Correction of moderate corneal astigmatism during cataract surgery: Toric intraocular lens versus peripheral corneal relaxing incisions

Rotational stability of toric intraocular lenses by lens model and haptic design: systematic review and single-arm meta-analysis

Rotational stability is key for optimizing postoperative visual outcomes because even a small degree of rotation of a toric intraocular lens (IOL) from its target axis can result in a significant reduction in astigmatic correction. This systematic review and meta-analysis evaluated the rotational stability of toric IOLs of different lens models and haptic designs. All published studies and clinical trials that investigate postoperative rotation of toric IOLs were searched and evaluated. Quality of studies was assessed using the Methodological Index for Nonrandomized Studies scale. A single-arm meta-analysis was performed in R4.3.1 software with subgroup analysis performed based on lens model and haptic design. 51 published studies of 4863 eyes were included in the meta-analysis. The pooled mean absolute rotation of all toric IOLs was 2.36 degrees (95% CI, 2.08-2.64). Postoperative rotation is dependent on many aspects of lens material and design. Modern commercially available toric IOLs exhibit exceptional rotational stability.

Visual outcomes and rotational stability of a new non-diffractive extended-vision toric intraocular lens

OBJECTIVE

To evaluate visual outcomes and intraocular lens (IOL) rotational stability of patients undergoing immediate sequential bilateral cataract surgery with a non-diffractive extended-depth-of-focus toric IOL.

DESIGN

Non-comparative single-centre cohort study.

PARTICIPANTS

Twenty patients (40 eyes) with significant cataracts and corneal astigmatism who underwent immediate sequential bilateral cataract surgery with the AcrySof IQ Vivity Extended Vision Lens (Alcon Laboratories Inc, Fort Worth, Tex.).

METHODS

Binocular uncorrected visual acuities (UCVA) and monocular best-corrected visual acuities (BCVA) were assessed at distance (6 m), intermediate (66 cm), and near (40 cm) postoperatively at 1 week and 3 months. The rotational stability of each IOL was assessed at 1 day, 1 week, and 3 months postoperatively. A validated questionnaire (Questionnaire for Visual Disturbances [QUVID]) was used for patient-reported subjective visual disturbances preoperatively at a 3-month follow-up.

RESULTS

Binocular distance, intermediate, and near UCVAs (mean ± SD) were 0.00 ± 0.16, 0.09 ± 0.08, and 0.14 ± 0.11 logMAR at 1 week and 0.01 ± 0.06, 0.08 ± 0.08, and 0.14 ± 0.07 logMAR at 3 months postoperatively, respectively. Distance monocular BCVA improved from 0.22 ± 0.23 logMAR preoperatively to 0.02 ± 0.06 logMAR at 3 months. Monocular BCVAs at 3 months were 0.08 ± 0.08 logMAR at intermediate distance and 0.05 ± 0.08 logMAR at near distance. IOL rotation from the intended placement axis was 2.5 ± 1.7 degrees at 1 week and 1.7 ± 1.7 degrees at 3 months postoperatively.

CONCLUSIONS

The AcrySof IQ Vivity Extended Vision IOL achieved good UCVAs and BCVAs for distance, intermediate, and near vision. This IOL also provided excellent rotational stability for astigmatism correction.

Rotational stability and refractive outcomes of a new hydrophobic acrylic toric intraocular lens

PURPOSE

To assess rotational stability and refractive outcomes of a new toric hydrophobic acrylic intraocular lens (IOL).

DESIGN

Single-center, prospective, interventional clinical trial.

METHODS

A total of 130 eyes of 82 patients with age-related cataract and total corneal astigmatism of greater than 1.0 diopters (D) received a hydrophobic acrylic toric IOL Clareon CNW0T3-9. Baseline measurement for rotational stability evaluation was performed at the end of surgery (EOS), with the patient still supine on the operating table, using non-movable vessels as reference landmarks. Postoperative retroillumination pictures were taken at 1 h, 1 week, 1 month and 4-6 months postoperatively. Subjective manifest refraction was assessed at the 6 months follow-up visit.

RESULTS

Final results were obtained in 126 eyes of 80 patients. Mean absolute rotation from EOS to 6 months was 1.33 ± 2.00 [0.01, 19.80] degrees. Rotational stability values from EOS to 1 h, 1 h to 1 week, 1 week to 1 month and 1 month to 6 months were 0.86 ± 0.82 [0.00, 3.90], 1.06 ± 1.94 [0.00, 19.45], 0.47 ± 0.42 [0.00, 2.03] and 0.38 ± 0.40 [0.00, 2.56] degrees. Mean preoperative corneal astigmatism was 1.78 ± 0.83 [1.00, 4.76] D which changed to a mean postoperative refractive astigmatism of 0.33 ± 0.27 [0.00, 1.25] D at 6 months.

CONCLUSION

The Clareon toric IOL presented very good rotational stability with a mean absolute rotation below 1.4° from EOS to 6 months. Only two IOLs rotated more than 5° with none of them requiring repositioning surgery. Refractive outcomes were satisfying with a mean residual refractive astigmatism below 0.50 D.

TRIAL REGISTRATION

Registered at Clinicaltrials.gov NCT03803852 ; on May 17, 2022.

Rotational stability and capsular bag performance of a hydrophobic acrylic open-loop single-piece intraocular lens

PURPOSE

To evaluate the rotational stability and capsular bag performance of a blue light-absorbing hydrophobic acrylic open-loop single-piece intraocular lens (IOL) with a blast-finished anchor wing haptic design during the first 6 postoperative months.

METHODS

In this prospective clinical study, patients with age-related cataract and potential postoperative corrected distance visual acuity (CDVA) of 0.2 logMAR or better were included. The patients received a non-toric hydrophobic acrylic single-piece IOL with an axis mark (YST0.00; Nidek Co. Ltd, Japan). Surgeries were video-taped. Retroillumination images were acquired 1 h, 1 week and 6 months postoperatively. Rotational stability was assessed by precise image overlay. At 6 months, Purkinje meter measurements were performed to evaluate tilt and decentration.

RESULTS

In total, 100 eyes of 77 patients were included in the analysis. Mean absolute rotation was 2.1 ± 1.7° (median 1.7, range: 0-7.9) at 6 months (1 h - 6 months postoperatively). IOL rotation was ≤3° and ≤6° in 74 (74%) and 98 (98%) eyes, respectively. Mean absolute IOL rotation from the end of surgery to 6 months was 2.5 ± 2.2° (median 2.3, range: 0-15.6; n = 78). Mean tilt (pupillary axis) and decentration were 4.1 ± 1.9° (median 4.0, range: 0.5-8.2) and 0.35 ± 0.17 mm (median 0.32, range: 0.06-0.91) respectively (n = 84). Postoperatively, 98 (98%) eyes achieved a CDVA of 0.2 logMAR or better, 95 (95%) of ≤0.1 and 81 (81%) of ≤0.0.

CONCLUSIONS

This hydrophobic acrylic single-piece IOL showed an excellent rotational stability and capsular bag position with low tilt and decentration values.

Attitudes and understanding of premium intraocular lenses in cataract surgery: a public health sector patient survey

OBJECTIVES

To investigate patient understanding of, and attitudes to, premium (toric, extended depth of focus/multifocal) intraocular lenses (premIOLs) in public health sector patients undergoing cataract surgery (CS) in the UK.

