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Li ES, Vanderford EK, Xu Y, Kang PC. Rotational stability of toric intraocular lenses by lens model and haptic design: systematic review and single-arm meta-analysis. J Cataract Refract Surg 2024; 50:976-984. [PMID: 38768060 PMCID: PMC11338026 DOI: 10.1097/j.jcrs.0000000000001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
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.
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Affiliation(s)
- Eric S. Li
- From the Yale School of Medicine, New Haven, Connecticut (Li, Vanderford); Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut (Li, Vanderford, Kang); Yale Center for Analytical Sciences, New Haven, Connecticut (Xu)
| | - Elliott K. Vanderford
- From the Yale School of Medicine, New Haven, Connecticut (Li, Vanderford); Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut (Li, Vanderford, Kang); Yale Center for Analytical Sciences, New Haven, Connecticut (Xu)
| | - Yunshan Xu
- From the Yale School of Medicine, New Haven, Connecticut (Li, Vanderford); Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut (Li, Vanderford, Kang); Yale Center for Analytical Sciences, New Haven, Connecticut (Xu)
| | - Paul C. Kang
- From the Yale School of Medicine, New Haven, Connecticut (Li, Vanderford); Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut (Li, Vanderford, Kang); Yale Center for Analytical Sciences, New Haven, Connecticut (Xu)
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Du Y, Meng J, He W, Qi J, Lu Y, Zhu X. Complications of high myopia: An update from clinical manifestations to underlying mechanisms. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:156-163. [PMID: 39036706 PMCID: PMC11260019 DOI: 10.1016/j.aopr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Background High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge. Main text High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain. Conclusions High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.
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Affiliation(s)
- Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Tañá-Rivero P, Muñoz-Tomás JJ, Orts-Vila P, Artiaga-Elordi E, Pastor-Pascual F, Marín-Sánchez JM, García-Elskamp C. Clinical Results of a Monofocal Aspheric Bitoric Intraocular Lens with Plate Haptics in Hyperopic Eyes. Clin Ophthalmol 2024; 18:1933-1944. [PMID: 38983598 PMCID: PMC11231029 DOI: 10.2147/opth.s467523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
Purpose To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery. Methods The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery. Results At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ±0.50 D and 98.04% were within ±1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤0.50D and 100% were ≤1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up. Conclusion Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.
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Affiliation(s)
- Pedro Tañá-Rivero
- Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, Spain
| | - José J Muñoz-Tomás
- Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, Spain
- Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain
| | - Paz Orts-Vila
- Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, Spain
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Schartmüller D, Röggla V, Schwarzenbacher L, Meyer EL, Abela-Formanek C, Leydolt C, Menapace R. Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial. Ophthalmology 2024; 131:445-457. [PMID: 37914042 DOI: 10.1016/j.ophtha.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL). DESIGN Intraindividual, randomized, double-masked, controlled clinical trial. PARTICIPANTS Patients scheduled for sequential same-day bilateral cataract surgery. METHODS All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT. MAIN OUTCOME MEASURES Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months. RESULTS One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively. CONCLUSIONS Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel Schartmüller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
| | - Veronika Röggla
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Elias Laurin Meyer
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Berry Consultants, Vienna, Austria
| | | | - Christina Leydolt
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Sun J, Bai H, Cui W, Wu X. Comparison of clinical outcome after implantation of two toric intraocular lenses with different haptic type: a prospective randomized controlled trial. Graefes Arch Clin Exp Ophthalmol 2024; 262:847-855. [PMID: 37672101 DOI: 10.1007/s00417-023-06232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/19/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To study the effect of astigmatism correction, rotational stability, and related factors of two different haptic type toric intraocular lenses. METHODS A prospective, randomized, controlled trial. Cataract patients with preoperative corneal astigmatism of > 1 D were randomly implanted with C-loop haptic toric IOL (AcrySof-toric IOL) (group A) or plate-haptic toric IOL (AT TORBI 709 M IOL) (group B). The residual astigmatism, intraocular lens rotation, and visual quality were determined and compared between the two groups at 3 months after surgery. RESULTS Seventy-nine eyes were included in this study, including 40 eyes in the group A and 39 eyes in the group B. No significant difference in preoperative visual acuity, intraocular pressure, and ophthalmic biological parameters was found between the two groups. There was no significant difference in residual astigmatism between the two groups at 3 months after surgery (P > 0.05). The rotation degree in the group A was 3.85 ± 2.92°, the rotation degree in the group B was 2.33 ± 2.31°, and a significant difference in intraocular lens rotation was identified between the two groups (P < 0.05). Upon exploring the rotation-related factors of the two different haptic type toric intraocular lenses, the rotation after implanting C-loop haptic toric IOL was positively correlated with axial length (Pearson r = 0.522, P = 0.01) and corneal white-to-white distance (Pearson correlation analysis r = 0.356, P = 0.024). CONCLUSIONS The two different haptic type toric intraocular lenses effectively corrected regular corneal astigmatism and provided a good rotational stability after surgery. But the stability of plate-haptic toric IOL was better than that of C-loop haptic toric IOL. The rotational stability of C-loop haptic toric IOL was often related to axial length and corneal white-to-white distance.
