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Rozema JJ, Hastings GD, Jiménez-García M, Koppen C, Applegate RA. Influence of rigid lens decentration and rotation on visual image quality in normal and keratoconic eyes. Ophthalmic Physiol Opt 2022; 42:1204-1213. [PMID: 36111637 PMCID: PMC9547948 DOI: 10.1111/opo.13045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 10/25/2023]
Abstract
PURPOSE To investigate whether the movement of a rigid sphero-cylindrical contact lens has a greater impact on the visual image quality in highly aberrated eyes than in normal eyes. METHODS For 20 normal and 20 keratoconic SyntEyes, a previously determined best sphero-cylindrical rigid lens was permitted to shift by up to ±1 mm from the line of sight and rotate up to ±15°. Each of the 52,111 lens locations sampled was ray-traced to determine the influence on the wavefront aberration. In turn, the logarithm of visual Strehl ratio (log10 [VSX]) was calculated for each aberration structure and was used to estimate the associated changes in logMAR visual acuity. Finally, contour surfaces of two-letter change in visual acuity were plotted in three-dimensional misalignment space, consisting of decentrations in the x and y directions and rotation, and volumes within these surfaces were calculated. RESULTS The variations in image quality within the misalignment space were unique to each eye. A two-letter loss was generally reached with smaller misalignments in keratoconic eyes (10.5 ± 4.7° of rotation or 0.27 ± 0.13 mm of shift) than in normal eyes (13.4 ± 1.8° and 0.39 ± 0.15 mm, respectively) due to larger cylindrical errors. For keratoconic eyes, on average, 14.4 ± 14.9% of misalignment space saw VSX values above the lower normal VSX threshold, well below the values of normal eyes of 48.5 ± 18.5%. In some eyes, a specific combination of lens shift and lens rotation away from the line of sight leads to a simulated improvement in visual image quality. CONCLUSION Variations in visual image quality due to the misalignment of rigid sphero-cylindrical contact lens corrections are larger for keratoconic eyes than for normal eyes. In some cases, a specific misalignment may improve visual image quality, which could be considered in the design of the next generation of rigid contact lenses.
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Affiliation(s)
- Jos J Rozema
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Gareth D Hastings
- College of Optometry, University of Houston, Houston, Texas, USA
- Center for Innovation in Optics and Vision, School of Optometry, University of California, Berkeley, California, USA
| | - Marta Jiménez-García
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Carina Koppen
- Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Singh VM, Ramappa M, Murthy SI, Rostov AT. Toric intraocular lenses: Expanding indications and preoperative and surgical considerations to improve outcomes. Indian J Ophthalmol 2021; 70:10-23. [PMID: 34937203 PMCID: PMC8917572 DOI: 10.4103/ijo.ijo_1785_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.
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Affiliation(s)
| | - Muralidhar Ramappa
- Cataract and Refractive Services; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cataract and Refractive Services; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Dragnea DC, Tru Latin Small Letter T With Comma Below A RN, Goemaere J, Tassignon MJ, Dhubhghaill SN. Intraocular Bag-in-the-Lens Exchange: Indications, Outcomes and Complications. J Cataract Refract Surg 2021; 48:568-575. [PMID: 34417783 DOI: 10.1097/j.jcrs.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the indications, outcomes, and complications regarding the Bag-in-the-lens (BIL) intraocular lens (IOL) exchanges over a period of 13 years in a tertiary ophthalmologic centre. SETTING Department of Ophthalmology of the University Hospital of Antwerp (UZA). DESIGN Observational retrospective study. PATIENTS AND METHODS Between 2003 and 2020, 12 176 patients were operated using the BIL technique. We included adult patients who underwent an intraocular BIL exchange and recorded the demographics, indications, outcomes, and complications. RESULTS Fifty-nine eyes of 59 patients who underwent a BIL exchange between 2007 and 2020 were included (0.48%). The mean age was 61.15 ±13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to the patients' risk factors e.g. preoperative corneal and refractive surgery. The mean preoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.36 ± 0.24 and 0.79 ± 0.24 respectively. The postoperative 1 month-UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19 respectively. The improvement in UDVA was statistically significant (<0.0001). The most common peroperative complication was damage to the anterior hyaloid in 9 eyes (15%), which did not prohibit reimplantation of a secondary BIL. CONCLUSIONS BIL to BIL exchange is an viable and successful technique that provides good refractive results with few, manageable complications. Because of the tertiary profile of our centre with referral of complex cases, BIL was our preferred IOL in patients at risk of postoperative refractive surprise.
