True rotational stability of a single-piece hydrophobic intraocular lens

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, Footplate Position, and Visual Outcomes of Toric Implantable Collamer Lenses in Eyes With Low Vault

PURPOSE

To evaluate the clinical outcomes, rotational stability, and footplate position of the toric Implantable Collamer Lens (TICL) (STAAR Surgical) in eyes with low vault and analyze factors related to rotational stability.

METHODS

This prospective observational study included 59 eyes of 59 patients with insufficient vault (< 250 µm). Postoperative rotation was defined as the difference between the achieved angle and the intraoperative fixation angle, and assessed with a digital anterior segment photograph after full mydriasis at 1 week and 1, 3, and 6 months postoperatively. Ultrasound biomicroscopy was used to determine the ciliary body morphology and position of the footplate. Correlation analysis was employed to identify the risk factors associated with TICL rotation at 6 months postoperatively.

RESULTS

At 6 months postoperatively, the mean central vault was 137.4 ± 61.0 µm (range: 40 to 236 µm), and the mean efficacy and safety indices were 1.04 and 1.15, respectively. The mean manifest refractive astigmatism decreased from -1.67 ± 0.82 diopters (D) preoperatively to -0.43 ± 0.33 D postoperatively, and the mean absolute rotation was 4.50 ± 3.08 degrees (range: 0 to 12.50 degrees). The angle of rotation was correlated with the preoperative spherical power (r = -0.318, P = .014), the average value of TICL footplates position (r = 0.284, P = .029), and postoperative astigmatism (r = -.469, P⩽ .001).

CONCLUSIONS

TICL implantation is predictable, safe, and effective in correcting myopic astigmatism in eyes with low vault. The rotational stability was acceptable and related to the malposition of the footplate and preoperative spherical power. [J Refract Surg. 2024;40(7):e460-e467.].

Clinical outcomes and rotational stability after implantation of a monofocal toric intraocular lens with textured haptics in normal vs high axial lengths

PURPOSE

To compare the clinical outcomes and rotational stability after implantation of a toric intraocular lens (IOL) with textured haptics in eyes with normal vs high axial lengths (ALs).

SETTING

Nethradhama Superspeciality Eye Hospital, Bangalore, India.

DESIGN

2-arm, retrospective comparative study.

METHODS

This retrospective study included 114 eyes of 114 patients who underwent femtolaser cataract surgery followed by implantation of the HOYA Vivinex Toric monofocal IOL (Model XY1A-SP), of which 62 and 52 eyes belonged to normal (≤23.9 mm) and high (≥24 mm) AL groups, respectively. 1 week and 3 months postoperatively, clinical outcomes and rotational stability of the toric IOL was evaluated.

RESULTS

3 months postoperatively, % eyes achieving refractive astigmatism accuracy within ≤0.50 diopter, was 100% (n = 62) in the normal vs 94% (n = 49) in the high AL group. All eyes that is, 100% (n = 62) in the normal and 96.15% (n = 50) eyes in the high myopia group were <5 degrees of the intended axis. The mean change in postoperative rotation from 1 week to 3 months was 0.28 ± 0.09 degrees in the normal, and 0.30 ± 1.11 degrees in the high AL group ( P = .80). No significant correlation was observed between AL and white-to-white diameter with 1-week postoperative rotation values. No eye required repositioning of toric IOL for significant misalignment.

CONCLUSIONS

No significant differences were observed for clinical outcomes and postoperative rotational stability between eyes with normal and high ALs, suggesting excellent rotational stability of the Vivinex Toric IOL with textured haptics in all eyes, irrespective of the preoperative AL measurements.

Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial

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.

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.

Rotational stability of monofocal and diffractive multifocal toric intraocular lens with identical design and material: a propensity score based prospective comparative study

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.

[Refractive Results after Implantation of Toric Intraocular Lenses Using the Zeiss Callisto System]

BACKGROUND

For cataract patients with astigmatism, the insertion of a toric intraocular lens is a safe and effective method to achieve emmetropia. The exact alignment of the lens along the calculated axis is essential for effective correction of astigmatism. The purpose of this study is to evaluate our own data using descriptive statistics. The primary focus is on the refractive outcome and thus the verification of the alignment accuracy of toric IOLs with the Zeiss Callisto system.

PATIENTS AND METHODS

The study evaluated a total of 106 eyes of 72 patients who underwent cataract surgery with implantation of a toric intraocular lens at our hospital between January 2019 and December 2020. Preoperative biometry and intraoperative marking of the implantation axis was performed using the Zeiss Callisto system. Postoperative controls were performed after one day, one week and 4 weeks, either at our hospital or by the referring ophthalmologist. For the analysis, only the data of the 4-week control were used.