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Affiliation(s)
- Jiajun Sun
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Huiran Bai
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Wei Cui
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Xiaoming Wu
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, People's Republic of China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China.
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Shi R, Ma D, Zeng Q, Hua Z, Shen W, Cai L, Yang J. Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study. BMC Ophthalmol 2024; 24:72. [PMID: 38365667 PMCID: PMC10870427 DOI: 10.1186/s12886-024-03281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024] Open
Abstract
PURPOSE To compare the rotational stability of a monofocal and a diffractive multifocal toric intraocular lens(IOLs) with identical design and material. METHODS This prospective study enrolled patients who underwent plate-haptic toric IOL (AT TORBI 709 M and AT LISA 909 M) implantation. Propensity score matching (PSM) was performed to balance baseline factors. Follow-up examinations were conducted at 1 h, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was used to investigate the changes in IOL rotation over time. A 2-week timeframe was utilized to assess differences in IOL rotation between the two groups. RESULT After PSM, a total of 126 eyes were selected from each group for further analysis. Postoperatively, the time course of IOL rotation change in the two groups remained consistent, with the greatest rotation occurring between 1 h and 1 day postoperatively. At the 2-week postoperative mark, the monofocal toric IOL exhibited a higher degree of rotation compared to the multifocal toric IOL (5.40 ± 7.77° vs. 3.53 ± 3.54°, P = 0.015). In lens thickness(LT) ≥ 4.5 mm and white-to-white distance(WTW) ≥ 11.6 mm subgroups, the monofocal toric IOL rotated greater than the multifocal toric IOL (P = 0.026 and P = 0.011, respectively). CONCLUSION The diffractive multifocal toric IOL exhibits superior rotational stability compared to the monofocal toric IOL, especially in subgroups LT ≥ 4.5 mm and WTW ≥ 11.6 mm. Moreover, the time course of IOL rotation change is consistent for both, with the maximum rotation occurring between 1 h and 1 day postoperatively.
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Affiliation(s)
- Runhan Shi
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongmei Ma
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Qiulin Zeng
- Department of Ophthalmology, Shanghai Xinshijie Dongqu Eye Hospital, Shanghai, China
| | - Zhixiang Hua
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenqian Shen
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Lei Cai
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.
- Key NHC Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Lin X, Ma D, Yang J. Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies. Front Med (Lausanne) 2024; 11:1349496. [PMID: 38414624 PMCID: PMC10896894 DOI: 10.3389/fmed.2024.1349496] [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: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Toric intraocular lenses (IOLs) have been developed to enhance visual acuity impaired by cataracts and correct corneal astigmatism. However, residual astigmatism caused by postoperative rotation of the toric IOL is an important factor affecting visual quality after implantation. To decrease the rotation of the toric IOL, significant advancements have been made in understanding the characteristics of toric IOL rotation, the factors influencing its postoperative rotation, as well as the development of various measurement techniques and interventions to address this issue. It has been established that factors such as the patient's preoperative refractive status, biological parameters, surgical techniques, postoperative care, and long-term management significantly impact the rotational stability of the toric IOL. Clinicians should adopt a personalized approach that considers these factors to minimize the risk of toric IOL rotation and ensure optimal outcomes for each patient. This article reviews the influence of various factors on toric IOL rotational stability. It discusses new challenges that may be encountered to reduce and intervene with rotation after toric IOL implantation in the foreseeable future.
