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Adjusted femtosecond laser capsulotomy distance in white cataracts to decrease incomplete capsulotomy: a randomized comparative cohort study. Graefes Arch Clin Exp Ophthalmol 2022; 260:2591-2595. [PMID: 35344089 DOI: 10.1007/s00417-022-05630-9] [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: 11/12/2021] [Revised: 02/01/2022] [Accepted: 03/10/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To compare safety and effectiveness between standard position and adjusted distance pre- and post-anterior capsule of femtosecond laser capsulotomy in white cataracts surgery. METHODS Selected white cataracts that underwent LenSx femtosecond laser capsulotomy were randomized into groups A (standard position, with 300 µm symmetrically pre- and post-anterior capsule), B (increased distance with 400 µm symmetrically pre- and post-anterior capsule), and C (unsymmetrical distances of 200 µm pre- and 400 µm post-anterior capsule, respectively). All these surgeries were performed by the same experienced surgeon. Complications, including incomplete capsulotomy and capsule tears, were recorded. In addition, femtosecond capsulotomy and phacoemulsification parameters, IOLs centrality and corrected distance visual acuity were assessed. RESULTS A total of 113 eyes were included in this study. There were 8 (21.6%) incomplete capsulotomy and 1 anterior capsule tear in group A. Meanwhile, only 2 eyes (5.1%) had incomplete capsulotomy with none showing capsule tear in group B. In group C, only 1 eye (2.7%) had incomplete capsulotomy and no capsule tear occurred. Mean femtosecond laser capsulotomy time was longer in group B compared with groups A and C. Average cumulative dispersed energy, IOL centrality and corrected distance visual acuity were similar in all groups. CONCLUSIONS Appropriate adjustment on femtosecond laser capsulotomy distance by reducing pre-anterior capsule and increasing post-anterior distance, may decrease incomplete capsulotomy and be more effective in white cataracts surgery. TRIAL REGISTRATION Clinical trial registration number: ChiCTR2100043863.
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Noh H, Yoo YS, Shin KY, Lim DH, Chung TY. Comparison of penetrating femtosecond laser-assisted astigmatic keratotomy and toric intraocular lens implantation for correction of astigmatism in cataract surgery. Sci Rep 2021; 11:7340. [PMID: 33795782 PMCID: PMC8016891 DOI: 10.1038/s41598-021-86763-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
This study tried to compare the clinical outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for astigmatism correction and identify factors affecting the efficacy of FSAK and toric IOL implantation in astigmatism correction. This retrospective case series comprised patients with corneal astigmatism ranging between 0.5 D and 4.5 D. Patients underwent FSAK or toric IOL implantation for cataract treatment and correction of astigmatism at the Samsung Medical Center, a tertiary surgical center, between April 2016 and December 2018. All patients underwent examination before and at three months after the surgery for comparative evaluation of refractive astigmatism, corneal high order aberrations and irregularity index. The astigmatism correction was analyzed by the Alpins method. Subgroup analysis of preoperative factors was based on the extent of target-induced astigmatism (TIA), the degree of astigmatism, and astigmatism classification based on topography. Thirty-one eyes underwent toric IOL implantation and 35 eyes underwent FSAK. The refractive astigmatism was significantly decreased in both toric IOL (P = 0.000) and FSAK group (P = 0.003). The correction index (CI) of refractive astigmatism was 0.84 ± 0.39 in the toric IOL and 0.71 ± 0.60 in the FSAK group. There was no difference between the two groups (P = 0.337). The CI of the FSAK group was significantly lower than in the toric IOL group when TIA was more than 1.5 D (P = 0.006), when correcting against-the-rule (P = 0.017), and limbus-to-limbus astigmatism (P = 0.008). In conclusion, toric IOL implantation is an effective and safe procedure for correcting preoperative astigmatism in cataract surgery in the short-term observation.
