birmingham and Midland Eye Centre, City Hospital, Birmingham BH18 7QH, United Kingdom
| | - Say A Quah
- Optegra Manchester Eye Hospital, Manchester M20 2EY, United Kingdom
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Posterior Corneal Astigmatism and Current Strategies for Optimizing Outcomes with Toric IOLs. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kessel L, Andresen J, Tendal B, Erngaard D, Flesner P, Hjortdal J. Toric Intraocular Lenses in the Correction of Astigmatism During Cataract Surgery: A Systematic Review and Meta-analysis. Ophthalmology 2015; 123:275-286. [PMID: 26601819 DOI: 10.1016/j.ophtha.2015.10.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022] Open
Abstract
TOPIC We performed a systematic review and meta-analysis to evaluate the benefit and harms associated with implantation of toric intraocular lenses (IOLs) during cataract surgery. Outcomes were postoperative uncorrected distance visual acuity (UCDVA) and distance spectacle independence. Harms were evaluated as surgical complications and residual astigmatism. CLINICAL RELEVANCE Postoperative astigmatism is an important cause of suboptimal UCDVA and need for distance spectacles. Toric IOLs may correct for preexisting corneal astigmatism at the time of surgery. METHODS We performed a systematic literature search in the Embase, PubMed, and CENTRAL databases within the Cochrane Library. We included randomized clinical trials (RCTs) if they compared toric with non-toric IOL implantation (± relaxing incision) in patients with regular corneal astigmatism and age-related cataracts. We assessed the risk of bias using the Cochrane Risk of Bias tool. We assessed the quality of evidence across studies using the GRADE profiler software (available at: www.gradeworkinggroup.org). RESULTS We included 13 RCTs with 707 eyes randomized to toric IOLs and 706 eyes randomized to non-toric IOLs; 225 eyes had a relaxing incision. We found high-quality evidence that UCDVA was better in the toric IOL group (logarithm of the minimum angle of resolution [logMAR] mean difference, -0.07; 95% confidence interval [CI], -0.10 to -0.04) and provided greater spectacle independence (risk ratio [RR], 0.51; 95% CI, 0.36-0.71) and moderate quality evidence that toric IOL implantation was not associated with an increased risk of complications (RR, 1.73; 95% CI, 0.60-5.04). Residual astigmatism was lower in the toric IOL group than in the non-toric IOL plus relaxing incision group (mean difference, 0.37 diopter [D]; 95% CI, -0.55 to -0.19). CONCLUSIONS We found that toric IOLs provided better UCDVA, greater spectacle independence, and lower amounts of residual astigmatism than non-toric IOLs even when relaxing incisions were used.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology, Rigshospitalet - Glostrup, Glostrup, Denmark; National Danish Medicines and Health Authorities, Copenhagen, Denmark.
| | | | - Britta Tendal
- National Danish Medicines and Health Authorities, Copenhagen, Denmark; The Nordic Cochrane Center, Copenhagen, Denmark
| | - Ditte Erngaard
- Department of Ophthalmology, Næstved Hospital, Næstved, Denmark
| | | | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital NBG, Aarhus, Denmark
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Aujla JS, Vincent SJ, White S, Panchapakesan J. Cataract Surgery in Eyes with Low Corneal Astigmatism: Implantation of the Acrysof IQ Toric SN6AT2 Intraocular Lens. J Ophthalmic Vis Res 2015; 9:324-8. [PMID: 25667733 PMCID: PMC4307669 DOI: 10.4103/2008-322x.143369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/07/2013] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the refractive and visual outcomes following cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 intraolcular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX, USA) in patients with low corneal astigmatism. METHODS This study is a retrospective, consecutive, single surgeon series of 98 eyes of 88 patients (with low preoperative corneal astigmatism) undergoing cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 IOL. Postoperative measurements were obtained 1-month postsurgery. Main outcome measures were monocular distance visual acuity and residual refractive astigmatism. RESULTS Mean preoperative corneal astigmatic power vector (APV) was 0.38±0.09 D. Following surgery and implantation of the toric IOL, mean postoperative refractive APV was 0.13±0.10 D. Mean postoperative distance uncorrected visual acuity was 0.08±0.09 logMAR. Postoperative spherical equivalent refraction (SER) resulted in a mean of -0.23±0.22 D, with 96% of eyes falling within 0.50 D of the target SER. CONCLUSION The AcrySof IQ Toric SN6AT2 IOL is a safe and effective option for eyes undergoing cataract surgery with low levels of preoperative corneal astigmatism.