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Affiliation(s)
- Diana Carmen Dragnea
- Department of Ophthalmology, Antwerp University Hospital, Wilrijk, Belgium Department of Medicine, University of Antwerp, Wilrijk, Belgium University of Medicine and Pharmacy, Târgu Mure[Latin Small Letter s with comma below], Romania
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[Posterior capsule opacification, glistenings and visual outcomes: 3 years after implantation of a new hydrophobic IOL]. J Fr Ophtalmol 2018; 41:513-520. [PMID: 29934027 DOI: 10.1016/j.jfo.2017.11.022] [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: 08/04/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the visual outcomes, the incidence of glistenings and posterior capsule opacification in a series of consecutive eyes with a new blue light-filtering hydrophobic acrylic intraocular lens (IOL) SETTING: Service d'ophtalmologie, clinique Beausoleil, avenue de Lodève, Montpellier. DESIGN Retrospective, cross-sectional study. METHODS This study included a series of 66 eyes that underwent routine cataract surgery with PODEye (PhysIOL SA, Liège, Belgium) monofocal IOL implantation between May 2011 and November 2011. These eyes were compared for glistenings with patients implanted with Acrysof material IOL (Alcon, Fort Worth, USA) who had a routine postoperative examination between January 2015 and August 2015. The safety of the IOL was assessed by visual acuity outcomes, as well as rotational stability, centration and postoperative medication. The incidence and severity of glistenings were evaluated with the slit lamp. Glistenings and PCO were graded subjectively (0=absent; 1=moderate; 2=dense). Follow-up was 3 years. RESULTS The mean visual acuity after PODEye implantation was 0.98±0.05 (n=50) in decimal notation at 1 year, 0.98±0.06 at 1 week, (n=66), 1.00±0.01 at 3 weeks (n=64) and 0.99±0.02 at 3 months (n=59). The IOL displayed stable positioning in all axes. Glistenings of grade 2 were absent in the G-Free/PODEye group, whereas they were significantly present in the Acrysof group. One out of 43 eyes at 3-year follow-up underwent YAG capulotomy at 37 months. Sixty-six percent of eyes had no PCO (grade 0) at 3 years. CONCLUSIONS The PODEye IOL was safe and stable. Glistenings grade 2 or more were not found with this blue light-filtering hydrophobic acrylic IOL. PCO occurrence was low at three years.