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Affiliation(s)
- Hoon Noh
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Young-Sik Yoo
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.411947.e0000 0004 0470 4224Department of Ophthalmology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do Republic of Korea
| | - Kyoung Yoon Shin
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,Department of Ophthalmology, Seongnam Citizens Medical Center, Seongnam-si, Gyeonggi-do Republic of Korea
| | - Dong Hui Lim
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Tae-Young Chung
- grid.264381.a0000 0001 2181 989XDepartment of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351 Republic of Korea
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Kim YJ, Wee WR, Kim MK. Efficacy of 4-Haptic Bitoric Intraocular Lens Implantation in Asian Patients with Cataract and Astigmatism. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:36-45. [PMID: 30746910 PMCID: PMC6372384 DOI: 10.3341/kjo.2018.0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/13/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine the efficacy of 4-haptic bitoric intraocular lens (IOL) implantation in Asian patients with cataract and astigmatism. METHODS A total of 19 eyes with ≤25.0 mm axial length and ≥0.75 diopters (D) corneal astigmatism were included in this prospective non-comparative study. All subjects underwent phacoemulsification with implantation of an AT Torbi 709M IOL. Visual and refractive outcomes as well as toric IOL axis were evaluated during a 3-month follow-up. Errors in predicted residual spherical equivalent were calculated by subtracting predicted residual spherical equivalent from postoperative refraction. RESULTS Uncorrected and corrected distance visual acuity improved significantly 3 months after surgery, from 0.43 to 0.05 and from 0.24 to -0.05, respectively. Mean refractive cylinders also decreased significantly, from -1.91 preoperatively to -0.54 D 3 months after surgery. Mean J0 and J45 decreased 3 months postoperatively, from 0.26 to 0.03 D and from 0.24 to -0.06 D, respectively. After 3 months, mean absolute IOL rotation was 1.81°. Errors in predicted residual spherical equivalent showed a hyperopic shift of 0.35 D. CONCLUSIONS Implantation of 4-haptic bitoric IOL proved to be effective for correcting astigmatism in Asian eyes during cataract surgery.
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Affiliation(s)
- Yu Jeong Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
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Femtosecond laser–assisted cataract surgery versus conventional phacoemulsification: Refractive and aberrometric outcomes with a diffractive multifocal intraocular lens. J Cataract Refract Surg 2019; 45:21-27. [DOI: 10.1016/j.jcrs.2018.08.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 11/20/2022]
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Nanavaty MA, Bedi KK, Ali S, Holmes M, Rajak S. Toric Intraocular Lenses Versus Peripheral Corneal Relaxing Incisions for Astigmatism Between 0.75 and 2.5 Diopters During Cataract Surgery. Am J Ophthalmol 2017. [PMID: 28647461 DOI: 10.1016/j.ajo.2017.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the outcomes after toric intraocular lens (tIOL) or peripheral corneal relaxing incisions (PCRI) for keratometric astigmatism (KA) between 0.75 and 2.5 diopters (D) during cataract surgery. DESIGN Prospective randomized clinical trial. METHODS Eighty eyes (80 participants) received either tIOL or PCRI and were assessed preoperatively, 1, 3, 6, and 12 months postoperatively. PRIMARY OUTCOME MEASURE Uncorrected (UCDVA) and best-corrected distance logMAR visual acuity (BCDVA) at 12 months. SECONDARY OUTCOME MEASURES Uncorrected near visual acuity (UCNVA), manifest refraction, KA and mean keratometry (KM), corneal aberrometry, tIOL rotation, and quality-of-life questionnaire. RESULTS Comparing tIOLs vs PCRIs, there was no significant difference in the UCDVA, BCDVA, and UCNVA. At 12 months, 61% vs 53% had UDCVA of 20/25 or better, 100% vs 76% gained ≥1 lines, and 59% vs 43% were within ±0.13 D spherical equivalent. In the PCRI group, anterior KA decreased at 1 month and remained stable thereafter; there was a nonsignificant trend toward a flatter posterior KA and steeper posterior KM and the total corneal Z2-2 was low at 1 and 12 months. Over 12 months, there were changes in posterior corneal tilt, coma, and hexafoil in the PCRI group. The mean rotation of the tIOLs at 12 months was 1.8 ± 1.4 degrees. tIOL patients were happier and were glad to use the nonprescription sunglasses. CONCLUSION There was no difference in visual acuity, although more tIOL patients gained ≥1 line and were within ±0.13 D. After PCRIs, the anterior KA decreased in the early postoperative period and remained stable thereafter and posterior corneal aberrations changed constantly over 12 months.