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Affiliation(s)
| | - Stephen J Vincent
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Shane White
- Queensland Eye Specialists, Bundaberg, Queensland, Australia
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Vasavada AR, Nath V, Raj S, Vasavada V, Vasavada S. Technology and Intraocular Lenses to Enhance Cataract Surgery Outcomes-Annual Review (January 2013 to January 2014). Asia Pac J Ophthalmol (Phila) 2014; 3:308-21. [PMID: 26107918 DOI: 10.1097/apo.0000000000000092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This article is aimed to provide a clinical update on recent developments in cataract surgical techniques, with specific focus on femtosecond laser technology. The article also focuses on recent improvements in the technology used in implanting intraocular lenses (IOLs). DESIGN Literature review. METHODS The authors conducted a review of literature available in the last 12 months in the English language using PubMed. The period used to conduct the literature search was from January 1, 2013, to December 31, 2013. The following search terms were used during the PubMed search: phacoemulsification, femtosecond laser, toric IOLs, multifocal IOLs, multifocal toric IOLs, manual small-incision cataract surgery, outcomes, surgically induced astigmatism, rotational stability, trifocal IOLs, laser cataract surgery, safety, and efficacy. RESULTS This review incorporates selected original articles that provide fresh insights and updates on the fields of toric and multifocal IOLs, femtosecond laser cataract surgery, and manual small-incision cataract surgery. Particular attention has been paid to observational, randomized controlled clinical trials, experimental trials, and analyses of larger cohorts with prospective and retrospective study designs. Letters to the editor, unpublished works, and abstracts do not fall under the purview of this review. CONCLUSIONS This review is not designed to be all-inclusive. It highlights and provides insights on literature that is most useful and applicable to practicing ophthalmologists.
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Affiliation(s)
- Abhay R Vasavada
- From the Iladevi Cataract & IOL Research Center, Raghudeep Eye Hospital, Ahmedabad, India
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Cataract surgery with toric intraocular lens for correction of high corneal astigmatism. Can J Ophthalmol 2014; 48:246-50. [PMID: 23931461 DOI: 10.1016/j.jcjo.2013.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/18/2012] [Accepted: 03/15/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the outcomes of cataract surgery with high-power toric intraocular lens (IOL) implantation in patients with high corneal astigmatism. DESIGN Retrospective case series. PARTICIPANTS Twelve eyes of 9 patients. METHODS Patients with idiopathic, pathologic, or postsurgical corneal astigmatism and a visually significant cataract were included in the study. Cataract extraction with implantation of a custom-made high-power toric IOL was performed on all patients. Outcomes included uncorrected and best corrected distance visual acuity (UDVA and BCDVA), manifest refraction, and mean and steepest keratometry. Analysis of astigmatic vectors was also performed. RESULTS The mean follow-up time was 3.75 months. At the last follow-up visit, there was a significant improvement of UDVA (1 ± 0.64 vs 0.39 ± 0.21 logMAR; p < 0.05), cylindrical refraction (-4.72 ± 1.13 vs -1.81 ± 1.10 D; p < 0.01), and refractive spherical equivalent (-4.56 ± 5.58 vs -0.36 ± 1.19 D; p < 0.05). The BCDVA improvement did not reach statistical significance. Astigmatism on the target axis was reduced by an average of 5 D (p < 0.01). CONCLUSIONS Cataract surgery with implantation of a high-power toric IOL was safe and effective in correcting high values of corneal astigmatism.