RESULTS

In 64 eyes (60%), a Zeiss AT Torbi 709 M or MP and in 42 eyes (40%) a PhysIOL Ankoris toric yellow IOL were implanted. In 46 eyes, postoperative uncorrected visual acuity was not recorded. Of the remaining 60 eyes, the mean postoperative uncorrected visual acuity was 0.07 ± 0.12 logMAR. Postoperative uncorrected visual acuity ≥ 1.0 (decimal) was achieved in 48% of the eyes and visual acuity ≥ 0.6 (decimal) in 92%. The postoperative cylinder averaged - 0.65 ± 0.53 D. The cylinder of the target refraction was - 0.45 ± 0.39 D on average. The mean of the absolute value of the postoperative cylinder minus the cylinder of the target refraction was 0.42 ± 0.32 D.

CONCLUSIONS

The Zeiss Callisto system is an effective tool to align toric intraocular lenses.

Rotational stability of plate-haptic toric intraocular lenses in Asian eyes: risk period for intraocular lens rotation and its influencing factors

PURPOSE

To investigate the rotational stability of plate-haptic toric intraocular lenses (IOLs) during 3-month follow-up.

SETTING

Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective observational study.

METHODS

Patients with cataracts implanted with AT TORBI 709M toric IOLs were enrolled and followed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was applied to investigate the time course of absolute IOL rotation change. The 2-week overall IOL rotation was analyzed in the age, sex, axial length (AL), lens thickness (LT), preexisting astigmatism, and white-to-white subgroups.

RESULTS

A total of 328 eyes of 258 patients were included. The rotation from the end of surgery to 1 hour and 1 day to 3 days was significantly smaller compared with the rotation from 1 hour to 1 day but more than that at other time intervals in the overall group. 2 weeks postoperatively, the mean uncorrected distance visual acuity and remaining positive cylinder were 0.19 ± 0.22 logMAR and 0.60 ± 0.44 diopters, respectively. Significant between-group differences in 2-week overall rotation were found in the age, AL, and LT subgroups.

CONCLUSIONS

Maximum rotation occurred within 1 hour to 1 day postoperatively, and the first 3 days postoperatively was a high-risk period for the plate-haptic toric IOL rotation. Surgeons should make the patients aware of this.

Rotational Stability, Decentration, and Tilt of a New Hydrophobic Acrylic Intraocular Lens Platform

PURPOSE

To evaluate rotational stability, decentration and tilt of the monofocal intraocular lens (IOL) Nanex (NC1-SP; HOYA Surgical Optics).

DESIGN

Prospective interventional case series.

METHODS

The study was performed at the Department of Ophthalmology, Medical University of Vienna. The study population comprised 130 eyes of 68 patients with age-related cataract who underwent cataract surgery with implantation of a Nanex IOL. Baseline image for rotational stability evaluation was obtained at the end of surgery (EoS) and compared to retroillumination images taken at 1 hour, 1 week, 1 month, and 6 months after surgery. Axis alignment was assessed using nonmovable landmarks on the sclera and the optic-haptic junctions of the IOL. Anterior segment OCT images were performed to evaluate decentration and tilt. The main outcome measure was absolute rotation from EoS to 6 months postoperatively.

RESULTS

Median IOL rotation of all eyes from EoS to 6 months was 1.9° (interquartile range 0.1°-37.5°). Ten eyes (9.71%) rotated more than 5° and 2 eyes (1.94%), more than 10°. IOL rotation did not correlate with axial eye length (Spearman r = -0.042, P = .46), crystalline lens thickness (Spearman r = 0.134, P = .19), and crystalline lens equatorial diameter (Spearman r = 0.101, P = .325). IOL rotation positively correlated with anterior fibrosis severity (Spearman r = 0.321, P = .002). Preoperative decentration (0.2 ± 0.12 mm) and tilt (5.7 ± 1.6°) did not change significantly after surgery (0.22 ± 0.12 mm and 5.62 ± 1.49°, respectively).

CONCLUSION

The investigated IOL presented good rotational stability and low decentration and tilt values. Nevertheless, anterior capsule fibrosis development led to a higher tendency of IOL rotation after 1 week.

Effect of capsular bend on the rotational stability of toric intraocular lens

PURPOSE

To assess the effect of capsular bend and axial length on the rotational stability of toric IOL.

METHODS

The prospective study included patients with preexisting astigmatism that were implanted with Acrysof IQ Toric IOL. According to the pre‑operative axial length, all patients were divided into 2 groups: high myopia (AL ≥ 26 mm) group, and emmetropia or low to moderate myopia group (AL <26 mm). High-speed Swept-source Optical Coherence Tomography (SS-OCT) radial scanning was performed after pupil dilation to obtain the toric IOL axial orientation and capsular bending index (CBI) at 1-day, 1-week, 1-month and 3-month intervals postoperatively. The correlation between the rotation of toric intraocular lens and the axial length or CBI was subsequently analyzed.