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Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Huang Z, Qi J, Cheng K, Liu S, Zhang K, Du Y, Lu Y, Zhu X. The relationships between lens diameter and ocular biometric parameters: an ultrasound biomicroscopy-based study. Front Med (Lausanne) 2024; 10:1306276. [PMID: 38288306 PMCID: PMC10822951 DOI: 10.3389/fmed.2023.1306276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose This study aims to explore the relationships between lens diameter (LD) measured with ultrasound biomicroscopy (UBM) and ocular biometric parameters. Methods Ocular biometric parameters including axial length (AL), white-to-white distance (WTW), anterior chamber depth (ACD), lens thickness (LT) and anterior segment length (ASL) were measured with IOL-Master 700, and the direct measurement of LD was conducted through UBM (ArcScan Insight 100). Relationships between LD and ocular biometric parameters were then investigated. Eyes with AL ≥ 28 mm were defined as eyes with extreme myopia, and eyes with AL < 28 mm were defined as eyes without extreme myopia. Results A total of 194 eyes from 194 subjects were included. The mean LD was 9.58 ± 0.49 mm, ranging from 8.60 to 10.96 mm. According to univariate analysis, larger LD was associated with elder age, male gender, larger WTW, ACD and ASL (all p < 0.05). Meanwhile, the LD was positively correlated with AL in eyes without extreme myopia (p < 0.05), but not in eyes with extreme myopia (p > 0.05). Backward stepwise regressions revealed that a larger LD was associated with larger WTW, ASL and AL in eyes without extreme myopia (all p < 0.05), while ASL was the only significant variable in eyes with extreme myopia (p < 0.05). Conclusion Larger WTW, ASL and AL in eyes without extreme myopia, as well as longer ASL in eyes with extreme myopia indicated a larger LD, which provides guidance in personalized surgical choice and promises ideal visual outcomes.
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Affiliation(s)
- Zhiqian Huang
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Jiao Qi
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Kaiwen Cheng
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Shuyu Liu
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Keke Zhang
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- Eye Institute, Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Shanghai, China
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Bai H, Sun J, Shi X, Li H, Wu X. Visual performance and rotational stability of a multifocal toric intraocular lens in myopic eyes. Graefes Arch Clin Exp Ophthalmol 2023; 261:2557-2565. [PMID: 37004517 DOI: 10.1007/s00417-023-06046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the visual performance and rotational stability of the multifocal toric intraocular lens in myopes. METHODS This prospective, observational study included patients with an axial length of ≥24.5 mm and regular corneal astigmatism of >1 diopter who underwent phacoemulsification cataract surgery and implantation of a multifocal toric intraocular lens (AT LISA toric 909M). The visual acuity, defocus curves, residual astigmatism, rotational stability, higher-order aberrations (HOAs), modulation transfer function (MTF), spectacle dependence and patient satisfaction were evaluated 3 months after surgery. RESULTS Forty-three eyes from 30 patients were enrolled in this study. Postoperatively, uncorrected distance and near visual acuities (logMAR) were 0.09 ± 0.08 (standard deviation, SD) and 0.14 ± 0.08, respectively. The defocus curve analysis provided a bimodal curve showing two peaks of maximum vision at 0.0 D and at -3.0 D defocus level. The multifocal toric intraocular lens showed excellent rotational stability; the mean rotation was 4.02 ± 2.49 (SD) degrees at 3 months postoperatively. Refractive predictability was excellent with a mean spherical equivalent of 0.19 ± 0.37 (SD) diopters (D) and a mean refractive cylinder of -0.34 ± 0.39 (SD) D. CONCLUSIONS The diffractive multifocal toric intraocular lens, AT LISA toric 909M, provided effective distance and near visual acuities in myopic eyes. It was a predictable and effective device with good rotational stability for the correction of preexisting astigmatism during cataract surgery. In this study, more than 80% of patients achieved spectacle independence.
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Affiliation(s)
- Huiran Bai
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Jiajun Sun
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Xiujing Shi
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Honglei Li
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Xiaoming Wu
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, 266071, Shandong Province, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China.