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He W, Zhu X, Du Y, Yang J, Lu Y. Clinical efficacy of implantation of toric intraocular lenses with different incision positions: a comparative study of steep-axis incision and non-steep-axis incision. BMC Ophthalmol 2017; 17:132. [PMID: 28750611 PMCID: PMC5531017 DOI: 10.1186/s12886-017-0528-x] [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] [Received: 04/05/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background To compare the clinical outcomes after implantation of AcrySof Toric IOLs with different clear corneal incisions. Methods Sixty cataract patients with regular corneal astigmatism who underwent phacoemulsification combined with implantation of an AcrySof Toric IOL were enrolled. They were divided into two groups according to the position of the clear corneal incision: steep-axis and non-steep-axis. Main outcome measurements included visual acuity, residual astigmatism and changes of corneal astigmatism 3 months postoperatively. Deviation of IOL axis according to the re-calculation using the actual surgically induced astigmatism (SIA) and visual function 3 months after surgery were also evaluated. Results The corneal astigmatism decreased significantly in steep-axis group 3 months postoperatively (P < 0.05). Besides, more patients in non-steep-axis group were with irregular corneal astigmatism after the surgery (43.33% vs 10%, P = 0.004). The deviation of IOL axis according to the re-calculation using the actual SIA was significantly larger in non-steep-axis group than that of steep-axis group (P < 0.001). Moreover, the postoperative visual function was better in eyes of steep-axis group in various measurements, including point spread function, modulation transfer function and high-order aberrations. Conclusion Steep-axis clear corneal incision could reduce the cylinder power of toric IOL and lower the chance of postoperative irregular astigmatism, which may consequently improve the postoperative visual quality.
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Affiliation(s)
- Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai Medical College of Fudan University, Shanghai, 200031, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai Medical College of Fudan University, Shanghai, 200031, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
| | - Yu Du
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai Medical College of Fudan University, Shanghai, 200031, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
| | - Jin Yang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, Shanghai Medical College of Fudan University, Shanghai, 200031, People's Republic of China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,Key Laboratory of Myopia, Ministry of Health, Shanghai Medical College of Fudan University, Shanghai, 200031, People's Republic of China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, People's Republic of China.
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Park Y, Kim MS, Kim EC. Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yooyeon Park
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Man Soo Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Zhao Y, Li J, Yang K, Li X, Zhu S. Combined Special Capsular Tension Ring and Toric IOL Implantation for Management of Astigmatism and High Axial Myopia with Cataracts. Semin Ophthalmol 2016; 33:389-394. [PMID: 28005433 DOI: 10.1080/08820538.2016.1247181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yang Zhao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiaxin Li
- Medical School, Pingdingshan University, Pingdingshan, China
| | - Ke Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiao Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Siquan Zhu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Eliwa TF, Abdellatif MK, Hamza II. Effect of Limbal Relaxing Incisions on Corneal Aberrations. J Refract Surg 2016; 32:156-62. [PMID: 27027622 DOI: 10.3928/1081597x-20160121-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the effect of limbal relaxing incisions on corneal aberrations after phacoemulsification with aspheric intraocular lens (IOL) implantation. METHODS Forty-five eyes underwent microincision cataract surgery with on-axis phacoemulsification incision. These eyes were divided into two groups: limbal relaxing incision group (23 eyes) and control group (22 eyes). In the limbal relaxing incision group, a single limbal relaxing incision was performed on the steepest meridian of corneal topography and the degrees of arc were determined using the DONO-Donnenfeld nomogram. The eyes in the control group were operated on by microincision cataract surgery without limbal relaxing incision. Corneal topography and wavefront analysis over 6-mm pupil size were performed preoperatively and 1 month postoperatively in both groups. Target induced astigmatism vector, surgically induced astigmatism vector, difference vector, magnitude of error, flattening effect, and torque were analyzed using the Alpins vectorial method. RESULTS The limbal relaxing incision group showed significant reduction in topographic astigmatism by 51.87% of preoperative topographical astigmatism (P < .0001). The mean surgically induced astigmatism of limbal relaxing incision was 1.29 ± 0.71 diopters (D), which was close to the mean target induced astigmatism (1.33 ± 0.20 D), whereas the control group did not show a significant change in topographic astigmatism (0.17 ± 0.11 D; P = .73). Higher order aberrations of the cornea did not show significant change in either group except quatrefoil aberration, which significantly increased in the limbal relaxing incision group but not in the control group, with no significant difference between the two groups regarding corneal aberrations. CONCLUSIONS Limbal relaxing incision is an effective method in reducing corneal astigmatism with neutral effect on corneal aberrations.