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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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Poyales F, Garzón N, Rozema JJ, Romero C, de Zárate BO. Stability of a Novel Intraocular Lens Design: Comparison of Two Trifocal Lenses. J Refract Surg 2017; 32:394-402. [PMID: 27304603 DOI: 10.3928/1081597x-20160428-04] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 02/04/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare visual outcomes, rotational stability, and centration in a randomized controlled trial in patients undergoing cataract surgery who were bilaterally implanted with two different trifocal intraocular lenses (IOLs) with a similar optical zone but different haptic shape. METHODS Twenty-one patients (42 eyes) with cataract and less than 1.50 D of corneal astigmatism underwent implantation of one FineVision/MicoF IOL in one eye and one POD FineVision IOL in the contralateral eye (PhysIOL, Liège, Belgium) at IOA Madrid Innova Ocular, Madrid, Spain. IOL allocation was random. Outcome measures, all evaluated 3 months postoperatively, included monocular and binocular uncorrected distance (UDVA), corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near (DCNVA) visual acuity (at 80, 40, and 25 cm) under photopic conditions, refraction, IOL centration, haptic rotation, dysphotopsia, objective quality of vision and aberration quantification, patient satisfaction, and spectacle independence. RESULTS Three months postoperatively, mean monocular UDVA, CDVA, DCIVA, and DCNVA (40 cm) under photopic conditions were 0.04 ± 0.07, 0.01 ± 0.04, 0.15 ± 0.11, and 0.16 ± 0.08 logMAR for the eyes implanted with the POD FineVision IOL and 0.03 ± 0.05, 0.01 ± 0.02, 0.17 ± 0.12, and 0.14 ± 0.08 logMAR for those receiving the FineVision/MicroF IOL. Moreover, the POD FineVision IOL showed similar centration (P> .05) and better rotational stability (P < .05) than the FineVision/MicroF IOL. Regarding halos, there was a minimal but statistically significant difference, obtaining better results with FineVision/MicroF. Full spectacle independence was reported by all patients. CONCLUSIONS This study revealed similar visual outcomes for both trifocal IOLs under test (POD FineVision and FineVision/MicroF). However, the POD FineVision IOL showed better rotational stability, as afforded by its design. [J Refract Surg. 2016;32(6):394-402.].
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Altenburg A, Ní Dhubhghaill SS, Tassignon MJ. Bean-shaped Ring Segments as a Capsule Enhancement Tool in Complex Bag-in-the-Lens Intraocular Lens Implantation. J Refract Surg 2017; 33:454-459. [DOI: 10.3928/1081597x-20170504-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
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Dhubhghaill SN, Van Os L, De Keizer RJ, Taal M, Zakaria N, Tassignon MJ. Intraocular lens exchange technique for an opacified bag-in-the-lens. J Cataract Refract Surg 2015; 41:924-8. [DOI: 10.1016/j.jcrs.2015.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
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Harrer A, Hirnschall N, Maedel S, Findl O. Influence of the overall intraocular lens diameter on rotational stability. Ophthalmic Res 2015; 53:117-21. [PMID: 25676189 DOI: 10.1159/000368658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the rotational stability of two intraocular lenses (IOLs) of similar design and material but with a difference of 1 mm in overall length. METHODS In this prospective study patients with age-related cataract were included. An IOL with an overall diameter of 12 mm (ACR6 = small-diameter IOL) was compared to an IOL with an overall diameter of 13 mm (IDEA 613 XC = large-diameter IOL). RESULTS In total, 60 patients were included in this study. Absolute rotation in the small- and large-diameter groups was 4.4° (SD: 4.0; range: 0.3-17.8) and 3.0° (SD: 2.4; range: 0.1-7.8), respectively. The differences between the two IOLs were not found to be statistically significant. CONCLUSION The effect of the overall length of an IOL appears to have little impact on early rotation after cataract surgery.
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Affiliation(s)
- Annette Harrer
- VIROS - Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Kasthurirangan S, Feuchter L, Smith P, Nixon D. Software-based evaluation of toric IOL orientation in a multicenter clinical study. J Refract Surg 2015; 30:820-6. [PMID: 25437480 DOI: 10.3928/1081597x-20141117-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the rotational stability of a new one-piece hydrophobic acrylic toric intraocular lens (IOL) using a custom-developed software for analysis of slit-lamp photographs. METHODS In a prospective, multicenter study, 174 eyes were implanted with the TECNIS Toric IOL (Abbott Medical Optics, Inc., Santa Ana, CA). A custom-developed software was used to analyze high-resolution slit-lamp photographs of 156 eyes taken at day 1 (baseline) and 1, 3, and 6 months postoperatively. The software uses iris and sclera landmarks to align the baseline image and later images for comparison. Validation of software was performed through repeated analyses of protractor images rotated from 0.1° to 10.0° and randomly selected photographs of 20 eyes. RESULTS Software validation showed precision (repeatability plus reproducibility variation) of 0.02° using protractor images and 2.22° using slit-lamp photographs. Good quality slit-lamp images and clear landmarks were necessary for precise measurements. At 6 months, 94.2% of eyes had 5° or less change in IOL orientation versus baseline; only 2 eyes (1.4%) had axis shift greater than 30°. Most eyes were within 5° or less of rotation between 1 and 3 months (92.9%) and 3 and 6 months (94.1%). Mean absolute axis change (± standard deviation) from 1 day to 6 months was 2.70° ± 5.51°. CONCLUSIONS The new custom software was precise and quick in analyzing slit-lamp photographs to determine postoperative toric IOL rotation.