RESULTS

68 eyes of 57 patients were included in the research. The rotation of toric IOL within the high myopia group was greater than the control group (P = 0.001, 1month postoperative). Capsular contact with the IOL was delayed in highly myopic eyes, although the results were not statistically significant (P = 0.094, 1-month postoperatively). There was a positive correlation between the degree of rotation and axial length at the interval found between 1-week and 1-month after the operation (r = 0.333, P = 0.005). There was a significant negative correlation between the IOL rotational speed and CBI (P < 0.001). The regression equation was Y = -0.441*X + 1.712 (R2 = 0.323, P < 0.001).

CONCLUSION

There was a significant negative correlation between the IOL rotation speed and the CBI, while the influence of the axial length and capsular bending mainly occurred between one week and one month after the operation.

Effects of Modified Haptics on Surgical Outcomes and Rotational Stability of Toric Intraocular Lens Implantation

PURPOSE

To assess the rotational stability of a new toric intraocular lens (IOL), TECNIS toric II (toric II), which is a modified version of the TECNIS toric IOL (toric I) with frosted haptics (Johnson & Johnson).

METHODS

A total of 101 eyes of 101 patients who had been treated with phacoemulsification and toric IOL implantation were included. Before and 1 day, 1 week, and 1 month after surgery, uncorrected (UDVA) and corrected (CDVA) distance visual acuity were measured. Preoperative corneal astigmatism and postoperative manifest refractive astigmatism at 1 day and 1 month were analyzed. At 1 day and 1 month postoperatively, the amount of IOL axis misalignment from the intended orientation, tilt, and decentration were measured using anterior segment optical coherence tomography.

RESULTS

Fifty-one eyes received the toric I IOL and 50 eyes received the toric II IOL. Toric I IOLs showed a significantly larger amount of axis misalignment than toric II IOLs at both 1 day (9.6 ± 7.6° vs 5.4 ± 4.8°, P = .003) and 1 month (9.1 ± 7.8° vs. 4.7 ± 4.2°, P = .003) postoperatively.The proportion of eyes with misalignment greater than 10° was significantly larger with toric I than toric II IOLs (P < .001). There were no significant differences between IOLs in the amount of residual astigmatism, UDVA, CDVA, and amount of tilt and decentration at 1 day and 1 month postoperatively.

CONCLUSIONS

The TECNIS toric II IOL with frosted haptics has significantly improved rotational stability compared to its previous model. [J Refract Surg. 2022;38(10):648-653.].

An Experimental Laboratory Study Using the Miyake-Apple Posterior View Technique to Investigate the Dynamics Between Capsular Bags and Different IOL Models

PURPOSE

To evaluate the dynamics between capsular bags and different intraocular lens (IOL) models in human cadaver eyes using the Miyake-Apple posterior view technique.

METHODS

In an in vitro laboratory study, human cadaver eyes were prepared according to the Miyake-Apple posterior view technique. Five IOLs from each of the six groups (Avansee 1P [Simonvision], Avansee 3P [Simonvision], CT Lucia [Carl Zeiss Meditec], Acrysof [Alcon Laboratories, Inc], RayOne [Rayner], and CT Asphina [Carl Zeiss Meditec]) were implanted into capsular bags with different diameters. The empty capsular bag diameter and capsular bag diameter with an IOL in it were evaluated based on the Miyake-Apple view pictures. Posterior capsule striae were observed and compared between groups. The arc of contact between IOLs and the capsular equator was noted. Correlations between the empty capsular bag diameter and the capsular bag diameter with IOL, as well as between the empty capsular bag diameter and the arc of contact, were examined. With the Avansee 3P as a reference, the area deviation of the haptics of IOL models with looped haptics was compared.

RESULTS

The capsular bag diameter with IOL inside and the arc of contact were proportional to the empty capsular bag diameter. The RayOne, Avansee 3P, and CT Lucia showed a longer arc of contact. Posterior capsule striae were observed in the Avansee 1P (1, 20%), Avansee 3P (5, 100%), Acrysof (1, 20%), and RayOne (2, 40%). Areas of deviation were 0.38 mm² (Avansee 1P), 0.24 mm² (CT Lucia), 0.34 mm² (Acrysof), and 0.31 mm² (RayOne), respectively.

CONCLUSIONS

Different IOL models showed varied characteristics in terms of capsular bag fitting and arc of contact. Understanding these dynamics is critical to optimizing postoperative outcomes. [J Refract Surg. 2022;38(10):654-660.].