METHODS

A 12 question survey with Likert scale questions was designed, to assess patient attitudes to post-operative spectacle dependence, refractive target and desirability of spectacle independence whilst considering possible complications of dysphotopsias and need for premIOL exchange/adjustment.

RESULTS

360 surveys were collected. CS had not been performed in 66.5%. Separate spectacles were worn for reading and distance in 28.8%, 19.2% had varifocals, 11.2% bifocals, 22.9% reading glasses only and 1.6% computer glasses only. Contact lenses were not worn in 95.7%. Only 41.6% were drivers. Most patients (85.8%) did not mind wearing glasses after CS, with 78.9% preferring reading glasses, compared with 29.7% preferring distance glasses. Most patients (75.3%) were not familiar with premIOLs, with 58.9% not willing to consider them in the context of a 2% risk of debilitating dysphotopsia and 54.2% rejecting a 5% risk of second surgery.

CONCLUSIONS

There is a lack of awareness of premIOLs in public health sector (NHS) patients in the UK, suggesting limitations in the "fully informed" consent process for CS. Most NHS CS patients are currently willing to wear spectacles after CS, especially reading glasses. There is reluctance in such patients to consider premIOLs on a background of small risks of debilitating dysphotopsias and increased risks of a second operation.

Refractive surprise of irregular astigmatism following cataract surgery in two patients with neglected subclinical corneal ectasia: two case reports

BACKGROUND

Corneal ectatic diseases are a group of corneal disorder characterized by the steepening and thinning of the cornea. Older people are not a high-risk population for corneal ectatic diseases; due to the lack of typical preoperative topographic manifestations, there is a high possibility that corneal ectasia is undetected.

CASE PRESENTATION

Two patients with subclinical corneal ectasia and senile cataracts presented with irregular astigmatism after steep-axis incision during cataract surgery. The two cases presented in this case report are rare because both patients experienced tremendous changes in astigmatism after cataract surgery.

CONCLUSION

This case report may shed some light on astigmatism-correcting steep-axis incisions in cataract surgeries.

Comparative evaluation of intraoperative aberrometry and Barrett's toric calculator in toric intraocular lens implantation

Purpose

Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real-time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation.

Methods

This was an institution-based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar-LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version-21 was used; P < 0.05 considered significant.

Results

Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (-0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (-0.14 ± 0.32D) than IA (0.001 ± 0.33D) (-0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one-month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, -0.57 ± 0.26D, and -0.18 ± 0.27D, respectively.

Conclusion

Both IA and BTC give reliable and comparable refractive results for tIOL implantation.

One-year long-term clinical outcomes following diffractive trifocal toric intraocular lens implantation: retrospective observational case series study

BACKGROUND

Trifocal intraocular lens (IOL) provides three foci for the external light to the eye. The reduction of corneal astigmatism makes three foci to clearly focus on the fovea. This study aimed to evaluate one-year clinical outcomes for near, intermediate, and far distance visual acuity and satisfaction in patients implanted with diffractive trifocal toric IOLs.

METHODS

This retrospective observational case series study was based on the medical records of patients who undergone uncomplicated cataract surgery with implantation of a trifocal toric IOL (POD AY 26P F-T FineVision Toric; PhysIOL SA, Liège, Belgium). Eyes with corneal astigmatism greater than 1.00 diopters were included. Postoperative evaluations included uncorrected near, intermediate, and distance and corrected distance visual acuity; defocus curves; and contrast sensitivity measured at both three months and one-year postoperatively. Subjective satisfaction was evaluated based on three kinds of questionnaires for spectacle dependence, quality of vision, and overall satisfaction.

RESULTS

Postoperative uncorrected distance visual acuity and that at 33, 43, 50, 60, and 80 cm at one-year were 0.07±0.08, 0.22±0.11, 0.17±0.11, 0.14±0.10, 0.14±0.10, and 0.15±0.10 logarithm of the minimal angle of resolution (logMAR), respectively. A smooth range of good visual acuity was found on defocus curve. Subjective scores for spectacle dependence, quality of vision, and subjective satisfaction showed no significant differences between three months and one-year postoperatively. The mean amount of IOL axis rotation was 2.14±1.72° (range: 0.2-5.1°) at one-year postoperatively.

CONCLUSIONS

Implantation of a diffractive trifocal toric IOL for cataract, presbyopia, and astigmatism correction provided good refractive and visual outcomes, relatively smooth range of intermediate vision, and high levels of visual quality and patient satisfaction until one-year after surgery.

Comparison of Visual Outcomes Between Toric Intraocular Lenses and Clear Corneal Incisions to Correct Astigmatism in Image–Guided Cataract Surgery

Purpose

To compare the astigmatism correction effects of toric intraocular lenses (IOL) and clear corneal incisions during image-guided cataract surgery.

Methods

All patients with regular corneal astigmatism of 0.75–1.5 D underwent cataract surgery and astigmatism correction using the Callisto eye image-guided system. One group had implantation of an AcrySof toric IOL. Another group had implantation of aspheric IOL with 3.0 mm single clear corneal incision (SCCI) on the steep axis. Uncorrected and best-corrected spectacle visual acuity, refraction, and toric IOL axis were evaluated at 1, 4, and 12 weeks postoperatively.

Results

Sixty-eight eyes of 68 patients were included. The mean residual refractive cylinder was 0.34 ± 0.40 D in the toric group and 0.64 ± 0.57 D in the SCCI group. There were no significant differences in residual refractive cylinder, spherical equivalent, uncorrected distance visual acuity (UDVA), and best-corrected spectacle visual acuity (BCSVA) between groups. The percentage of the residual cylinder within ± 0.50 D was 75 and 56% for toric and SCCI cases, respectively (p &gt; 0.1). The mean surgical induced astigmatism vector was 0.61 ± 0.29 D in the SCCI group and 1.04 ± 0.38 D in the toric group. The mean magnitude of error was negative (−0.54 ± 0.48 D) and the correction index was &lt;1.0 (p &lt; 0.05) in SCCI group. At 3 months, all toric IOL alignment errors were within 5 degrees from the intended axis.

Conclusions

Both toric IOL and SCCI can correct low and medium astigmatism effectively with the help of a precise image-guided system.

Do limbal relaxing incisions during cataract surgery still have a role?

BACKGROUND

Though Limbal Relaxing Incisions (LRI) were used widely to correct pre-existing corneal astigmatism during cataract surgery, they have been replaced recently with the more expensive methods like the use of toric Intra Ocular Lenses (IOL) and femtosecond during cataract surgery. We conducted our study to re-evaluate the role of (LRI) in correcting pre-existing moderate corneal astigmatism during cataract surgery in settings where other options are neither available nor affordable.

METHODS

Retrospective analysis of all consecutive cases of LRI performed by a single surgeon at the time of cataract surgery to correct moderate corneal astigmatism (1.5-3D) in a community hospital over a period of 6 months. Corneal astigmatism, uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) were recorded pre-operatively, 4 weeks and 3 months post-operatively. Data on age, intraocular lens (IOL) power, predictive refraction and post-operative spherical equivalent was also collected and analyzed. The number and position of LRI was determined based on the pre-existing corneal astigmatism using online calculator.