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Savini G, Hoffer KJ, Ducoli P. A New Slant on Toric Intraocular Lens Power Calculation. J Refract Surg 2013; 29:348-54. [DOI: 10.3928/1081597x-20130415-06] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/05/2013] [Indexed: 11/20/2022]
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Bascaran L, Mendicute J, Macias-Murelaga B, Arbelaitz N, Martinez-Soroa I. Efficacy and stability of AT TORBI 709 M toric IOL. J Refract Surg 2013; 29:194-9. [PMID: 23446016 DOI: 10.3928/1081597x-20130129-02] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/03/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the intraocular rotational stability and refractive results of the toric AT TORBI 709 M (former AT.Comfort 464 TLC) intraocular lens (IOL) (Carl Zeiss Meditec AG, Jena, Germany). METHODS Forty-eight eyes of 32 consecutive patients with cataract and greater than 1 diopter of corneal astigmatism were included. Implantation of the toric IOL was performed after phacoemulsification. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive sphere, residual keratometric and refractive cylinders, and toric IOL axis were measured before and 1, 3, and 6 months after surgery. RESULTS Mean logMAR UDVA and CDVA improved significantly after surgery (P < .05). UDVA was 20/40 or better in 88.1% of eyes and 20/25 or better in 61.9%. CDVA was 20/40 or better in 100% of eyes and 20/25 or better in 90.2%. Mean refractive cylinder decreased significantly from -2.23 ± 1.72 before to -0.43 ± 0.53 after surgery (P < .05). Vector analysis of attempted versus achieved correction showed 100% of eyes within ± 1.00 D and 95.2% within ± 0.50 D for J and 100% of eyes were within ± 1.00 D and 95.2% within ± 0.50 D for J. Mean toric IOL axis rotation was 4.42 ± 4.31 degrees (range: 0 to 16 degrees) and 86% of the lenses rotated less than 10 degrees. CONCLUSIONS The AT TORBI 709 M IOL has proved to be a predictable and effective device with good rotational stability for the correction of preexisting astigmatism during cataract surgery.
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Affiliation(s)
- Lucia Bascaran
- Ophthalmology Department, Hospital Universitario Donostia, San Sebastian, Spain.
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Watanabe K, Negishi K, Dogru M, Yamaguchi T, Torii H, Tsubota K. Effect of pupil size on uncorrected visual acuity in pseudophakic eyes with astigmatism. J Refract Surg 2013; 29:25-9. [PMID: 23472266 DOI: 10.3928/1081597x-20121106-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the effect of pupil size on the relationship between refractive astigmatism and uncorrected distance visual acuity (UDVA) and pseudoaccommodation in pseudophakic eyes. METHODS Thirty-six eyes from 36 patients who underwent phacoemulsification and intraocular lens (IOL) implantation were included. All eyes were divided into two groups based on the presence of postoperative-with-the-rule astigmatism or against-the-rule astigmatism. Uncorrected and corrected distance visual acuity (CDVA), refractive astigmatism, subjective accommodation amplitude, and pupil sizes under photopic and mesopic conditions were measured 1 month postoperatively. The effects of pupil size on the relationship between refractive astigmatism and UDVA were investigated. RESULTS Against-the-rule astigmatism had a moderate but significant negative linear correlation with UDVA irrespective of the pupil size (R(2)=0.60, P<.01). A moderate but significant negative linear correlation was found when the pupil diameter exceeded 2.9 mm in eyes with with-the-rule astigmatism (R(2)=0.46, P=.04). Refractive astigmatism was not significantly correlated with pseudoaccommodation regardless of the pupil diameter in either group. CONCLUSIONS The results of the current study suggest that pupil size may have an impact on postoperative UDVA in eyes having against-the-rule astigmatism and in eyes with a large pupil diameter and with-the-rule astigmatism.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Opthalmology, Keio University School of Medicine, Tokyo, Japan