Reproducibility of the Magnitude of Lens Rotation Following Implantation of a Toric Intraocular Lens with Modified Haptics

Purpose

To evaluate the reproducibility of magnitude of postoperative IOL rotation following implantation of a toric intraocular lens (IOL) with modified haptics, in comparison with a Proof-of-Concept (POC) study of prototype IOLs featuring the same haptic design.

Patients and Methods

A post-market, prospective, multicenter, single-arm, open-label clinical study was conducted. TECNIS Toric II IOL (Johnson & Johnson Vision, Irvine, CA, USA, Models ZCU150 to 600) were implanted in 125 subjects and evaluated at 1-day and 1-week postoperatively. An objective photographic method was used to determine postoperative IOL rotation. Uncorrected distance visual acuity (UCDVA), postoperative astigmatism, and surgeon satisfaction were also assessed. Rotation data were compared to the POC study in which two prototype non-toric monofocal IOLs, one with the same haptic design as Model ZCU, were studied.

Results

Mean absolute rotation was 0.82° ± 1.0° and 0.84° ± 0.92°at 1-day and 1-week visits, respectively. The percentage of eyes with ≤5° of absolute rotation was 98.9% and 99.5% at the 1-day and 1-week visits, respectively. The magnitude of rotation was similar to the POC study prototype IOLs. At 1-week, mean monocular UCDVA was 0.026 ± 0.135 (~20/21) logMAR and mean residual manifest refractive cylinder was 0.30 D ± 0.35 D. The mean signed axis difference (postoperative minus operative) of the TECNIS Toric II IOL was 0.23° ± 1.27° at 1-day and −0.07° ± 1.25° at 1-week, indicating a clockwise drift. At 1-week, surgeons were very satisfied or satisfied with overall clinical outcomes and rotational stability in 98% of implanted eyes.

Conclusion

The TECNIS Toric II IOL, with frosted, squared haptics, demonstrated low magnitude of postoperative IOL rotation, excellent uncorrected distance vision, and minimal residual astigmatism. The POC study design was supported, demonstrating that prototype non-toric monofocal IOLs can predict clinical performance of toric IOLs with the same haptic design.

Deviation from the planned axis of three toric intraocular lenses

In this study, we retrospectively evaluated the deviation from the planned axis of 3 Toric intraocular lenses (TIOL). Included in the study 190 eyes, operated by two surgeons using two different manual marking techniques. The patients were implanted with either AcrySof IQ Toric SN6AT (Alcon) (n = 90), POD FT (PhysIOL) (n = 50), or TECNIS Symfony Toric (J&J) (n = 50). At least 1 month postoperatively, the IOL was photographed, and the axis was measured using a designed software. The difference between the planned and actual axis was defined as axis deviation. The effect of IOL type, astigmatism direction, and marking techniques on the average degree and direction of the IOL deviation were evaluated and compared. There was no significant difference in the average deviation between the IOLs (TECNIS Symfony: 4.03° ± 4.34, POD FT: 3.52° ± 3.38, and SN6AT: 4.24° ± 4.10), and its direction (55.8%, 39.0%, and 56.6% clockwise (CW) deviation, respectively). With the rule, astigmatism had significantly more CW deviation compared with against the rule and oblique astigmatism (64.3%, 43.8%, and 41.7%, respectively, P = 0.027), but the average deviation was similar. The marking techniques did not influence the degree or direction of the deviation.

Refractive Changes Following Premature Posterior Capsulotomy Using Neodymium:Yttrium–Aluminum–Garnet Laser

We aimed to determine the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy on corrected-distance visual acuity (CDVA), intraocular pressure (IOP), and spherical equivalent (SE) in patients with posterior capsular opacification (PCO). There were 59 patients with unilateral PCO and a history of Nd:YAG laser capsulotomy enrolled and further divided into the early Nd:YAG group (timing < 12 months, n = 25) and late Nd:YAG group (timing > 12 months, n = 34) depending on the elapsed months from phacoemulsification to Nd:YAG laser capsulotomy. The primary outcomes were CDVA, IOP, and SE before (immediately before Nd:YAG laser capsulotomy) and after (weeks one and four after the laser treatment). The independent t test was applied to analyze the difference in CDVA, IOP, and SE between the two groups, while the generalized estimating equation with Bonferroni adjustment was conducted to evaluate the effect of all the parameters on the change in SE with adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA showed significant improvement in both the early Nd:YAG group (p = 0.005) and the late Nd:YAG group (p = 0.001), and hyperopic change occurred in both the early Nd:YAG group (p = 0.003) and the late Nd:YAG group (p = 0.017). The early Nd:YAG group revealed more significant hyperopic change compared with the late Nd:YAG group four weeks after Nd:YAG treatment (p < 0.001), which was still significant after multivariable analysis (aOR: 0.899, 95% CI: 0.868–0.930, p = 0.011). In addition, a deeper ACD (aOR: 0.764, 95% CI: 0.671–0.869, p = 0.019) was significantly correlated with hyperopic change. In conclusion, Nd:YAG laser capsulotomy performed within one year after cataract surgery may lead to significant hyperopic change, in which the ACD alteration affects the hyperopic shift significantly.