RESULTS

29 eyes of 25 patients with the mean age of 73.6 years (range: 46 to 90 years) and corneal astigmatism between 1.5 to 3D were included. Statistically significant reduction in the mean corneal astigmatism was recorded from 2.05 ± 0.45D preoperatively to 0.85 ± 0.56D postoperatively (P < 0.0001). All eyes showed reduction in astigmatism; 83% of eyes had < 1.0D post-operatively and 66% of eyes had < 0.75D. UDVA of 6/9 or better was recorded in 80% of eyes post-operatively (CDVA of 6/9 or better in 100%). The spherical equivalent was within 1.0D of the predictive refraction postoperatively in nearly all eyes (97%) and within 0.5D in 86% of the eyes. There were no peri-operative or post-operative complications were recorded in any case.

CONCLUSION

Combining LRI and cataract surgery to address moderate degrees of corneal astigmatism is a safe, reliable and predictable option especially in areas where more expensive methods such as toric IOL or excimer laser are not available or affordable. LRI has no significant effect on the spherical equivalent and is an excellent tool in reducing patient's spectacle dependence.

Rotational stability and clinical outcomes of a new one piece toric intraocular lens with anchor-wing haptics

Background

To evaluate the safety and efficacy of a new toric intraocular lens (IOL) with anchor-wing haptics.

Methods

The new toric IOL with anchor-wing haptics (NS60YT, NIDEK Co., Ltd.) was implanted in eligible patients with age-related cataracts with preoperative corneal astigmatism of 1.0 D or greater at a university hospital and two private hospitals in Japan. The following IOL cylinder powers were evaluated: 1.50 D (NS60YT3), 2.25 D (NS60YT4), 3.00 D (NS60YT5) and 4.50 D (NS60YT7). All patients were assessed out to 12 months postoperatively. The primary endpoint was visual acuity (VA) with spherical addition at 6 months postoperatively, and the primary analysis calculated the proportion of eyes with VA with spherical addition of 0.1 logMAR or better. The magnitude of rotation was compared to the intended axis of IOL implantation at each postoperative examination. Adverse events were evaluated for the safety analysis.

Results

This study enrolled 64 eyes of 53 patients. At 6 months postoperatively, for all IOL powers, VA with spherical addition of 0.1 logMAR or better was achieved in 90% [95% confidence interval (CI): 80–96] of eyes. The mean IOL rotation was 5.3 ± 4.3° at 12 months postoperatively. The mean magnitude of rotation ranged from 1.9° to 2.5° between each postoperative examination from 1 day to 12 months. There were no vision-threatening intraoperative or postoperative complications for the duration of the study.

Conclusions

The NS60YT IOL remained stable after implantation and was efficacious for treating 1.00 D or greater astigmatism in patients with senile cataracts.

Trial registration

This study was registered at ClinicalTrials.gov (NCT03242486) on August 8, 2017 - Retrospectively registered.

Outcomes of a Toric Monofocal Piggyback Intraocular Lens for Residual Astigmatic Refractive Error in Pseudophakic Eyes

PURPOSE/AIM

To evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes.

MATERIALS AND METHODS

Visual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards.

RESULTS

Twenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p < .05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%).

CONCLUSIONS

In this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes.

Precision and refractive predictability of a new nomogram for femtosecond laser-assisted corneal arcuate incisions

PURPOSE

Validating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium- and Bowman-penetrating femtosecond laser-assisted arcuate incisions.

METHODOLOGY

Prospective, interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser-assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity.

RESULTS

The study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was -0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D.

CONCLUSION

The Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism.

Lasting Effects: Seven Year Results of the Castrop Nomogram for Femtosecond Laser-Assisted Paired Corneal Arcuate Incisions

PURPOSE

Long-term results of arcuate incisions are rarely reported. This is unfortunate as long-term stability of astigmatic correction is of great interest to surgeons performing astigmatic correction. This study investigates the 7 year stability of results after application of femtosecond laser-assisted arcuate incisions with the Castrop nomogram.

METHODS

Prospective interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Single site, single surgeon study. Seven year results of cataract patients with low to moderate corneal astigmatism receiving femtosecond laser-assisted arcuate incisions using a TechnolasVictus SW 2.7 (Bausch & Lomb Inc, Dornach, Germany) were assessed and compared to 1 year results. Outcome evaluation was based on astigmatic vector analysis, manifest refraction, and visual acuity.

RESULTS

The study analyzed 19 eyes of 19 patients 7 years after surgery. Ocular residual astigmatism changed from -0.26 to -0.39 D. Preoperative corneal astigmatism was -1.51 D. Correction Index changed from 1.0 to 1.16. The magnitude of difference vector changed from 0.26 to 0.39 D. The index of success changed from 0.20 to 0.29. Spherical equivalent remained stable. A slight tendency to change toward astigmatic overcorrection was mainly observed for patients with preoperative with the rule astigmatism, but not with patients with against the rule astigmatism.

CONCLUSIONS

The Castrop nomogram showed stable results 7 years after surgery. Similar to toric IOL surgery, it is advisable to be less aggressive when correcting with the rule astigmatism, to avoid overcorrection over a long period.

Visual outcome and refractive status with monofocal toric intraocular lens implantation to correct astigmatism during cataract surgery

Purpose:

Measurement, calculations, visual assessment, and refractive status after monofocal toric intraocular lens (IOL) implantation were the purpose of this study.

Methods:

This was a hospital-based interventional prospective study, where 40 eyes were included with astigmatism of more than 2D. They underwent biometric assessment using Lenstar. Toric IOL power calculation was done based on Barrett's Toric calculation method. Preoperative axis marking was done using both bubble marker and direct slit beam to avoid cyclotorsion in sleeping position. On table, axis marking was reassessed. Post phacoemulsification, monofocal Supra Phob Toric IOL was rotated till its marking matches corneal axis marking. Postoperative best-corrected visual acuity was measured at 1 and 3 months.

Results:

Mean of refractive astigmatism reduced from 3.55 ± 0.97 preoperatively to 0.81 ± 0.28 at 1 month and 0.79 ± 0.27 at 3 months postoperatively. In total, 92.5% had residual astigmatism less than 1D at 3 months postoperatively, while 7.5% eyes had residual astigmatism more than 1D. In total, 72.5% patients had IOL rotation of less than or equal to 5°, 20% patients had it between 6° and 10° and 7.5% eyes had more than 10° at day 7 postoperatively, which required IOL repositioning.

Conclusion:

Accurate measurement of parameters and proper calculation reduce the postoperative residual astigmatism after toric IOL.

Clinical differences between toric intraocular lens (IOL) and monofocal intraocular lens (IOL) implantation when myopia is determined as target refraction

BACKGROUND

The aim of this study is to analyze and compare the clinical results of toric intraocular lens (IOL) and monofocal IOL implantation when the target refraction value is -3 diopter (D) in cataract patients with corneal astigmatism > 1.5 diopters (D).

METHODS

We performed a retrospective chart review for patients with corneal astigmatism > 1.5D who underwent cataract surgery and their target refraction is -3D. 100 eyes (100 patients; monofocal IOL, 60; toric IOL, 40) were enrolled in the current study. Near and distant uncorrected visual acuity (UCVA), corrected VA, spherical equivalent and refractive, corneal astigmatism were evaluated before and after surgery.