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Gangwani V, Hirnschall N, Findl O, Maurino V. Multifocal toric intraocular lenses versus multifocal intraocular lenses combined with peripheral corneal relaxing incisions to correct moderate astigmatism. J Cataract Refract Surg 2014; 40:1625-32. [DOI: 10.1016/j.jcrs.2014.01.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/29/2013] [Accepted: 01/13/2014] [Indexed: 11/25/2022]
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Évaluation des performances visuelles après implantation d’une lentille intraoculaire torique à double anse en C. J Fr Ophtalmol 2014; 37:507-13. [DOI: 10.1016/j.jfo.2014.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 11/20/2022]
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Sanders DR, Sarver EJ, Cooke DL. Accuracy and precision of a new system for measuring toric intraocular lens axis rotation. J Cataract Refract Surg 2014; 39:1190-5. [PMID: 23889866 DOI: 10.1016/j.jcrs.2013.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 11/26/2022]
Abstract
We determined the accuracy and precision of a new system for measuring postoperative toric intraocular lens (IOL) axis rotation. The system performs high-resolution retroillumination photography to identify toric IOL axis markings and then takes a photograph of the iris and conjunctival/scleral vessels. Built-in software measures the toric axis to within 0.2 degree. If performed twice on the same eye, the system will correct the 2 toric axis measurements for cyclorotation/head tilt using iris/vessel registration. Testing in 37 eyes showed that using iris/vessel registration correction reduced the mean absolute toric IOL axis rotation by a factor of 4.5. We conclude that this system seems to be both accurate and precise for measuring postoperative toric IOL axis rotation.
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Affiliation(s)
- Donald R Sanders
- Center for Clinical Research, Elmhurst, Sarver and Associates, Carbondale, Illinois 60126, USA.
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Hirnschall N, Gangwani V, Crnej A, Koshy J, Maurino V, Findl O. Correction of moderate corneal astigmatism during cataract surgery: Toric intraocular lens versus peripheral corneal relaxing incisions. J Cataract Refract Surg 2014; 40:354-61. [DOI: 10.1016/j.jcrs.2013.08.049] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 06/28/2013] [Accepted: 08/14/2013] [Indexed: 10/25/2022]
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Rotational stability of a single-piece toric acrylic intraocular lens: a pilot study. Am J Ophthalmol 2014; 157:405-411.e1. [PMID: 24332372 DOI: 10.1016/j.ajo.2013.09.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual performance and rotational stability of the Tecnis Toric 1-piece intraocular lens (IOL) during the first 3 postoperative months. DESIGN Prospective, single-center study. METHODS In this study, patients with age-related cataract and corneal astigmatism of 1.0 to 3.0 diopters measured with the IOLMaster 500 (Carl Zeiss Meditec AG) were included. Before surgery, rotating Scheimpflug scans (Pentacam HR; Oculus) were performed and the cornea was marked in the sitting position at the slit lamp. Patients received a single-piece toric hydrophobic acrylic IOL (Tecnis Toric; AMO). Immediately and 3 months after surgery, retroillumination photographs were obtained to assess the rotational stability of the IOL. Additionally, Autorefraction (Topcon), subjective refraction, uncorrected and distance-corrected visual acuity, keratometry, and Scheimpflug and ocular wavefront (WASCA, Carl Zeiss Meditec AG) measurements were performed at the 3-month follow-up. RESULTS Thirty eyes of 30 patients were included in this study. Mean absolute difference between the IOL axis at the 3-month and 1-hour follow-up was 2.7 degrees (standard deviation, 3.0 degrees). The IOL rotation was less than 3 degrees and less than 6 degrees in 62% and 95% of all cases, respectively. CONCLUSIONS The Tecnis Toric 1-piece IOL is rotationally stable and shows excellent capsule bag performance and refractive outcomes.