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Lee J, Lee H, Kang DSY, Choi JY, Kim EK, Kim TI. Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism. Yonsei Med J 2016; 57:1475-81. [PMID: 27593877 PMCID: PMC5011281 DOI: 10.3349/ymj.2016.57.6.1475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/15/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the effectiveness of toric foldable iris-fixated phakic intraocular lens (pIOL) implantation and non-toric foldable iris-fixated pIOL implantation with limbal relaxing incisions (LRIs) for correcting moderate-to-high astigmatism in myopic eyes. MATERIALS AND METHODS The medical records of 146 patients (195 eyes) with myopic astigmatism who underwent toric foldable iris-fixated pIOL implantation (toric group; 94 eyes) or non-toric foldable iris-fixated pIOL implantation with concurrent LRIs (LRI group; 101 eyes) were retrospectively reviewed. For subgroup analysis, the two groups were subdivided according to preoperative astigmatic severity [moderate, 2.00 to <3.00 diopters (D); high, 3.00-4.00 D]. Visual and astigmatic outcomes were compared 6 months postoperatively. RESULTS The uncorrected distance visual acuity was at least 20/25 in 100% and 98% of the toric and LRI group eyes, respectively. The toric group had lower mean residual cylindrical error (-0.67±0.39 D vs. -1.14±0.56 D; p<0.001) and greater mean cylindrical error change (2.17±0.56 D vs. 1.63±0.72 D; p<0.001) than the LRI group, regardless of the preoperative astigmatic severity. The mean correction index (1.10±0.16 vs. 0.72±0.24; p<0.001) and success index (0.24±0.14 vs. 0.42±0.21; p<0.001) also differed significantly between the groups. CONCLUSION Both surgical techniques considerably reduced astigmatism and had comparable visual outcomes. However, toric foldable iris-fixated pIOL implantation was more reliable for correcting moderate-to-high astigmatism in myopic eyes.
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Affiliation(s)
- Jeihoon Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | | | - Jin Young Choi
- The Institute of Vision Research, Eyereum Eye Clinic, Seoul, Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Astigmatism Correction in Cataract Surgery: Toric Intraocular Lens Placement Versus Peripheral Corneal Relaxing Incisions. Int Ophthalmol Clin 2016; 56:39-47. [PMID: 27257721 DOI: 10.1097/iio.0000000000000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 203] [Impact Index Per Article: 22.6] [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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Abstract
To compare the clinical outcome of digital and manual marking for toric intraocular lens (IOL) alignment. This is a prospective clinical study that included 60 eyes of 60 patients undergoing cataract surgery with coexisting corneal astigmatism more than 1 diopter (D). The eyes were randomly assigned to either digital image guidance using VERION digital marker (Alcon Laboratories, Ft. Worth, TX) or manual slitlamp-assisted preoperative marking using pendulum-attached marker. Tecnis toric IOL (Abbott Medical Optics, Inc, Santa Ana, CA) was implanted in all cases. The mean postoperative uncorrected distance visual acuity (UCDVA) for the digital-marking group was 0.12 + 0.12 logMAR, and for the manual-marking group was 0.18 + 0.14 logMAR (P = 0.104). The mean deviation from targeted induced astigmatism (TIA) for the first group was 0.10 + 0.08 D and for the second group was 0.20 + 0.14 D (P = 0.001). The mean postoperative toric IOL misalignment measured by the slitlamp was 2.4° + 1.96° for the first group and was 4.33° + 2.72° for the second group (P = 0.003). Accurate alignment of the toric IOL is important to achieve the desired astigmatism correction. VERION system has the advantage of preoperative planning and intraoperative digital guidance of the toric IOL alignment. The use of VERION system resulted in less postoperative deviation from TIA and showed less postoperative toric IOL misalignment than using manual-marking technique.