RESULTS

The near UCVA of the toric IOL group (0.26 ± 0.33) after cataract surgery was significantly better than that of the monofocal IOL group (0.48 ± 0.32) (p = 0.030). The distant UCVA of the toric IOL group (0.38 ± 0.14) was also significantly better than that of the monofocal IOL group (0.55 ± 0.22) (p = 0.026). Best-corrected visual acuity (p = 0.710) and mean spherical equivalent (p = 0.465) did not show significant differences between the toric IOL group and the monofocal IOL group. In the toric IOL group, postoperative refractive astigmatism was - 0.80 ± 0.46D and postoperative corneal astigmatism was - 1.50 ± 0.62D, whereas the corresponding values in the monofocal IOL group were - 1.65 ± 0.77D and - 1.45 ± 0.64D; residual refractive astigmatism was significantly lower with toric IOL implantation compared with monofocal IOL implantation (p = 0.001). There were no postoperative complications.

CONCLUSIONS

When myopic refraction such as -3D was determined as the target power in patients with corneal astigmatism, toric IOL implantation led to excellent improvement in both near and distant UCVA.

One-Year Results of Arcuate Keratotomy in Patients With Low to Moderate Corneal Astigmatism Using a Low-Pulse-Energy Femtosecond Laser

PURPOSE

To investigate corneal astigmatism (CA) reduction and corneal optical quality after surface-penetrating femtosecond laser arcuate keratotomies (Femto AK) considering anterior (CA_ant) and posterior corneal curvature (CA_post), total corneal refractive power astigmatism (CA_tot), and corneal higher-order aberrations (HOAs) through 1 year.

DESIGN

Prospective interventional case series.

METHODS

Setting: Department of Ophthalmology, Medical University of Vienna. PatientPopulation: Forty-three eyes of 43 patients with age-related cataract and CA_tot between 1 and 3 diopters (D).

INTERVENTION

Paired keratotomies were created with a low-energy femtosecond laser (LDV Z8; Ziemer Ophthalmic Systems, Port, Switzerland) and combined with an astigmatic neutral manual posterior-limbal cataract incision. CA and HOAs measurements were obtained preoperatively and after 1 month, 3 months, and 1 year. MainOutcomeMeasure: Change of CA and HOAs after low-energy Femto AK through 1 year.

RESULTS

Mean preoperative CA_ant and CA_tot (1.62 ± 0.49 D and 1.58 ± 0.44 D) were significantly reduced, to 0.66 ± 0.38 and 0.50 ± 0.30 D (P < .001) 1 year after surgery, respectively. CA_post showed no significant change, from 0.31 ± 0.19 D preoperatively to 0.31 ± 0.13 D (P = .732) at the 1-year follow-up period. Astigmatism as calculated by vector astigmatism analysis stayed stable at 1 month, 3 months, and 1 year. Corneal wavefront HOAs significantly improved at 1 month, 3 months, and 1 year.

CONCLUSIONS

Paired surface-penetrating keratotomies created by a low-energy femtosecond laser showed efficient and stable CA reduction within 1 year after surgery. The optical quality of the cornea was preserved with lower HOAs than preoperatively.

Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

PURPOSE

The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS).

METHODS

This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection.

RESULTS

The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ± 0.37 D in the transepithelial group and 0.53 ± 0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ± 0.71 in the transepithelial group and 0.68 ± 0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group.

CONCLUSIONS

Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

PURPOSE

The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS).

METHODS

This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection.

RESULTS

The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group.

CONCLUSIONS

Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Prevalence and Age-Related Changes of Corneal Astigmatism in Patients Undergoing Cataract Surgery in Northern China

Purpose

To examine the magnitude, orientation, and age-related changes of corneal astigmatism of the eyes before cataract surgery. Setting. Hebei Eye Hospital, Hebei, China.

Design

A clinical-based retrospective study.

Results

The study consisted of 5662 eyes of 5662 consecutive cataract surgery patients with a mean age of 68.26 ± 10.39 (mean ± standard deviation (SD)) years (range 40 to 97 years), and 59.86% of the patients were women. Mean corneal astigmatism was 0.98 ± 0.76 diopter (D) (range 0.00-9.61 D). Corneal astigmatism of 0.50-0.99 D was the most common range of values (30.08%), followed by 1.00-1.49 D (22.15%), ≤0.50 D (21.21%), and 1.50-1.99 D (10.28%). There was a strong U-shaped relation between corneal astigmatism and age (p for nonlinearity <.01). With the increase of age, the astigmatism axis gradually changes from with-the-rule (WTR) to against-the-rule (ATR). Moreover, in young patients with age below 65 years, WTR astigmatism was negatively correlated with age, while ATR was positively correlated with age (r = -0.11, p=.001; r = 0.10, p=.010, respectively). However, in the old patients with age above and equal to 65 years, all types of astigmatism were positively correlated with age.

Conclusion

This study may provide valuable and practical information to surgeons when selecting the appropriate surgical method and toric intraocular lens (IOLs).

A randomised, prospective study of 'off-the-shelf' use of toric intraocular lenses for cataract patients with pre-existing corneal astigmatism in the NHS

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.

Refractive and Visual Outcomes After Implantation of a Secondary Toric Sulcus Intraocular Lenses

Purpose

To evaluate the rotational stability, visual acuity and refractive error after sulcus implantation of a secondary toric IOL.

Setting

One clinical practice in Haugesund, Norway.

Design

Non-interventional single-arm diagnostic study.

Methods

Eligible subjects who had previous successful primary cataract or refractive lens exchange surgery in one or both eyes and the AddOn^® secondary toric IOL implanted in the sulcus were evaluated at a single postoperative diagnostic visit to measure visual outcomes. Subjects with surgical complications (either primary or secondary) or pathology that would affect best-corrected visual acuity (eg, amblyopia) were excluded. Clinical evaluations at the diagnostic visit included measurement of visual acuity, manifest refraction and IOL orientation.

Results

Eighteen eyes were evaluated. After secondary IOL implantation, mean residual refractive astigmatism was significantly reduced (1.66 ± 0.92 to 0.32 ± 0.25 D). There was no appreciable change in the spherical equivalent refraction. Sixteen of 18 eyes (89%) had residual refractive astigmatism ≤0.50D, and no eye had more than 0.75D after secondary IOL implantation. Mean UCVA was 0.00 ± 0.03 logMAR, with no eyes worse than 0.10. Mean BCVA was −0.05 ± 0.03 logMAR (20/20+2), with all eyes having BCVA of 0.00 logMAR. The mean change in orientation was near zero, with a mean absolute change of 4.9 ± 3.7 degrees. Sixteen of 18 eyes (89%) had a lens orientation ≤10 degrees from intended, with no eye oriented more than 13 degrees from intended.

Conclusion

The AddOn^® toric sulcus IOL significantly reduced postoperative refractive astigmatism in patients with high astigmatism after their primary cataract or RLE surgery, providing very good uncorrected distance vision.

Outcome of toric intraocular lenses implanted in eyes with previous corneal refractive surgery

PURPOSE

To evaluate the outcome of toric intraocular lens (IOL) implantation in eyes with previous laser in situ keratomileusis/photorefractive keratectomy (LASIK/PRK).

SETTING

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

DESIGN

Retrospective case series.