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10
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Oshika T, Nakano S, Inamura M, Ikai N, Kato Y, Izumi I, Shimokawabe K. Extensive misalignment of plate-haptic rotationally asymmetric multifocal toric intraocular lens. Jpn J Ophthalmol 2023; 67:560-564. [PMID: 37289297 DOI: 10.1007/s10384-023-01001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Plate-haptic rotationally asymmetric multifocal toric intraocular lenses (IOL) (Lentis Comfort Toric) occasionally rotate extensively after surgery. We conducted the current study to investigate the incidence of extensive misalignment of this IOL and its association with clinical parameters. STUDY DESIGN Retrospective case series. SUBJECTS AND METHODS Data were collected from patients who had undergone phacoemulsification and implantation of a plate-haptic multifocal toric IOL. RESULTS Among 332 eyes, extensive misalignment of toric IOLs ≥ 45º occurred in 3.3% (11 eyes). The amount of misalignment in eyes with extensive misalignment was 81.6 ± 22.9º, while in those without extensive misalignment, it was 3.0 ± 2.7º. The eyes with extensive misalignment showed significantly greater axial length (p < 0.001), larger corneal diameter (p = 0.034), and flatter corneas (p = 0.044) than those without extensive misalignment. Repositioning surgery to correct toric IOL misorientation was conducted in 9 eyes between 7 and 28 days after cataract surgery. In 2 eyes, repositioning surgery was carried out twice. CONCLUSIONS In majority of cases plate-haptic multifocal toric IOLs showed satisfactory rotational stability, but extensive misalignment ≥ 45º occurred in 3.3% of cases.
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Affiliation(s)
- Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shinichiro Nakano
- Division of Ophthalmology, Ryugaski Saiseikai Hospital, Ryugasaki, Ibaraki, Japan
| | | | - Nakako Ikai
- Inamura Eye Clinic, Yokoham, Kanagawa, Japan
| | - Yuji Kato
- Sapporo Kato Eye Clinic, Sapporo, Hokkaido, Japan
| | - Iori Izumi
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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11
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Rocha-de-Lossada C, García-Lorente M, La Cruz DZD, Rodríguez-Calvo-de-Mora M, Fernández J. Supplemental Toric Intraocular Lenses in the Ciliary Sulcus for Correction of Residual Refractive Astigmatism: A Review. Ophthalmol Ther 2023; 12:1813-1826. [PMID: 37145259 PMCID: PMC10287861 DOI: 10.1007/s40123-023-00721-0] [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: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE This study conducted a critical review of the peer-reviewed literature on the use of supplemental toric intraocular lenses (STIOL) in the ciliary sulcus to correct residual refractive astigmatism. METHODS This review used PubMed as a database from 1 January 2010 to 13 March 2023. According to the inclusion and exclusion criteria defined, 14 articles were selected for the current review. RESULTS The data of 155 eyes were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and retrospective cohorts. The follow-up period ranged from 43 days to 4.5 years. STIOL rotation was the most frequently described complication in the literature, with a mean rotation of 30.48 ± 19.90°. These patients required repositioning in 50 of 155 eyes (32.25%). Moreover, four eyes (2.58%) required scleral fixation sutures and two eyes (1.29%) iris fixation. Other complications were high intraocular pressure (3 eyes, 1.93%), transient corneal edema (2 eyes, 1.29%), corneal decompensation (2 eyes, 1.29%), and pigment dispersion (1 eye, 0.64%). From the total, 57.41% of eyes (89 eyes from 155) achieved within ± 0.50D of target refractive astigmatism. It is important to highlight that at least 52 eyes out of the 155 (33.54%) had an abnormal cornea with irregular astigmatism. CONCLUSION STIOL seem to offer good visual and refractive outcomes. However, STIOL showed variable rotational stability, especially in some platforms. Further studies with a more robust design, methodology, and standardized analysis methods are needed to confirm these trends.
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Affiliation(s)
- Carlos Rocha-de-Lossada
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain.
- Ophthalmology Department, Vithas Málaga, Malaga, Spain.
- Ophthalmology Department, Hospital Regional Universitario Málaga, Malaga, Spain.
- Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Seville, Spain.