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Tassignon MJ, Dhubhghaill SN. Bean-shaped ring segments for capsule stretching and centration of bag-in-the-lens cataract surgery. J Cataract Refract Surg 2014; 40:8-12. [DOI: 10.1016/j.jcrs.2013.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/05/2013] [Indexed: 11/25/2022]
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Visser N, Bauer NJC, Nuijts RMMA. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg 2013; 39:624-37. [PMID: 23522584 DOI: 10.1016/j.jcrs.2013.02.020] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 11/17/2022]
Abstract
We present an overview of currently available toric intraocular lenses (IOLs) and multifocal toric IOLs. Relevant patient selection criteria, IOL calculation issues, and surgical techniques for IOL implantation are discussed. Clinical outcomes including uncorrected visual acuity, residual refractive astigmatism, and spectacle independency, which have been reported for both toric IOLs and multifocal toric IOLs, are reviewed. The incidence of misalignment, the most important complication of toric IOLs, is determined. Finally, future developments in the field of toric IOLs are discussed.
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Affiliation(s)
- Nienke Visser
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands.
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Lauwers N, Ní Dhubhghaill S, Mathysen DGP, Tassignon MJ. Assessment of the bag-in-the-lens implantation technique in diabetic patients. Ophthalmologica 2013; 229:212-8. [PMID: 23615267 DOI: 10.1159/000350236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 02/24/2013] [Indexed: 11/19/2022]
Abstract
Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. The bag-in-the-lens (BIL) intraocular implant is an alternative approach to standard lens-in-the-bag cataract surgery. The lens is supported by anterior and posterior capsulorhexes, which confers a number of advantages in terms of lens centration, rotational stability and prevention of posterior capsular opacity. The purpose of this report is to describe the results of BIL cataract surgery in a retrospective cohort of diabetic patients. Fifty-four cases of BIL surgery are included with a follow-up period of 1 year. Visual acuity outcomes were comparable to previously published standard lens-in-the-bag procedures. There were no reports of posterior capsular opacification and the grade of diabetic retinopathy remained stable. Three cases of clinically significant macular edema were detected over the follow-up period. We conclude that the BIL implantation technique is an advantageous approach to treating cataract in the diabetic population.
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Affiliation(s)
- Noémie Lauwers
- Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium.
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Chassain C, Pagnoulle C, Gobin L, Rozema J. Évaluation d’une nouvelle plateforme d’implant intraoculaire : centrage et stabilité rotatoire. J Fr Ophtalmol 2013; 36:336-42. [DOI: 10.1016/j.jfo.2012.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 10/27/2022]
Affiliation(s)
- C Chassain
- Département d'ophtalmologie, clinique Beausoleil, 119, avenue de Lodève, 34070 Montpellier, France
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Tassignon MJ, Gobin L, Mathysen D, Van Looveren J, De Groot V. Clinical outcomes of cataract surgery after bag-in-the-lens intraocular lens implantation following ISO standard 11979-7:2006. J Cataract Refract Surg 2012; 37:2120-9. [PMID: 22108108 DOI: 10.1016/j.jcrs.2011.06.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 05/30/2011] [Accepted: 06/06/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the clinical outcomes of bag-in-the-lens intraocular lens (BIL IOL) implantation following the International Organization for Standardization (ISO) 11979-7:2006 in pediatric eyes and eyes with ocular comorbidities. SETTING Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. DESIGN Cohort study. METHODS This cohort included the first series of patients having IOL implantation using the bag-in-the-lens technique. Surgeries were performed between December 1999 and September 2006. In addition to IOL implantation, the technique comprised creation of a primary posterior continuous curvilinear capsulorhexis (PCCC) equal in size to the anterior capsulorhexis. RESULTS The study enrolled 807 eyes of 547 patients; 326 of the eyes (40.40%) had ocular comorbidity. In the 481 eyes without ocular comorbidity, the mean decimal corrected distance visual acuity was 0.52 ± 0.24 (SD) (0.276 ± 0.206 logMAR) preoperatively and 0.94 ± 0.18 (-0.012 ± 0.053 logMAR) postoperatively. The mean postoperative achieved spherical equivalent was 0.48 ± 0.83 diopter (D) and the mean targeted refraction, -0.24 ± 0.71 D. The A-constant was modified from 118.4 to 118.04. Posterior capsule opacification (PCO) did not occur in any adult eye during the follow-up. Retinal detachment after IOL implantation occurred in 10 eyes (1.24%). In 19 eyes, the iris was captured by the IOL haptics postoperatively. Hypopyon occurred in 3 patients and toxic anterior segment syndrome in 1 patient. CONCLUSION The BIL IOL met the ISO criteria; that is, primary PCCC was safe in healthy eyes and in eyes with ocular comorbidities and no eye developed PCO over a mean follow-up of 26.1 ± 21.3 months.