METHODS

Consecutive cases that had previous myopic or hyperopic LASIK/PRK and had undergone cataract surgery with toric IOL implantation were retrospectively reviewed. Included were eyes that had (1) preoperative ocular biometry measurements with the Lenstar, (2) no intraoperative or postoperative complications, and (3) available postoperative manifest refraction at ≥3 weeks with corrected distance visual acuity of 20/30 or better. Vector analysis was used to assess the preoperative corneal and postoperative refractive astigmatism.

RESULTS

In 56 eyes with previous myopic LASIK/PRK and 19 eyes with previous hyperopic LASIK/PRK, respectively, the mean magnitudes of corneal astigmatism were 1.34 ± 0.62 diopters (D) and 1.66 ± 0.80 D, 5% and 0% of eyes had anterior corneal astigmatism ≤0.50 D, and the centroid values were 0.31 D at 19 degrees ± 1.45 D and 0.74 D at 92 degrees ± 1.72 D preoperatively. Postoperatively, the mean magnitudes of refractive astigmatism were 0.36 ± 0.31 D and 0.34 ± 0.34 D, 80% and 84% of eyes had refractive astigmatism of ≤0.50 D, and the centroid values were 0.12 D at 152 degrees ± 0.46 D and 0.05 D at 172 degrees ± 0.48 D (all P < .05).

CONCLUSIONS

Toric IOLs were effective to correct preexisting corneal astigmatism in eyes with previous excimer laser corneal refractive surgery.

Efficacy of astigmatic correction after femtosecond laser-guided cataract surgery using intraoperative aberrometry in eyes with low-to-moderate levels of corneal astigmatism

PURPOSE

To evaluate the efficacy of astigmatic correction with two types of toric intraocular lenses (IOLs) after femtosecond laser-assisted cataract surgery (FLACS) in eyes with low-to-moderate corneal astigmatism using intraoperative aberrometry for optimizing the position of the toric IOL.

METHODS

Retrospective study includes a total of 99 eyes of 73 patients with anterior keratomeric astigmatism ≤ 3 D and undergoing FLACS (Catalys, Johnson & Johnson Vision) with implantation of a monofocal (Ankoris, PhysIOL) or a multifocal toric IOL with the same platform (Pod FT, PhysIOL). In all cases, intraoperative aberrometry was used (Optiwave refractive analysis, ORA, system, Alcon). Visual and refractive outcomes were evaluated preoperatively and at 4 months after surgery with vector analysis of astigmatic changes.

RESULTS

A total of 89.9%, 93.9% and 97.0% showed a postoperative sphere, cylinder and spherical equivalent within ± 0.50 D, respectively. Mean difference vector (DV) was 0.22 ± 0.27 D, mean magnitude of error (ME) was 0.13 ± 0.29 D, and mean angle of error (AE) was 1.52 ± 11.64°. Poor correlations of preoperative corneal astigmatism with DV (r = - 0.032, p = 0.833), ME (r = - 0.344, p = 0.001) and AE (r = - 0.094, p = 0.377) were found. Likewise, no statistically significant differences were found between monofocal and multifocal toric IOL subgroups in DV (p = 0.580), ME (p = 0.702) and AE (p = 0.499).

CONCLUSIONS

The combination of FLACS and intraoperative aberrometry to optimize the position of a toric IOL allows a very efficacious correction of preexisting low-to-moderate corneal astigmatism.

Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification

BACKGROUND

Cataract is the leading cause of blindness in the world, and clinically significant astigmatism may affect up to approximately 20% of people undergoing cataract surgery. Pre-existing astigmatism in people undergoing cataract surgery may be treated, among other techniques, by placing corneal incisions near the limbus (limbal relaxing incisions or LRIs) or by toric intraocular lens (IOLs) specially designed to reduce or treat the effect of corneal astigmatism on unaided visual acuity.

OBJECTIVES

To assess the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 9); Ovid MEDLINE; Ovid Embase and four other databases. The date of the search was 27 September 2019.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing toric IOLs with LRIs during phacoemulsification cataract surgery.  DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. We graded the certainty of the evidence using GRADE. Our primary outcome was the proportion of participants with postoperative residual refractive astigmatism of less than 0.50 dioptres (D) six months or more after surgery. We also collected data on mean residual refractive astigmatism. Secondary outcomes included: uncorrected distance visual acuity, vision-related quality of life, spectacle independence and adverse effects including postoperative lens rotation requiring re-alignment. To supplement the main systematic review assessing the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery, we sought to identify economic evaluations on the subject.

MAIN RESULTS

We identified 10 relevant studies including 517 people (626 eyes). These studies took place in China (three studies), UK (three), Brazil (one), India (one), Italy (one) and Spain (one). The median age of participants was 71 years. The level of corneal astigmatism specified in the inclusion criteria of these studies ranged from 0.75 D to 3 D. A variety of toric IOLs were used in these studies, in all but one study, these were monofocal. Studies used three different nomograms to determine the size and placement of the LRI. Two studies did not specify this. None of the studies were at low risk of bias in all domains, but two studies were at low risk of bias in all domains except selective outcome reporting, which was unclear. The remaining studies were at a mixture of low, unclear or high risk of bias. People receiving toric IOLs were probably more likely to achieve a postoperative residual refractive astigmatism of less than 0.5 D six months or more after surgery (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.10 to 1.78; 5 RCTs, 262 eyes). We judged this to be moderate-certainty evidence, downgrading for risk of bias. In the included studies, approximately 500 eyes per 1000 achieved postoperative astigmatism less than 0.5 D in the LRI group compared with 700 per 1000 in the toric IOLs group. There was a small difference in residual astigmatism between the two groups, favouring toric IOLs (mean difference (MD) -0.32 D, 95% CI -0.48 to -0.15 D; 10 RCTs, 620 eyes). Although all studies favoured toric IOLs, the results of individual studies were inconsistent (range of effects -0.02 D to -0.71 D; I² = 89%). We considered this to be low-certainty evidence, downgrading for risk of bias and inconsistency. People receiving a toric IOL probably have a small improvement in visual acuity at six months or more after surgery compared to people receiving LRI, but the difference is small and probably clinically insignificant (MD -0.04 logMAR, 95% CI -0.07 to -0.02; 8 RCTs, 474 eyes; moderate-certainty evidence). Low-certainty evidence from one study of 40 people suggested little difference in vision-related quality of life measured using the Visual Function Index (VF-14) (MD -3.01, 95% CI -8.56 to 2.54). Two studies reported spectacle independence and suggested that people receiving toric IOLs may be more likely to be spectacle independent (RR 1.56, 95% CI 1.14 to 2.15; 100 people; low-certainty evidence). There were no cases of lens rotation requiring surgery (very low-certainty evidence). Five studies (320 eyes) commented on a range of other adverse effects including corneal oedema, endophthalmitis and corneal ectasia. All these studies reported that there were no adverse events with the exception of one study (40 eyes) where one participant in the LRI group had a central de-epithelisation which recovered over 10 days. We found no economic studies that compared toric IOLs with LRIs.

AUTHORS' CONCLUSIONS

Toric IOLs probably provide a higher chance of achieving astigmatism within 0.5 D after cataract surgery compared with LRIs. There may be a small mean difference in postoperative astigmatism, favouring toric IOLs, but this difference is likely to be clinically unimportant. There was no evidence of an important difference in postoperative visual acuity or quality of life between the techniques. Evidence on adverse effects was uncertain. The apparent shortage of relevant economic evaluations indicates that economic evidence regarding the costs and consequence of these two procedures is currently lacking.