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Affiliation(s)
- Abdel Hamid Elhofi
- From the Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lam DKT, Chow VWS, Ye C, Ng PKF, Wang Z, Jhanji V. Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and ≤3 dioptres of astigmatism. Br J Ophthalmol 2015; 100:258-62. [PMID: 26089214 DOI: 10.1136/bjophthalmol-2014-306587] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/01/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism. METHODS In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence. RESULTS The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group. CONCLUSIONS Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism.
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Affiliation(s)
- Douglas K T Lam
- Department of Ophthalmology, Hong Kong Eye Hospital, Mongkok, Kowloon, Hong Kong SAR
| | - Vanissa W S Chow
- Department of Ophthalmology, Hong Kong Eye Hospital, Mongkok, Kowloon, Hong Kong SAR
| | - Cong Ye
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR
| | - Paul Ka-Fai Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR
| | - Zheng Wang
- Department of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Vishal Jhanji
- Department of Ophthalmology, Hong Kong Eye Hospital, Mongkok, Kowloon, Hong Kong SAR Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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Zhu X, He W, Zhang K, Lu Y. Factors influencing 1-year rotational stability of AcrySof Toric intraocular lenses. Br J Ophthalmol 2015; 100:263-8. [PMID: 26089212 DOI: 10.1136/bjophthalmol-2015-306656] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/04/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the 1-year rotational stability of AcrySof Toric intraocular lenses (IOLs) and factors influencing their stability. METHODS This retrospective study enrolled 75 patients who underwent phacoemulsification, and were implanted with an AcrySof Toric IOL for 1 year. Their preoperative clinical data were reviewed. The 1-year clinical outcomes included uncorrected visual acuity, best-corrected visual acuity and residual astigmatism. Rotation of the IOL and the grade of anterior capsular opacification (ACO; graded from 0=none to 3=severe) were evaluated after mydriasis. RESULTS Of the 75 eyes analysed, 29.33% had high myopia. Residual astigmatism at 1 year (-0.76±0.47 dioptre(D)) was significantly reduced compared with the preoperative corneal astigmatism (2.08±0.71 D). The mean absolute rotation of the IOL was 8.83±5.26°. Toric IOL rotation was significantly and positively correlated with the degree of residual astigmatism in the T3 (Pearson's r=0.552, p<0.001) and T4 groups (Pearson's r=0.622, p=0.003). Regarding factors associated with IOL rotation, toric IOL rotation was positively correlated with axial length (AXL; Pearson's r=0.335, p=0.003) and negatively correlated with ACO grade (Spearman's r=-0.541, p<0.001). On multiple linear regression analysis, only AXL (B=0.889, p=0.031) and ACO grade (B=-3.216, p<0.001) were predictors of toric IOL rotation (R(2)=0.397). CONCLUSIONS Long AXL is a risk factor for toric IOL rotation, while higher ACO grade may decrease toric IOL rotation, indicating that reducing the polishing of anterior capsule may improve the rotational stability of a toric IOL. TRIAL REGISTRATION NUMBER NCT02182921.
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Affiliation(s)
- Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China Key Laboratory of Myopia, Ministry of Health, Shanghai, China Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China Key Laboratory of Myopia, Ministry of Health, Shanghai, China Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Keke Zhang
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China Key Laboratory of Myopia, Ministry of Health, Shanghai, China Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China Key Laboratory of Myopia, Ministry of Health, Shanghai, China Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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