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Thomas BC, Auffarth GU, Reiter J, Holzer MP, Rabsilber TM. Implantation of Three-Piece Silicone Toric Additive IOLs in Challenging Clinical Cases With High Astigmatism. J Refract Surg 2013; 29:187-93. [DOI: 10.3928/1081597x-20130212-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/10/2013] [Indexed: 11/20/2022]
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Inoue M, Noda T, Ohnuma K, Bissen-Miyajima H, Hirakata A. Quality of image of grating target placed in model eye and observed through toric intraocular lenses. Am J Ophthalmol 2013; 155:243-252.e1. [PMID: 23036568 DOI: 10.1016/j.ajo.2012.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the quality of an image of a grating target placed in a model eye and viewed through implanted toric intraocular lenses (IOLs). DESIGN Laboratory investigation. METHODS Toric IOLs, SN6AT5 with a cylinder power of 3.0 diopters (3.0 D, Alcon), ST6AT9 (6.0 D, Alcon), 311T5 (3.0 D, HOYA), or 311T9 (6.0 D, HOYA), were placed in a fluid-filled model eye. A United States Air Force test target was placed internally on the posterior surface of the model eye. A flat contact lens or a wide-angle contact lens was placed on the cornea. The contrast and length of the grating targets perpendicular (vertical) or parallel (horizontal) to the flat meridian of the toric IOL were compared with those obtained through aspheric IOLs. RESULTS The contrast of the targets viewed through the flat contact lens and toric IOLs in the vertical direction was significantly lower than that viewed through the aspheric IOL at 16 cycle/mm (SN6AT9, P=.002; SN6AT5, P=.028; 311T9, P=.002; 311T5, P =.011) but not with the wide-angle viewing lens at 16, 32, and 64 cycle/mm. The vertical length of the target with a flat contact lens was longer and the horizontal length was shorter than that through the aspheric IOL by 1% to 3% with the SN6AT5 and 311T5 IOLs and by 3% to 5% with the SN6AT9 and 311T9 IOLs. However, the vertical and horizontal lengths were not significantly different through the wide-viewing lens. CONCLUSION Toric IOLs affect the contrast of a grating target viewed through a flat contact lens but not through a wide-angle viewing lens. The wide-angle viewing system is not influenced by cylindrical aberrations.
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Affiliation(s)
- Makoto Inoue
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan.
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Humbert G, Colin J, Touboul D. [AcrySof® Toric (SN60T) intraocular lens implantation: refractive predictibility and aberrometric impact of decentration]. J Fr Ophtalmol 2013; 36:352-61. [PMID: 23332291 DOI: 10.1016/j.jfo.2012.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/14/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate refractive outcomes of toric intraocular lens (IOL) implantation with a detailed analysis of decentration and its effect on aberrometry. METHODS This retrospective study enrolled 19 eyes implanted with SN60T AcrySof(®) Toric (Alcon - USA) IOL's. Spherocylindric correction was studied in depth by the Alpins method, and retro-illumination images were used to analyze the alignment of the IOL with its intended axis. IOL decentration as well as its aberrometric impact were evaluated with a strict, novel protocol. RESULTS Three months postoperatively, uncorrected distance visual acuity was greater or equal to 20/40 in 94.74% of cases, postoperative subjective cylinder was less or equal to 0.5 D in 68.42% of eyes, with a mean index of success of 0.24. Mean error of toric IOL alignment was 5.68° (0 to 14). Mean IOL decentration was 0.78 mm (0 to 1.78) with a mean coma and trefoil of 0.18 μ (0.06 to 0.33) and 0.19 μ (0.05 to 0.51), respectively. The larger the IOL decentration, the higher the optical aberrations were. CONCLUSION Toric intraocular lens implantation is an effective, safe and predictable method of spherocylindrical correction during cataract surgery, with a refractive accuracy similar to that of LASIK in the treatment of astigmatism in young patients. IOL decentration produces optical aberrations including coma and trefoil, which interfere with visual performance.