| | | | - Diego Zamora-de La Cruz
- Anterior Segment Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
- Anterior Segment Department, Hospital Mexiquense de Salud Visual, ISEM, Naucalpan de Juárez, Mexico
| | - Marina Rodríguez-Calvo-de-Mora
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain
- Ophthalmology Department, Vithas Málaga, Malaga, Spain
- Ophthalmology Department, Hospital Regional Universitario Málaga, Malaga, Spain
| | - Joaquín Fernández
- Ophthalmology Department, Clínica QVision, Vithas Almería, Almería, Spain
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12
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Yao Y, Wei L, Chen Z, Li H, Qi J, Wu Q, Zhou X, Lu Y, Zhu X. Single-cell RNA sequencing: Inhibited Notch2 signalling underlying the increased lens fibre cells differentiation in high myopia. Cell Prolif 2023:e13412. [PMID: 36717696 PMCID: PMC10392066 DOI: 10.1111/cpr.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/26/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
High myopia is the leading cause of blindness worldwide. It promotes the overgrowth of lens, which is an important component of ocular refractive system, and increases the risks of lens surgery. While postnatal growth of lens is based on the addition of lens fibre cells (LFCs) supplemented by proliferation and differentiation of lens epithelial cells (LECs), it remains unknown how these cellular processes change in highly myopic eyes and what signalling pathways may be involved. Single-cell RNA sequencing was performed and a total of 50,375 single cells isolated from the lens epithelium of mouse highly myopic and control eyes were analysed to uncover their underlying transcriptome atlas. The proportion of LFCs was significantly higher in highly myopic eyes. Meanwhile, Notch2 signalling was inhibited during lineage differentiation trajectory towards LFCs, while Notch2 predominant LEC cluster was significantly reduced in highly myopic eyes. In consistence, Notch2 was the top down-regulated gene identified in highly myopic lens epithelium. Further validation experiments confirmed NOTCH2 downregulation in the lens epithelium of human and mouse highly myopic eyes. In addition, NOTCH2 knockdown in primary human and mouse LECs resulted in enhanced differentiation towards LFCs accompanied by up-regulation of MAF and CDKN1C. These findings indicated an essential role of NOTCH2 inhibition in lens overgrowth of highly myopic eyes, suggesting a therapeutic target for future interventions.
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Affiliation(s)
- Yunqian Yao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhenhua Chen
- State Key Laboratory of Molecular Development Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hao Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Qingfeng Wu
- State Key Laboratory of Molecular Development Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,National Health Center Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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13
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Kim HW, Lee SH, Lee CE, Lee KW, Seo S. A Case Exhibiting Late, Postoperative, Toric Intraocular Lens Rotation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.12.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: We present a case of spontaneous toric intraocular lens (IOL) rotation in the late postoperative period (after 10 months).Case summary: A 44-year-old male underwent phacoemulsification and placement of an IOL (AcrySof IQ Toric, Alcon Laboratories Inc., Fort Worth, FL, USA) in the right eye. The preoperative best corrected visual acuities (BCVAs) were 0.2 in the right eye and 0.3 in the left eye, and the corneal astigmatisms -2.25 × 175° and -2.25 × 178°. Ten months later, the astigmatic IOL axis was 85° (the initial [correct] value). The BCVA after surgery was 1.0. At 11 months postoperatively, the patient presented with a sudden decrease in visual acuity in the right eye. The IOL had rotated 50° clockwise; we decided to reposition it. A capsular tension ring had been placed during surgery. The IOL was re-aligned but rotated again 1 week later. We replaced the IOL with a monofocal non-toric IOL (enVista MX60, Bausch & Lomb, Rochester, NY, USA).Conclusions: Severe toric IOL rotation is a late postoperative complication.
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14
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Propensity-matched comparison of postoperative stability and visual outcomes of toric intraocular lens with or without a capsular tension ring and updated meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 261:989-998. [PMID: 36201025 DOI: 10.1007/s00417-022-05851-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the contribution of capsular tension ring (CTR) to postoperative stability and visual outcomes of a plate-haptic toric intraocular lens (IOL). METHODS This prospective cohort study was performed among patients underwent toric IOL (AT TORBI 709 M) implantation with or without CTR at the Eye and ENT hospital between April 2020 and November 2021. Propensity score matching (PSM) was performed to balance baseline factors. Postoperatively, uncorrected distance visual acuity (UCVA) and residual astigmatism, as well as IOLs' rotation, tilt, and decentration, were analyzed. Grouped multiple linear regression analysis was used to model predictive factors of rotation in each group. Additionally, a meta-analysis of data from 4 publications (284 eyes) and current study was performed to evaluate the effect of CTR co-implantation on toric IOL rotation. RESULTS After PSM, 126 eyes from each group were included for further analysis. Postoperatively, UDVA was 0.31 ± 0.38 logMAR and 0.27 ± 0.36 logMAR in the CTR and NCTR groups, respectively (P = 0.441), and residual astigmatism was 0.75 ± 0.52 D and 0.86 ± 0.65 D, respectively (P = 0.139). The rotation of toric IOL was significantly smaller in the CTR group than in the NCTR group (4.63 ± 6.27 vs. 10.93 ± 16.05 degrees, P < 0.001). The regression models of the two groups and the coefficients of LT were significantly different (P < 0.001 and P = 0.001, respectively). Furthermore, the meta-analysis confirmed that CTR co-implantation reduced toric IOL rotation (MD, - 1.59; 95% CI, - 3.10 to - 0.09; P = 0.038). CONCLUSION CTR enhances rotational stability of toric IOL by reducing the impact of LT, and CTR co-implantation is recommended in patients with lens thickness (LT) ≥ 4.5 mm, white-to-white (WTW) ≥ 11.6 mm, or high preexisting astigmatism.