Rotational Stability of Intraocular Lenses: A Standardized Method for More Accurate Measurements in Future Studies

PURPOSE

To assess the reliability and reproducibility of a new semiautomated evaluation method, "Rotix," for intraocular lens (IOL) rotation and to define a standardized evaluation method for future toric IOL studies.

DESIGN

Reliability and reproducibility study.

METHODS

Setting: Department of Ophthalmology, Medical University of Vienna.

PATIENT POPULATION

A dataset of 25 patients with 2 consecutive follow-up visits was created to test the intra- and interrater reliability. A data test set of 10 patients including 30 pictures taken 5 minutes apart was created to test the short-term reproducibility.

INTERVENTION

Evaluation of IOL rotational stability using nontoric implants in 25 × 2 consecutive follow-up visits. Two experienced graders performed axis evaluation 3 times in a randomized order. One experienced grader performed axis evaluation for the short-term reproducibility study. Reference landmarks at the end of operation were used to assess the IOL axis.

MAIN OUTCOME MEASURES

Intra- and interrater reliability and short-term reproducibility of axis measurements.

RESULTS

Mean standard deviation for intrarater reliability was 0.16 degrees. The intraclass correlation coefficients were 0.97 for grader 1 and 0.96 for grader 2. A very high interrater correlation of 0.95 was found. The mean individual difference between grader 1 and grader 2 was 0.061 ± 0.28 degrees. Short-term reproducibility showed a mean standard deviation of 0.22 ± 0.14 degrees.

CONCLUSION

The novel semiautomated evaluation method showed an accurate inter- and intrarater reliability. Short-term reproducibility was below 0.25 degrees. The method of using nonmovable reference landmarks showed reliable results and should be used as a standard in future toric IOL studies.

Comparison of Axis Determination With Different Toric Intraocular Lens Power Calculation Methods

PURPOSE

To compare the axis position of the measured total corneal astigmatism (TCA) with the axis of the anterior keratometry and the calculated axis position of different toric intraocular lens (IOL) calculators.

METHODS

A total of 163 astigmatic eyes of 163 patients were retrospectively analyzed. The axis of the actual TCA, measured with anterior segment optical coherence tomography, was compared to the anterior keratometric value (Group I) and three different methods of TCA calculation for toric IOL power determination: Abulafia-Koch regression formula (Group II), Barrett Toric Calculator V2.0 (Group III), and Barrett Toric Calculator V2.0 including measured posterior keratometric value (Group IV). Eyes were assigned to three subgroups: with-the-rule, against-the-rule, and oblique astigmatism.

RESULTS

The mean deviation calculated from measured TCA was +0.56° (Group I), -0.32° (Group II), -0.37° (Group III), and -1.00° (Group IV). For with-the-rule astigmatism, the TCA axis agreed most with Group I (6.5% outliers > 5° deviation). For against-the-rule astigmatism, Group IV and Group II were closest to the measured TCA axis (1.5% and 3% outliers with > 5° deviation).

CONCLUSIONS

The means of the calculated axis were similar to the measured TCA, but the proportion of outliers with an axis deviation of greater than 5° showed remarkable differences. Isolated anterior keratometric value measurements showed the fewest outliers in with-the-rule astigmatism. In against-the-rule astigmatism, Abulafia-Koch calculation should be used for axis determination. [J Refract Surg. 2021;37(9):642-647.].

Rotational Stability of a New Hydrophobic Acrylic IOL With Modified C-loop Haptics

PURPOSE

To assess rotational stability, axial stability, decentration, and tilt of the Rayner RAO800C single-piece hydrophobic acrylic intraocular lens (IOL) (Rayner Intraocular Lenses Ltd) from end of surgery to 4 to 7 months postoperatively.

METHODS

Surgeries were performed at the Department of Ophthalmology at the Medical University of Vienna. A total of 130 eyes of 68 patients received an aspheric hydrophobic Rayner RAO0800C IOL. IOLs were randomly implanted to the 0 ± 10, 45 ± 10, 90 ± 10, or 135 ± 10 degree axis. Baseline measurement was performed with the patient still supine on the operating table. Axis alignment after 1 hour, 1 week, 1 month, and 4 months was evaluated by retroillumination pictures. Postoperative IOL decentration, tilt, and aqueous depth at 4 months were assessed using an anterior segment swept-source optical coherence tomography.