Toric IOL positioning with a no-touch head-up display axis alignment

PURPOSE

To compare a new no-touch alignment technique for toric intraocular lenses (IOL) with the conventional technique that uses a manual pendulum.

METHODS

In this retrospective case-control study, patients who underwent toric IOL implantation using two different alignment techniques (digital Callisto^® system vs. manual-pendulum-based marking) were compared in a vector analysis using the Alpins method and an analysis of variance regarding corrected and uncorrected visual acuity and the deviation of the achieved IOL axis from the targeted axis.

RESULTS

Sixty-one eyes were included into analysis. Thirty-six of these surgeries were performed via the Callisto^® system and 25 eyes via pendulum-based corneal markings. Median IOL axis misalignment was 3° in both groups. Median uncorrected distance visual acuity was 0.097 logMAR versus 0.200. Median best-corrected visual acuity was 0.000 logMAR versus 0.097. All these data were below the range of statistical significance (p > 0.05). Vector analysis showed no significant difference for TIA [median of 3.14 diopters (D) vs. 2.73 D], SIA (median of 3.82 D vs. 3.79 D), DV (1.18 D vs. 1.08 D), and CI (1.23 vs. 1.29). Median angle of error was 1.96° versus - 0.44° (p > 0.05).

CONCLUSIONS

We found no significant difference in the refractive results, the IOL positioning, and the best-corrected and uncorrected distance visual acuity between the two compared methods. Nevertheless, the Callisto^® IOL alignment system delivers a standardized and easy-to-use technology. In particular, less-experienced surgeons might benefit from this marking technique.

Astigmatic correction with implantation of a light adjustable vs monofocal lens: a single site analysis of a randomized controlled trial

AIM

To evaluate the light adjustable lens (LAL) vs a standard monofocal lens in achieving target astigmatic refraction and improving postoperative uncorrected distance visual acuity (UDVA).

METHODS

This randomized controlled clinical trial included 40 patients with pre-existing astigmatism and visually significant cataract. Twenty-eight patients received the LAL and 12 control patients received a monofocal intraocular lens (IOL) after cataract extraction at a single institution. The patients with the LAL underwent adjustment by ultraviolet (UV) light postoperatively plus subsequent lock-in procedures and all patients returned to clinic for follow up of study parameters at 6, 9, and 12mo. Manifest refraction, distance visual acuity, and adverse events were recorded at each visit.

RESULTS

The mean cylinder before adjustment in eyes with the LAL was -0.89±0.58 D (-2.00 to 0.00 D) and -0.34±0.34 D (-1.25 to 0.00 D) after lock-in (P=1.68x10^-8). The mean cylinder in patients with the monofocal lens was -1.00±0.32 D (-1.50 to -0.50 D) at 17-21d postoperatively, which was statistically different from the LAL cylinder post lock-in (P=1.43x10^-6). UDVA in the LAL group was 20/20 or better in 79% of patients post lock-in with good stability over 12mo compared with 33% of the control patients with UDVA of 20/20 or better.

CONCLUSION

These results demonstrate that the LAL is more effective in achieving target refractions and improving postoperative UDVA in patients with pre-existing corneal astigmatism than a standard monofocal lens.

Utilizing intraoperative aberrometry and digital eye tracking to develop a novel nomogram for manual astigmatic keratotomy to effectively decrease mild astigmatism during cataract surgery

PURPOSE:

The purpose of the study is to develop a novel nomogram and validate with a retrospective comparative study for manual astigmatic keratotomy (MAK) with the assistance of intraoperative aberrometry (Optiwave Refractive Analysis [ORA]) and digital eye tracking (VERION) in mild astigmatic correction enhancement.

SETTING:

The study was conducted in Honolulu, Hawaii.

DESIGN:

This was a single-surgeon comparative study with retrospective data collection.

METHODS:

Sixty consecutive adult cataract surgery cases with regular astigmatism of 1.25 D or less were included for study from April 2016 to April 2017. VERION was used preoperatively in all cases. MAK was performed before phacoemulsification according to the surgeon's own nomogram. ORA then was utilized to obtain the axis and remaining cylinder power after phacoemulsification and intraocular lens implant implantation. MAK extension was performed for eyes with 1 D or more of remaining cylinder. Extensions were carried out slowly and slightly until the amount of cylinder was 1½ D or less under ORA. The mean degrees of extension plus the original MAK plan were calculated to develop the new nomogram. Sixty consecutive similar cases by the same surgeon using the surgeon's nomogram without using ORA/VERION for enhancement were reviewed from April 2015 to April 2016 for comparison. All patients included in this study signed the consent form.

RESULTS:

Using Alpins vector analysis for comparison, the proportion of patients with cylinder <0.5 D 3 months postoperatively was 87% in the ORA/VERION group compared to 70% in the non-ORA/VERION group (P < 0.05). Better than 20/25 best-corrected visual acuity was achieved more in the ORA/VERION group compared to non-ORA/VERION group.

CONCLUSIONS:

This novel nomogram developed by the surgeon may have better outcomes than the old surgeon's own nomogram. Further prospective control study is needed to validate the efficacy. If validated, those surgeons who do not have ORA/VERION can hopefully use this nomogram with greater success.

Correcting astigmatism at the time of cataract surgery: Toric IOLs and corneal relaxing incisions planned with an image-guidance system and intraoperative aberrometer versus manual planning and surgery

PURPOSE

To compare the outcomes of the combination of an image-guided system and intraoperative aberrometer with the surgeon's standard of care in correcting astigmatism using toric intraocular lenses (IOLs) or corneal incisions.

SETTING

Single site in United States.

DESIGN

Prospective case series.

METHODS

Contralateral eyes of patients having uncomplicated bilateral cataract surgery and astigmatism correction were randomly assigned to Group A or Group B. Group A received the surgeon's preferred standard of care. Group B had preoperative planning using an image-guidance system (VERION), intraoperative aberrometry (ORA System with VerifEye+), and femtosecond laser-assisted cataract surgery. The primary endpoint was the residual refractive astigmatism at 3 months.

RESULTS

Thirty-eight eyes were treated with toric IOLs and 40 eyes with corneal astigmatic incisions. On average, toric IOLs resulted in almost 0.25 diopter (D) less cylinder than corneal astigmatic incisions (P < .01), with no difference between groups (P = .41). There was no statistically significant difference in the mean spherical equivalent refraction by group (P = .51). At 3 months, the IOL in 4 eyes (11%) (2 in Group A and Group B each) was more than 10 degrees of absolute orientation from the intended orientation. The mean keratometry was 0.16 D higher with the image-guided system compared with optical biometry (Lenstar). The vector difference between the 2 measurements was 0.5 D or lower in all eyes.

CONCLUSIONS

The combined use of an image-guided system and intraoperative aberrometer did not significantly improve outcomes compared with the surgeon's standard of care. Based on keratometry, there was good agreement in corneal astigmatism measurements between the image-guided system and the optical biometer.

Consensus on the management of astigmatism in cataract surgery

This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.

Comparison of visual performance of toric vs non-toric intraocular lenses with same material

Aim

We compared the visual performance of toric intraocular lenses (IOLs) and non-toric IOLs made of the same material.