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Affiliation(s)
- G Humbert
- Service d'ophtalmologie, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Debois A, Nochez Y, Bezo C, Bellicaud D, Pisella PJ. [Refractive precision and objective quality of vision after toric lens implantation in cataract surgery]. J Fr Ophtalmol 2012; 35:580-6. [PMID: 22704587 DOI: 10.1016/j.jfo.2011.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/05/2011] [Accepted: 10/07/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE To study efficacy and predictability of toric IOL implantation for correction of preoperative corneal astigmatism by analysing spherocylindrical refractive precision and objective quality of vision. PATIENTS AND METHODS Prospective study of 13 eyes undergoing micro-incisional cataract surgery through a 1.8mm corneal incision with toric IOL implantation (Lentis L313T(®), Oculentis) to treat over one D of preoperative corneal astigmatism. Preoperative evaluation included keratometry, subjective refraction, and total and corneal aberrometry (KR-1(®), Topcon). Six months postoperatively, measurements included slit lamp photography, documenting IOL rotation, tilt or decentration, uncorrected visual acuity, best-corrected visual acuity and objective quality of vision measurement (OQAS(®) Visiometrics, Spain). RESULTS Postoperatively, mean uncorrected distance visual acuity was 8.33/10 ± 1.91 (0.09 ± 0.11 LogMar). Mean postoperative refractive sphere was 0.13 ± 0.73 diopters. Mean refractive astigmatism was -0.66 ± 0.56 diopters with corneal astigmatism of 2.17 ± 0.68 diopters. Mean IOL rotation was 4.4° ± 3.6° (range 0° to 10°). DISCUSSION Mean rotation of this IOL at 6 months was less than 5°, demonstrating stability of the optic within the capsular bag. Objective quality of vision measurements were consistent with subjective uncorrected visual acuity. CONCLUSION Implantation of the L313T(®) IOL is safe and effective for correction of corneal astigmatism in 1.8mm micro-incisional cataract surgery.
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Affiliation(s)
- A Debois
- Service d'ophtalmologie, CHU de Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France.
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Lehmann RP, Houtman DM. Visual performance in cataract patients with low levels of postoperative astigmatism: full correction versus spherical equivalent correction. Clin Ophthalmol 2012; 6:333-8. [PMID: 22399846 PMCID: PMC3295631 DOI: 10.2147/opth.s28241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate whether visual performance could be improved in pseudophakic subjects by correcting low levels of postoperative astigmatism. Methods An exploratory, noninterventional study was conducted using subjects who had been implanted with an aspheric intraocular lens and had 0.5–0.75 diopter postoperative astigmatism. Monocular visual performance using full correction was compared with visual performance using spherical equivalent correction. Testing consisted of high- and low-contrast visual acuity, contrast sensitivity, and reading acuity and speed using the Radner Reading Charts. Results Thirty-eight of 40 subjects completed testing. Visual acuities at three contrast levels (100%, 25%, and 9%) were significantly better using full correction than when using spherical equivalent correction (all P < 0.001). For contrast sensitivity testing under photopic, mesopic, and mesopic with glare conditions, only one out of twelve outcomes demonstrated a significant improvement with full correction compared with spherical equivalent correction (at six cycles per degree under mesopic without glare conditions, P = 0.046). Mean reading speed was numerically faster with full correction across all print sizes, reaching statistical significance at logarithm of the reading acuity determination (logRAD) 0.2, 0.7, and 1.1 (P < 0.05). Statistically significant differences also favored full correction in logRAD score (P = 0.0376), corrected maximum reading speed (P < 0.001), and logarithm of the minimum angle of resolution/logRAD ratio (P < 0.001). Conclusions In this study of pseudophakic subjects with low levels of postoperative astigmatism, full correction yielded significantly better reading performance and high- and low-contrast visual acuity than spherical equivalent correction, suggesting that cataractous patients may benefit from surgical correction of low levels of preoperative corneal astigmatism.