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15
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Goggin M. Toric intraocular lenses: Evidence‐based use. Clin Exp Ophthalmol 2022; 50:481-489. [PMID: 35584257 PMCID: PMC9543206 DOI: 10.1111/ceo.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
Uncorrected refractive astigmatism degrades visual acuity. Spherical intraocular lenses (IOLs) leave astigmatic errors resident in the cornea manifest in refractive astigmatism. Toric IOLs, correcting for this corneal astigmatism, contribute to spectacle‐free vision in the pseudophakic eye. This review provides information to assist surgeons in a rational choice of eyes suitable for toric IOL implantation, methods of IOL cylinder power calculation, surgical techniques for toric IOLs and management of complications. With appropriate application of this information, correction of visually detrimental astigmatism can be achieved routinely.
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Affiliation(s)
- Michael Goggin
- The Queen Elizabeth Hospital University of Adelaide Woodville South South Australia Australia
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16
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Borkenstein AF, Borkenstein EM. Geometry of Acrylic, Hydrophobic IOLs and Changes in Haptic-Capsular Bag Relationship According to Compression and Different Well Diameters: A Bench Study Using Computed Tomography. Ophthalmol Ther 2022; 11:711-727. [PMID: 35122227 PMCID: PMC8927568 DOI: 10.1007/s40123-022-00469-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Characteristics of the haptics and optic–haptic junction (OHJ) of an intraocular lens (IOL) affect IOL position in the capsular bag, positional stability, and the development of posterior capsule opacification. Therefore, the haptics and OHJ have a role in determining initial and long-term visual outcomes after cataract surgery. Understanding differences in the haptics and OHJ of available IOLs and in the relationships between the haptics of each IOL and the capsular bag across a range of capsular bag sizes might inform selection of an IOL model for individuals. Purpose To evaluate the geometry of five currently marketed, commonly used one-piece hydrophobic acrylic monofocal IOLs and changes in haptic–capsular bag relationships according to capsular bag size using a range of compression well diameters. Methods AcrySof SN60WF, CT LUCIA 621PY, enVista MX60, TECNIS ZCB00, and Vivinex XY1 IOLs were scanned with computed tomography (CT) in a dry, uncompressed state for quantitative analyses of haptic and OHJ dimensions and qualitative assessment of geometry. CT scanning was done after IOL placement into a series of compression wells (11.5, 11.0, 10.0, and 9.0 mm) for analyses of haptic angle of contact (AoC) and capsular bag contact (CBC). IOL axial alignment and haptic–capsular bag relationships were assessed on side-view and 3-dimensional top-view images, respectively. Results The qualitative and quantitative evaluations highlighted differences in haptic and OHJ geometry and dimensions across the five IOLs. All haptic dimensions (length, thickness, surface area, volume) and all OHJ dimensions (surface area and volume) were greatest for the CT LUCIA 621PY IOL. Compared to the IOL that had the smallest measurement for each parameter, the value for the CT LUCIA 621PY IOL was 31–91% larger. The lens with the largest OHJ surface area and volume showed values that were 500% and 240% greater than the corresponding values for the lens with the smallest OHJ surface area and OHJ volume. The AoC and CBC values decreased with increasing well size for all IOLs. The CT LUCIA 621PY had the greatest AoC and CBC values for all well sizes and the smallest percentage change in AoC and CBC comparing the values from the 9.0 mm and 11.5 mm wells. Conclusion The in vitro evaluations in this study highlight differences in the haptic and OHJ geometric characteristics of the five IOLs studied. The collected evidence refutes opinions that all hydrophobic acrylic one-piece IOLs are the same and supports the idea that individual IOLs can have relative advantages and disadvantages that depend on the individual case. We believe the knowledge of geometry is necessary for the surgeon to have the opportunity to select the best “customized” option in the individual case as a result of anatomical conditions and secondary diagnoses. Our bench study shows how big the differences are in currently available monofocal hydrophobic acrylic lenses.
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Affiliation(s)
- Andreas F Borkenstein
- GrazBorkenstein & Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Kreuzgasse 35, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- GrazBorkenstein & Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Kreuzgasse 35, 8010, Graz, Austria
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