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Affiliation(s)
- Marie-José Tassignon
- From Antwerp University Hospital, Department of Ophthalmology and Antwerp University, Faculty of Medicine, Antwerp, Belgium.
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Felipe A, Artigas JM, Díez-Ajenjo A, García-Domene C, Alcocer P. Residual astigmatism produced by toric intraocular lens rotation. J Cataract Refract Surg 2011; 37:1895-901. [PMID: 21865007 DOI: 10.1016/j.jcrs.2011.04.036] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/30/2011] [Accepted: 04/07/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze changes in the eye's refractive properties when a toric intraocular lens (IOL) rotates. SETTING Fundación Oftalmológica del Mediterráneo, Valencia, Spain. DESIGN Experimental study. METHODS The matrix definition of astigmatism was used in this theoretical study and compared with another vector representation. Two methods were compared: (1) The cylinder, C, resulting from the addition of 2 cylinders C(1) and C(2) whose axes form an angle a, is obtained by the addition of 2 vectors of values C(1) and C(2) forming an angle 2a; (2) the power matrix, F, of a thin astigmatic dioptric system that decomposes naturally into 3 orthogonal components: the purely spherical part F(nes,) the ortho-astigmatism F(or), and oblique astigmatism F(ob). RESULTS The residual cylinder was one third of the corneal astigmatism when a toric IOL rotated ±10 degrees when the cylinder values for the cornea (C(1)) and IOL (C(2)) were equal. Nevertheless, in most cases C(1) is greater than C(2); therefore, the residual astigmatism did not change noticeably with small rotations. The angle of rotation, b, which annuls the astigmatism correction, could be obtained from the following: cos(π + 2b) = -r/2, with r being the ratio between the IOL and cornea cylinders. CONCLUSIONS The 2 methods gave equivalent results. When the IOL cylinder had a value different from that of the corneal astigmatism, a better choice would be a lower, rather than higher, cylinder value to reduce residual astigmatism. In general, toric IOL rotations less than 10 degrees changed the eye's refraction less than 0.50 diopter. Thus, small axis rotations are not an obstacle for satisfactory astigmatism correction with toric IOLs. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Adelina Felipe
- Fundación Oftalmológica del Mediterráneo, Facultad de Física, Universidad de Valencia, Burjassot (Valencia), Spain.