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Chang M, Kang SY, Kim HM. Which keratometer is most reliable for correcting astigmatism with toric intraocular lenses? KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:10-4. [PMID: 22323879 PMCID: PMC3268162 DOI: 10.3341/kjo.2012.26.1.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 01/07/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the accuracy of preoperative keratometers used in cataract surgery with toric intraocular lens (IOL). METHODS Twenty-five eyes received an AcrySof toric IOL implantation. Four different keratometric methods, a manual keratometer, an IOL master, a Pentacam and an auto keratometer, were performed preoperatively in order to evaluate preexisting corneal astigmatism. Differences between the true residual astigmatism and the anticipated residual astigmatism (keratometric error) were compared at one and three months after surgery by using a separate vector analysis to identify the keratometric method that provided the highest accuracy for astigmatism control. RESULTS The mean keratomeric error was 0.52 diopters (0.17-1.17) for the manual keratometer, 0.62 (0-1.31) for the IOL master, 0.69 (0.08-1.92) for the Pentacam, and 0.59 (0.08-0.94) for the auto keratometer. The manual keratometer was the most accurate, although there was no significant difference between the keratometers (p > 0.05). All of the keratometers achieved an average keratometric error of less than one diopter. CONCLUSIONS Manual keratometry was the most accurate of the four methods evaluated, although the other techniques were equally satisfactory in determining corneal astigmatism.
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Affiliation(s)
- Minwook Chang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Affiliation(s)
- Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, 600 Sherbourne Street, Suite 601, Toronto, Ontario, Canada
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In vivo Assessment of Higher-Order Aberrations after Acrysof Toric Intraocular Lens Implantation: A Comparative Study. Eur J Ophthalmol 2011; 22:531-40. [DOI: 10.5301/ejo.5000090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2011] [Indexed: 11/20/2022]
Abstract
Purpose To compare higher-order aberrations (HOAs) and optical quality in eyes implanted with AcrySof SN60TT toric intraocular lens (IOL) or with non-toric AcrySof SN60AT IOL (Alcon Laboratories, Inc., Fort Worth, TX). Methods This was a prospective, consecutive, nonrandomized, interventional, comparative study. One hundred eyes with cataract in 56 patients were included (SN60TT group, n=50; SN60AT group, n=50). Patients underwent phacoemulsification through a 2.2-mm temporal corneal incision. Postoperative HOAs, point spread function (PSF) and modulation transfer function (MTF), residual objective refractive astigmatism, and IOL alignment were evaluated using Optical Path Difference (OPD)–Scan II (Nidek, Gamagori, Japan). A novel technique to calculate IOL axis alignment was introduced. Results One year postoperatively, no statistical difference in corneal, intraocular, and total HOAs, Strehl ratio, and MTF based on HOAs was found between groups. Toric IOL patients had a net residual refractive astigmatism (M) of 0.44 D±0.47; the difference between expected and obtained astigmatism (M) was 0.043 D (p=0.16). Toric IOL axis misalignment was 2.65±2.39 degrees and no correlation with HOAs was found. Conclusions AcrySof SN60TT determines HOAs comparable to the non-toric version providing a good optical quality, and predictably corrects corneal cylinder with a stable postoperative alignment. The OPD-Scan II might be regarded as a fast and reliable method of toric IOL analysis.
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McKelvie J, McGhee CNJ. Virtual solutions and real issues: a special edition dedicated to cataract and cataract surgery in 2010. Clin Exp Ophthalmol 2010; 38:745-6. [PMID: 21050348 DOI: 10.1111/j.1442-9071.2010.02387.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stewart CM, McAlister JC. Comparison of grafted and non-grafted patients with corneal astigmatism undergoing cataract extraction with a toric intraocular lens implant. Clin Exp Ophthalmol 2010; 38:747-57. [DOI: 10.1111/j.1442-9071.2010.02336.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Statham M, Apel A, Stephensen D. Intraocular lens outcomes: a concern – response. Clin Exp Ophthalmol 2010. [DOI: 10.1111/j.1442-9071.2010.02248_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew Apel
- The Eye Health Centre, Brisbane, Queensland, Australia
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