Patients and materials:

The subjects included patients implanted with either Acrysof IQ^® toric IOLs (SN6AT3-9) or Acrysof IQ^® IOLs (SN60WF) bilaterally. The toric group included 103 patients who were implanted with Acrysof IQ toric IOLs bilaterally. The non-toric group was a corneal astigmatism-matched control group and included 103 patients who were implanted with Acrysof IQ IOLs bilaterally.

Results

The uncorrected distance visual acuity was significantly better in the toric group, whereas the uncorrected 50 cm visual acuity was better in the non-toric group. There was no significant difference in contrast sensitivity (with and without glare) between both the groups. The rate of spectacle dependency for distance vision was significantly lower in the toric group. There were no significant differences between the two groups in all items of the postoperative quality-of-vision questionnaire (25-item Visual Function Questionnaire).

Conclusion

The toric IOLs used in this study reduced spectacle dependency more than the non-toric IOLs and did not compromise the subjective visual function, but the uncorrected 50 cm vision was worse in toric IOL implanted eyes.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes

PURPOSE

To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes.

METHODS

A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included.

RESULTS

In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°.

CONCLUSION

Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Toric intraocular lenses in eyes with with-the-rule, against-the-rule, and oblique astigmatism: One-year results

PURPOSE

To assess 1-year clinical results of toric intraocular lenses (IOLs) in eyes having with-the-rule (WTR), against-the-rule (ATR), or oblique corneal astigmatism.

SETTING

Four ophthalmic surgical sites, Japan.

DESIGN

Prospective case series.

METHODS

One of 3 toric IOLs or 1 nontoric IOL was implanted in eyes having phacoemulsification and IOL implantation.

RESULTS

The study comprised 218 eyes (155 patients). Based on the suggestion of an online toric calculator with anterior corneal curvature data, 63 eyes received the SN6AT3 IOL with a cylinder power of 1.50 diopters [D] at IOL plane (1.50 D cylinder IOL) 55 eyes the SN6AT4 IOL with a cylinder power of 2.25 D at IOL plane (2.25 D cylinder IOL), and 58 eyes the SN6AT5 IOL with a cylinder power of 3.00 D at IOL plane (3.00 D cylinder IOL) (all Acrysof IQ toric), and 42 eyes received the SN60WF IOL (nontoric IOL). One hundred ninety-four eyes (89.0%) completed 1-year of follow-up. The centroid error in predicted residual astigmatism calculated using vector analysis was close to the origin in eyes with WTR astigmatism (0.17 diopter [D] @ 174.9 ± 0.54 D), while those with ATR and oblique astigmatism were significantly shifted toward the ATR direction (P < .001). The distance from the origin was significantly smaller in the WTR group than in ATR and oblique groups (P < .05). The centroid errors were shifted toward ATR in all toric IOL groups (P < .001); however, the distance from the origin was not different between groups (P = .52). Postoperatively, the mean absolute misalignment of the IOLs was 5.92 degrees ± 5.59 (SD) at 1 day and 6.24 ± 5.87 degrees at 1 year. The results of other clinical parameters were excellent, with no significant differences between astigmatism categories or IOL models.

CONCLUSION

Based on anterior corneal curvature alone, toric IOLs undercorrected ATR and oblique astigmatism; however, 1-year clinical results of toric IOLs were highly stable and satisfactory.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

[Refractive outcomes and precision in toric intraocular lens alignment using an automated alignment system]

PURPOSE

To compare precision in toric intraocular lens (TIOL) alignment and refractive outcomes between an intraoperative automated digital marker system and the conventional manual-ink marking.

MATERIALS AND METHODS

Prospective single center study including consecutive patients undergoing uneventful cataract surgery with corneal astigmatism greater than 1 diopter. Total corneal astigmatism was measured using a placido-dual Scheimpflug system (GalileiG4^®, Ziemer). Acrysof^® SN6AT (Alcon) TIOL's were implanted, and patients were divided into 2 groups, the digital group (Verion^®, Alcon) and the ink-marking group (Pendular marker, AMO). Mean error in TIOL axis, visual acuity and residual astigmatism were analyzed at 3 days, one month and 6 months after surgery.

RESULTS

In total, 45 eyes of 30 patients were included (n=25 digital group, n=20 ink-marking group). The mean preoperative total corneal astigmatism was 1.71±0.53 diopters. At one month, there was a significantly lower mean average error in TIOL axis in the digital group compared to the ink-marking group (2.6±2.3° and 6.4±2.8° respectively, P=0.009). At 6months, these results remained statistically significant. Mean residual astigmatism was 0.7±0.4 diopters at one month, without significant difference between the two groups (P=0.9). The rate of misalignment less than or equal to 5° was 86 % (n=25) in the digital group and 63 % (n=20) in the ink-marking group (P=0.05).

CONCLUSION

Intraoperative digital marker system is associated with better TIOL alignment accuracy and better reproducibility than the manual ink-marking method.

[Toric lens implantation in cataract surgery: Automatic versus manual horizontal axis marking, analysis of 50 cases]

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.

Toric lens implantation in cataract surgery: Automated versus manual horizontal axis marking, analysis of 50 cases

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.

Tomographic Analysis of Anterior and Posterior and Total Corneal Refractive Power Changes After Femtosecond Laser-Assisted Keratotomy

PURPOSE

To analyze the effect of penetrating femtosecond laser-assisted keratotomy (pFLAK) during laser lens surgery on anterior and posterior corneal astigmatism and total corneal refractive power (TCRP) astigmatism (CA_ant, CA_post, CA_TCRP) measured with Scheimpflug tomography.

DESIGN

Prospective, interventional case series.

METHODS

This institutional study included 27 eyes of 23 patients (aged 65 ± 8 years) with low-to-moderate CA_TCRP determined with Scheimpflug tomography (Pentacam HR; Oculus, Wetzlar, Germany) after penetrating femtosecond laser-assisted keratotomy (pFLAK) and laser lens surgery. The CA_ant, CA_post, and CA_TCRP were determined before and 1 and 3 months after surgery. Vector analysis according to the Alpins method was used to calculate surgically induced astigmatism (SIA).

RESULTS

The mean preoperative CA_ant (0.97 ± 0.30 diopter [D]) was significantly reduced to 0.63 ± 0.34 D (P < .001). SIA_ant was 0.71 ± 0.37 D. The CA_post showed no significant change, from preoperative 0.26 ± 0.12 D to 0.26 ± 0.10 D postoperatively (P = .625). In line with this finding, SIA_post was low (0.12 ± 0.07 D). The CA_TCRP showed similar results as CA_ant.

CONCLUSION

pFLAKs planned according to Scheimpflug-based CA_TCRP result in a significant reduction of the CA_ant and CA_TCRP, but do not affect the posterior corneal curvature significantly, as measured by Scheimpflug tomography. Further research is required to develop a new valid nomogram for laser-assisted lens surgery.

Toric Intraocular Lenses Versus Peripheral Corneal Relaxing Incisions for Astigmatism Between 0.75 and 2.5 Diopters During Cataract Surgery

PURPOSE

To compare the outcomes after toric intraocular lens (tIOL) or peripheral corneal relaxing incisions (PCRI) for keratometric astigmatism (K_A) 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, K_A and mean keratometry (K_M), 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 K_A decreased at 1 month and remained stable thereafter; there was a nonsignificant trend toward a flatter posterior K_A and steeper posterior K_M 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 K_A decreased in the early postoperative period and remained stable thereafter and posterior corneal aberrations changed constantly over 12 months.