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Gobin L, Tassignon MJ, Mathysen D. Spherotoric bag-in-the-lens intraocular lens: power calculation and predictive misalignment nomogram. J Cataract Refract Surg 2011; 37:1020-30. [PMID: 21596245 DOI: 10.1016/j.jcrs.2010.12.057] [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: 07/08/2010] [Revised: 12/13/2010] [Accepted: 12/29/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To propose a method of calculating the power of the 1-sided posterior chamber toric bag-in-the-lens (BIL) intraocular lens (IOL) and propose a misalignment nomogram to calculate the postoperative rotational misalignment or predict the effect of preoperative existing irregular corneal astigmatism. SETTING Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. DESIGN Cohort study. METHODS The new IOL calculation formula uses the steepest corneal meridian and flattest corneal meridian separately (regular spherical IOL formula) followed by a customized A-constant approach based on the changes in the IOL principal plane depending on the spherical and cylindrical powers (thickness) of the IOL. The calculation of the remaining astigmatism (power and axis) in cases of postoperative rotational misalignment resulted in a nomogram that can also be used to predict the degree of tolerance for irregular corneal astigmatism correction at the lenticular plane. The calculation is performed using a worksheet. RESULTS Because 10 degrees of misalignment would result in 35% refractive inaccuracy, it is the maximum acceptable corneal astigmatic irregularity for correction at the lenticular plane. CONCLUSIONS Calculation of spherocylindrical power is specific to each toric IOL. Because the surgeon must fully understand the optical properties of the toric IOL that is going to be implanted, a comprehensive outline of a new calculation method specific to the toric BIL IOL is proposed. Primary rotational misalignment of the toric BIL IOL can be fine tuned postoperatively. FINANCIAL DISCLOSURE Drs. Gobin and Mathysen have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
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Affiliation(s)
- Laure Gobin
- Department of Ophthalmology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Tassignon MJ, Gobin L, Mathysen D, Van Looveren J. Clinical results after spherotoric intraocular lens implantation using the bag-in-the-lens technique. J Cataract Refract Surg 2011; 37:830-4. [DOI: 10.1016/j.jcrs.2010.12.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/06/2010] [Indexed: 11/27/2022]
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Gobin L, Tassignon MJ, Wouters K, De Groot V. Surgically induced astigmatism after intraocular lens implantation using the bag-in-the-lens technique. J Cataract Refract Surg 2011; 37:1015-9. [PMID: 21493036 DOI: 10.1016/j.jcrs.2010.12.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 12/08/2010] [Accepted: 12/12/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine surgically induced astigmatism (SIA) after monofocal spherical intraocular lens (IOL) implantation using the bag-in-the-lens (BIL) technique. SETTING Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium. DESIGN Case series. METHODS Adult patients had routine phacoemulsification followed by BIL IOL implantation, which requires a double capsulorhexis for IOL fixation. The 2.8 mm limbo-corneal self-sealing incision was temporally located. Preoperative and 3-month postoperative keratometries were measured by Scheimpflug imaging (Pentacam). The patients were divided into 2 groups based on corneal astigmatism. Group A0 consisted of eyes with physiological corneal astigmatism less than 1.00 diopter (D). Group A1 consisted of eyes with corneal astigmatism of 1.00 D or higher. Vector analysis of the corneal power was used to determine the SIA. RESULTS The study comprised 100 eyes (58 patients). There was no difference in SIA between Group A0 and Group A1. The mean preoperative and postoperative keratometries were highly correlated in both groups (A0: r(2) = 0.95; A1: r(2) = 0.83). The correlation between preoperative and postoperative vectorial astigmatism was low in Group A0 (J0: r(2) = 0.24; J45: r(2) = 0.10). The mean postoperative SIA was 0.06 D @ -24 degrees in Group A0 and 0.09 D @ 6 degrees in Group A1, with an uncertainty of ± 1.00 D. CONCLUSIONS After BIL IOL implantation, the SIA was not statistically significant. Based on these findings, the technique can be considered an option for spherocylindrical correction of corneal astigmatism of 1.00 D or more. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
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Affiliation(s)
- Laure Gobin
- Department of Ophthalmology, Antwerp University Hospital, University of Antwerp, Belgium
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Rotational stability of a single-piece toric acrylic intraocular lens. J Cataract Refract Surg 2010; 36:1665-70. [DOI: 10.1016/j.jcrs.2010.05.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 04/30/2010] [Accepted: 05/03/2010] [Indexed: 11/20/2022]
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