RESULTS

Absolute median IOL rotation from end of surgery to 4 months was 2.4 degrees (range: 0.0 to 85.0 degrees). Median IOL rotation from end of surgery to 1 hour, 1 hour to 1 week, 1 week to 1 month, and 1 month to 4 months was 1.6 (range: 0.0 to 86.2), 1.1 (range: 0.0 to 28.8), 0.6 (range: 0.0 to 5.2), and 0.7 (range: 0.0 to 2.6) degrees. Respective proportions of IOLs rotating more than 5, 10, and 20 degrees from end of surgery to 4 months were 23.9%, 11.0%, and 6.4%. Horizontal and vertical decentration at 4 months was -0.09 ± 0.14 and 0.09 ± 0.14 mm, respectively. Horizontal and vertical tilt at 4 months was -4.78 ± 1.36 and -1.58 ± 1.10 degrees, respectively. A posterior axial shift of 0.052 ± 0.055 mm was observed from 1 week to 4 months.

CONCLUSIONS

Although median IOL rotation appeared to be low, a significant proportion of IOLs rotated postoperatively. Decentration and tilt values were generally low. A minimal posterior optic shift was observed after 1 week. [J Refract Surg. 2021;37(2):112-118.].

Anterior capsule coverage and rotational stability of an acrylic toric intraocular lens

PURPOSE

To investigate factors related to the rotational stability of an acrylic toric intraocular lens (IOL).

SETTING

Four ophthalmic surgical sites in Japan.

DESIGN

Prospective case series.

METHODS

The study included 120 eyes of 120 patients undergoing phacoemulsification and implantation of a toric IOL (AcrySof IQ, Alcon Laboratories, Inc.). At 1 hour postoperatively, the area of continuous curvilinear capsulorhexis (CCC) was measured, and the state of anterior capsule coverage on the IOL optic (total on or partial on) was recorded. The toric IOL axis orientation was assessed at the end of surgery and at 1 hour, 1 week, 1 month, and 6 months postoperatively. Multiple regression analysis was performed to explore any clinical factors relevant to IOL rotation from the end of surgery to 6 months postoperatively. The explanatory variables included age, anterior chamber depth preoperatively, axial length, type of corneal astigmatism (with-the-rule, against-the-rule, or oblique astigmatism), area of CCC, state of anterior capsule overlap on IOL optic (total coverage vs partial coverage), and surgical sites (surgeons).

RESULTS

The multiple regression analysis in 110 eyes of 110 patients indicated that anterior capsule overlap on the IOL optic was the only variable associated with IOL rotation at 6 months postoperatively (P = .0482). The mean absolute rotation at 6 months was 1.96 ± 1.81 degrees in the total on group and 3.79 ± 3.12 degrees in the partial on group (P = .0004).

CONCLUSIONS

Rotational stability of a single-piece, acrylic toric IOL was better in eyes with total anterior capsule coverage than that in those with partial anterior capsule coverage on the IOL optic.

Influence of lens position as detected by an anterior segment analysis system on postoperative refraction in cataract surgery

AIM

To predict postoperative intraocular lens (IOL) position using the Sirius anterior segment analysis system and investigate the effect of lens position and IOL type on postoperative refraction.

METHODS

A total of 97 patients (102 eyes) were enrolled in the final analysis. An anterior segment biometry measurement was performed preoperatively with Sirius and Lenstar. The results of predicted lens position (PLP) and IOL power were automatically calculated by the software used by the instruments. Effective lens position (ELP) was measured manually using Sirius 3mo postoperatively. Pearson's correlation analysis and linear regression analysis were used to determine the correlation of lens position to other parameters.

RESULTS

PLP and ELP were positively correlated to axial length (AL; r=0.42, P<0.0001 and r=0.49, P<0.0001, respectively). There was a weak correlation between the peLP (ELP-PLP) and the prediction error of spherical refraction (peSR; r=0.34, P<0.0001). The peLP of Softec HD IOL differed statistically from those of both the TECNIS ZCB00 and Sensor AR40E IOLs. Multiple linear regression was used to obtain the prediction formula: ELP=0.66+0.63×[aqueous depth (AQD)+0.6LT] (r=0.61, P<0.0001), and a new variable (AQD+0.6 LT) was found to have the strongest correlation with ELP.

CONCLUSION

The Sirius anterior segment analysis system is helpful to predict ELP, which reduces postoperative refraction error.