Effect of Limbal relaxing incisions during implantable collamer lens surgery

Background

The limbal relaxing incisions (LRIs) technique is a safe and an inexpensive procedure, which is simple for experts to perform. It can effectively reduce astigmatism and result in a rapid visual rehabilitation. But there are few reports about reducing pre-existing corneal astigmatism by LRI in ICL surgery. Our research was aimed to study the effect of limbal relaxing inci sions during implantable collamer lens (ICL) surgery.

Methods

A prospective analysis reviewing consecutive cases of corneal astigmatism that had either independent ICL surgery (control group) or combined with LRIs (LRIs group). The study population consisted of 45 patients, 85 eyes, with high myopia and regular corneal astigmatism more than 0.50 diopter (D) and less than 3.00 D. The first group received ICL surgery combined with LRIs (limbal relaxing incisions); the control group received only ICL surgery alone. The outcomes considered were uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), refraction, keratometry, slit lamp biomicroscopy, indirect ophthalmoscopy, corneal topography, corneal astigmatism, endothelial cell count, and patient satisfaction. The follow-up period covered 12 months.

Results

The mean uncorrected distance visual acuity (UDVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up period, the UCVA was statistically better for the patients with LRIs compared with those underwent ICL surgery alone. The LRIs group showed significant reduction in the mean topographic astigmatism from 1.48 ± 0.35 D preoperatively to 0.37 ± 0.14 D postoperatively (P < .0001) after one month. The control eyes did not show a statistically significant change (P > 0.05). The mean magnitude of the surgically induced astigmatism (SIA) read 1.10 ± 0.35 D,1.13 ± 0.34D,1.13 ± 0.34D,1.11 ± 0.35D by the end of the 1st, the ^3rd, the ^6th and the 12th month postoperatively in LRIs group, which was slightly lower than the target-induced astigmatism (TIA). The difference in SIA between the LRI and the control group was statistically significant by the end of the 1st, the ^3rd, the ^6th and the 12th month postoperatively (P < 0.001). The mean correction index (CI) was less than 1, which indicated undercorrection effect of limbal relaxing incision. No difference was observed in the postoperative endothelial cell count between the two groups. There was no intraoperative and postoperative ocular or systemic complication.

Conclusion

Limbal relaxing incision is an effective method in reducing corneal astigmatism during implantable collamer lens surgery.

Trial registration

The trial was retrospectively registered in 14 April 2017. (NO:ChiCTR-ONR-17011147).

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-017-0458-7) contains supplementary material, which is available to authorized users.

Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism

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.

Anterior stromal puncture with staining: A modified technique for preoperative reference corneal marking for toric lenses and its retrospective analyses

Introduction:

Toric intraocular lenses (IOLs) are an effective way of compensating preexisting corneal astigmatism during cataract surgery. To achieve success, it is imperative to align the toric IOLs in desired position and preoperative reference marking is one among the three important steps for accurate alignment. To make the marking procedure simpler and effective, we have modified the conventional three-step slit lamp-based technique.

Materials and Methods:

Patient is seated in front of the slit lamp and asked to keep the chin over chin rest. A 26-gauge bent needle with tip stained by sterile blue ink marker is used to make anterior stromal puncture (ASP) at the edges of horizontal 180° axis near the limbus.

Results:

A total of 58 eyes were retrospectively evaluated. Mean (+/-SD) IOL deviation on day 1 and day 30 was 5.7 ± 6.5° and 4.7 ± 5.6°, respectively. Median IOL misalignment on day 1 and day 30 was 3°. Redialing of IOL was required in 2 (3.4%) eyes only, all of which were performed within 1 week of surgery. In total, 2 (3.7%) eyes had a residual astigmatism of − 0.5 Dcyl and − 1.0 Dcyl, respectively.

Conclusion:

ASP is an effective technique for reference marking, technically simpler and can be practiced by most of the surgeons. It avoids the necessity of high-end sophisticated machinery and gives a better platform for the reference corneal marking along with the benefit of reproducibility and simplicity.

Corneal Astigmatism and Aberrations After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy: Two-Year Results

PURPOSE

To investigate the stability of corneal astigmatism and higher-order aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy.

DESIGN

Retrospective, interventional case series.

METHODS

Surgery was performed using a VICTUS (Bausch & Lomb Inc, Dornach, Germany) platform. A single, 450-μm deep, arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism and higher-order aberration measurements obtained preoperatively and at 2 months and 2 years postoperatively were analyzed.

RESULTS

Fifty eyes of 50 patients (mean age 66.2 ± 10.5 years) were included. The mean preoperative corneal astigmatism was 1.35 ± 0.48 diopters (D). This was reduced to 0.67 ± 0.54 D at 2 months and 0.74 ± 0.53 D at 2 years postoperatively (P < .001). There was no statistically significant difference between postoperative corneal astigmatism over 2 years (P = .392). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .283). At postoperative 2 months and 2 years, 72% and 70% of eyes were within 15 degrees of preoperative meridian of astigmatism, respectively. All wavefront measurements increased significantly at 2 months and 2 years (P < .007), except spherical aberration (P > .150). There was no significant difference in higher-order aberrations between 2 months and 2 years postoperatively (P > .486).

CONCLUSIONS

Our study showed the stability of femtosecond-assisted arcuate keratotomy. Further studies using other platforms and nomograms are needed to corroborate the findings of this study.

Rotational stability and patient satisfaction after implantation of a new toric IOL

PURPOSE

To evaluate rotational stability, astigmatism correction, visual outcomes, and patient satisfaction after implantation of the toric intraocular lens (IOL) Torica-aA following cataract extraction over a 6-month follow-up period.

METHODS

This prospective observational study enrolled 40 eyes of 26 patients presenting with preexisting corneal astigmatism of 1.00 to 2.60 D. The rotational stability of the IOL was evaluated using retroillumination photographs taken within 24 hours after surgery and 1 week and 6 months postoperatively. Other main study outcomes were assessed 6 months postoperatively and included uncorrected and distance-corrected visual acuities, astigmatism correction, and patient satisfaction.

RESULTS

Six months postoperatively, mean absolute IOL rotation was 1.99 ± 1.88° (range 0.10-7.40°) and secondary repositioning was not required. The IOL rotation was &lt;3° in 85% of eyes, ≤5° in 94% of eyes, and &lt;8° in 100% of eyes. Mean residual refractive cylinder was -0.57 ± 0.34 D. The magnitude of the J0 vector was significantly decreased postoperatively (p&lt;0.0001). The mean J45 vector was close to zero preoperatively and postoperatively (p = 0.27). Mean monocular uncorrected distance visual acuity (UDVA) was 0.09 ± 0.12 logMAR and 97% of eyes achieved UDVA of 20/40 or better including 66% of eyes having 20/25 or better. The good UDVA resulted in high levels of spectacle independence and patient satisfaction.

CONCLUSIONS

Implantation of the Torica-aA IOL was safe and effective in reducing low to moderate preexisting corneal astigmatism and provided good rotational stability and refractive outcomes, which led to a high degree of patient satisfaction.