Evaluation of Intraocular Lens Rotational Stability in a Multicenter Clinical Trial

Purpose

To evaluate the postoperative rotational stability of two prototype intraocular lens (IOL) designs (subsequently termed version 1 and version 2).

Patients and Methods

A prospective, multicenter, randomized, paired-eye, 6-month study evaluated the version 1 and version 2 IOLs. Results were compared with a control IOL (TECNIS^® toric 1-piece monofocal IOL) evaluated in a separate, similarly designed study. Participants aged ≥22 years and scheduled to undergo bilateral cataract extraction were randomly assigned 1:1 to receive the version 1 or version 2 IOL in the first operative eye; the alternate test IOL was then implanted in the second operative eye.

Results

Mean absolute IOL rotation at postoperative week 1 was the primary effectiveness end point. Additional end points included the percentage of eyes with postoperative IOL rotation >5°/>10°, direction of lens rotation, surgeon-reported ease of IOL handling during implantation, and safety. At postoperative week 1, mean (±standard deviation) absolute IOL rotation was significantly lower for both version 1 and version 2 versus control (0.88° [±0.94] and 0.71° [±0.69] vs 2.24° [±3.21], respectively; both P < 0.001). For both study lenses, absolute rotation was <5° for all eyes at postoperative week 1, and no cases of rotation >10° were observed at any postoperative time point. From postoperative week 1 onward, version 2 had a statistically significant clockwise bias in the direction of rotation (P = 0.03); similar findings were observed for version 1. Surgeons reported acceptable ease of IOL handling during implantation for both version 1 and version 2. No device-related adverse events were reported.

Conclusion

Both the version 1 and version 2 IOLs, each with frosted, squared haptics, demonstrated improved postoperative rotational stability compared with a control lens without frosted haptics. Because version 2 had the same overall geometry as the current TECNIS toric IOL, this design was selected for commercialization.

Trial Registration

German Clinical Trials Register, DRKS00015287.

Comparison of Long-Term Rotational Stability of Three Commonly Implanted Intraocular Lenses

PURPOSE

To compare rotational stability and its influencing factors in 3 different widely used hydrophobic acrylic intraocular lenses (IOLs) from the end of surgery (EoS) to 4-7 months (6 months) in over 380 eyes.

DESIGN

Prospective interventional comparative clinical study.

METHODS

Setting: Department of Ophthalmology, Medical University of Vienna.

PATIENT POPULATION

A total of 381 eyes of 199 patients with age-related cataract received an IOL Acrysof SN60WF, Tecnis ZCB00, or Envista MX60 in a consecutive order.

INTERVENTION

Implantation of an Acrysof, Tecnis, or Envista IOL randomized to the 0 ± 10, 45 ± 10, 90 ± 10, or 135 ± 10° axis in 1 or both eyes. Baseline measurement was performed with patients supine still on the operating table. Postoperative follow-ups were conducted after 1 hour, 1 week, 1 month, and 6 months.

MAIN OUTCOME MEASURES

Difference of absolute rotation from the EoS to 6 months.

RESULTS

Absolute rotations from the EoS to 6 months were 1.65 ± 2.1, 2.65 ± 4.1, and 3.18 ± 5.8° for the Acrysof, Tecnis, and Envista group, respectively. Rotational stability was statistically significantly superior in the Acrysof compared with the Envista group (P = .014), but not compared with the Tecnis group (P = .10). No significant difference was found between the Tecnis and Envista groups (P = .761). Maximum values of 15.8, 38.6, and 44.9° were observed for the Acrysof, Tecnis, and Envista group, respectively.

CONCLUSION

The Acrysof IOL showed the least amount of absolute rotation compared with the Tecnis and Envista IOLs. Outliers possibly requiring secondary intervention were observed in all groups. The amount of rotation was greatest during the first postoperative hour.

Prospective assessment of plate-haptic rotationally asymmetric multifocal toric intraocular lens with near addition of + 1.5 diopters

Background

To prospectively evaluate surgical results following implantation of rotationally asymmetric, plate-haptic, refractive segmented multifocal toric intraocular lenses (IOLs) with near addition of + 1.5 diopters (D) (Lentis Comfort LS-313 MF15T, Oculentis GmbH).

Methods

In 59 eyes of 41 patients, ocular examinations were conducted before and 1 day, 1 week, 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were tested. A defocus curve was drawn, and the degree of disturbing photic phenomena were questioned.

Results

The IOL showed excellent rotational stability; the average absolute rotation was 1.66 ± 1.17 degrees from 1 day 1 to 6 months postoperatively, and 98.1 and 100% of eyes yielded rotation of less than 5 and 10 degrees, respectively. Postoperative distance and intermediate visual acuity were highly satisfactory; UDVA, CDVA, UIVA, and DCIVA were about 20/20, 20/16, 20/25, 20/25, respectively. Near visual acuity was suboptimal; UNVA and DCNVA were at approximately 20/60. The defocus curve analysis showed that 20/25 and 20/40 uncorrected visual acuity was attained at as close as 60 and 40 cm, respectively. Contrast sensitivity was within a normal range, and subjective photic phenomena were minimum.

Conclusions

The refractive segmented, rotationally asymmetric multifocal toric IOLs with + 1.5 D near addition showed superb rotational stability and highly satisfactory distance and intermediate vision. Contrast sensitivity was high and incidence of photic symptoms was very low.

Trial registration

This study was registered at JAPIC Clinical Trials Information, ID: JapicCTI-183,877, https://www.clinicaltrials.jp/cti-user/trial/Search.jsp (February 5, 2018).

Rotational stability and refractive outcomes of a single-piece aspheric toric intraocular lens with 4 fenestrated haptics

PURPOSE

To assess the outcomes of implantation of a single-piece toric intraocular lens (IOL) with 4 fenestrated haptics.

SETTING

IRCCS Fondazione Bietti, Rome, Italy.

DESIGN

Prospective case series.

METHODS

All patients who had implantation of the Mini Toric Ready IOL were consecutively enrolled. Intraoperatively, the IOL was aligned using an automated system. Follow-up visits were performed at 1 day, 1 week, and 1, 3, and 6 months. At each visit, retroillumination pictures were taken to assess IOL orientation; visual acuity and refraction were also measured.

RESULTS

The final analysis comprised 63 eyes (63 patients). From the first to the last follow-up, the mean arithmetic rotation was -0.2 degrees ± 3.5 (SD) (range -13 to +10 degrees) and the mean absolute rotation was 1.6 ± 3.1 degrees. Intraocular lens rotation from the first to the last examination was within 5 degrees in 92.1% of eyes and on consecutive visits, within 5 degrees in 98.4% or more of eyes. By 6 months, 10 IOLs (15.9%) had rotated clockwise and 10 counterclockwise. Linear regression did not show a statistically significant relationship between rotational stability and the axis of placement with any preoperative parameter (eg, axial length). The mean magnitude of preexisting corneal astigmatism was 1.9 ± 0.7 diopters (D) (range 0.76 to 3.72 D). At the last follow-up, the mean magnitude of refractive astigmatism was 0.5 ± 0.4 D (range 0.0 to 1.5 D); the difference was statistically significant (P < .05).

CONCLUSION

The toric IOL showed good rotational stability and is an option for correcting corneal astigmatism at the time of cataract surgery.

Rotation of a toric intraocular lens with and without capsular tension ring: data from a multicenter non-inferiority randomized clinical trial (RCT)

BACKGROUND

Evaluation of clinical outcome in cohorts with versus without simultaneous implantation of a capsular tension ring (CTR) and a toric lens (Tecnis Toric). Main parameter was rotation referring - in contrast to misalignment - to the IOL axis change from immediately after implantation to the final postoperative position.

METHODS

Lens position was measured at baseline with the patient still in recumbent position, postoperative rotation was calculated by software. Postoperative evaluation included measurement three months after surgery or prior to an indicated revision surgery. Explorative re-evaluation of the underlying RCT's intent-to-treat population was performed for the entire sample and stratified for cohorts by 95% confidence intervals for binary endpoints' incidences (primary endpoint: absolute postoperative rotation ≤5 degrees; secondary endpoints: absolute deviation between achieved cylinder and target cylinder ≤0.5 dpt, postoperative corrected distance visual acuity (CDVA) ≥ 0.8). Data exploration was based on medians and quartiles.

SETTING

Outpatient study sites.

DESIGN

Re-evaluation based on data from a multicenter non-inferiority randomized clinical trial (RCT).

RESULTS

Sub cohorts (without CTR 89, with CTR 90 patients) did not present clinically relevant differences in preoperative characteristics: revision surgery was performed in 7 cases (3 without and 4 with CTR). Primary endpoint incidences for the total sample, without and with CTR were 90%/89%/90%; cylinder endpoint incidences were 46%/45%/46% and CDVA endpoint incidences 90%/92%/88%. Median absolute rotations were 1.74°/1.79°/1.72°, median absolute cylinder deviations 0.55/0.52/0.55 dpt and median visual acuity 1.0/1.0/1.0.

CONCLUSION

No clinically relevant differences between CTR subgroups were found; a satisfying three months rotational stability was achieved.

TRIAL REGISTRATION

The trial was registered retrospectively in the trial registry DRKS, trial registration number DRKS00015316 , date of registration 27. August 2018.