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Liu S, Liu J, Lin F, Yu L, Cheng C, Wang T, Zhou X. Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism. Ophthalmol Ther 2023; 12:1711-1722. [PMID: 37016057 PMCID: PMC10164207 DOI: 10.1007/s40123-023-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION To compare the visual outcomes of astigmatism correction with implantable collamer lens (ICL) surgery with low-to-moderate astigmatism through a steep-meridian corneal relaxing incision (SM-CRI) and non-steep-meridian corneal relaxing incision (NSM-CRI). METHODS Seventy eyes of 70 patients with myopia and myopic astigmatism who underwent ICL V4c implantation were classified into two groups: SM-CRI and NSM-CRI. Refractive outcomes and vector analysis were evaluated preoperatively and 6 months postoperatively. RESULTS At the postoperative 6 month visit, all participants in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The difference vector (DV) showed that the residual astigmatism in the SM-CRI group was much smaller than that in the NSM-CRI group (P = 0.021), and the correction index (CI) was 0.84 ± 0.30 and 0.67 ± 0.35 for the SM-CRI and NSM-CRI groups, respectively, with a significant statistical difference (P = 0.013). Approximately 71% of eyes in the SM-CRI group had an angle of error (AE) within ± 15°, whereas 55% of eyes in the NSM-CRI group were within that range. The absolute mean AE was 10.13 ± 14.57° in the SM-CRI group, compared with 23.88 ± 28.22° in the NSM-CRI group (P = 0.038). CONCLUSION SM-CRI can alleviate corneal astigmatism and decrease the cylindrical diopter of the ICL, thus improving postoperative visual quality compared with NSM-CRI.
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Affiliation(s)
- Shengtao Liu
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Jingying Liu
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Feng Lin
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Lanhui Yu
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Chiwen Cheng
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Ti Wang
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China.
| | - Xingtao Zhou
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China.
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Effect of two different preoperative calculation schemes on visual outcomes of patients after toric intraocular lens implantation. Int Ophthalmol 2023; 43:491-501. [PMID: 35932419 DOI: 10.1007/s10792-022-02447-7] [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: 04/09/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the postoperative visual outcomes of two different preoperative corneal incision schemes in TECNIS toric intraocular lens (IOL) implantation. METHODS In this randomized controlled study, patients with preoperative corneal astigmatism greater than 1.0 diopter (D) were included. These patients were grouped according to the different preoperative schemes: steep-axis group and minimum-residual refractive astigmatism group. The outcome measurements were the residual refractive astigmatism, visual acuity, changes of corneal astigmatism, and high-order aberration at 1 month postoperatively. RESULTS This study consisted of 90 eyes (45 eyes steep-axis group, 45 eyes minimum-residual refractive astigmatism group). 1 month after surgery, the refractive astigmatism was statistically lower in the minimum-residual refractive astigmatism group compared with the steep-axis group (0.58 ± 0.40D vs 0.38 ± 0.37D, P = 0.021). The minimum-residual refractive astigmatism group had a smaller difference vector (0.56 ± 0.38D vs 0.36 ± 0.35D; P = 0.047) and a smaller prediction error (0.60 ± 0.44D vs 0.37 ± 0.35D; P = 0.004). In the steep-axis group, corneal astigmatism significantly decreased compared with preoperative value (1.65 ± 0.57D vs 1.17 ± 0.64D; P < 0.001). In the minimum-residual refractive astigmatism group, the changes of corneal astigmatism before and after surgery were not significant. Moreover, total aberration and second astigmatism in ocular aberration were lower in the minimum-residual refractive astigmatism group compared with the steep-axis group (1.86 ± 1.09 vs 1.37 ± 0.95; P = 0.035 and 0.47 ± 0.28 vs 0.31 ± 0.19; P = 0.015, respectively). CONCLUSION Minimum-residual refractive astigmatism incision had better astigmatism correction and more accurate prediction. The corneal astigmatism was stable 1 month after surgery. It might lead to better visual quality in the early postoperative stage. Trial registration number for prospectively registered trials: clinicaltrials.gov NCT04006912, 07/02/2019.
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Singh A, Kapoor G, Baranwal VK, Kalra N. Rotational stability of Toric intraocular lenses. Med J Armed Forces India 2022; 78:68-73. [PMID: 35035046 PMCID: PMC8737107 DOI: 10.1016/j.mjafi.2020.03.014] [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: 07/17/2018] [Accepted: 03/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A prospective study to evaluate the rotational stability of toric intraocular lenses (IOLs). METHODS A prospective study of 30 eyes in 29 patients. All patients with regular astigmatism of range 0.75-4 D were included in the study. Exclusion criteria included irregular corneal astigmatism, post-refractive surgery and corneal dystrophies. All patients underwent uncomplicated phacoemulsification cataract surgery by the same surgeon. Three eyes with corneal astigmatism of 0.75-1.5 D were implanted with the AcrySof SA60T3 IOL, eight eyes with astigmatism between 1.5 and 2.0 D received the SA60T4 IOL and eight eyes with astigmatism between 2.0 and 2.50 D received the SA60T5 and rest with astigmatism of 2.5 D and higher received SA60T6 and above models. Main outcome measure was the post-operative position of the lens, assessed at day 1, 1 week, 1 month and 6 months, using toric marker and the slit lamp. RESULTS There was no significant rotation of IOL observed during a follow-up period of 6 months. Overall, the post-operative rotation was within 5° in 95% of cases. There was no trend for either clockwise or anti-clockwise rotation. However, IOL rotation happens mostly within the first month of surgery, and if it is significant, it requires early repositioning. CONCLUSION Toric IOLs are very effective and consistent in correcting astigmatism during the cataract surgery. Once placed to its position, toric IOLs demonstrate rotational stability in the capsular bag.
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Affiliation(s)
- Abhinav Singh
- Graded Specialist (Ophthalmology), Military Hospital, Agra, India
| | - Gaurav Kapoor
- Senior Adviser (Ophthalmology), Base Hospital, Delhi Cantt, India,Corresponding author.
| | | | - Nidhi Kalra
- Classified Specialist (Ophthalmology), Base Hospital, Delhi Cantt, India
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Park SY, Choi JS, Pak KH, Chung SK, Kwag JY. Accuracy of Intraocular Lens Power Calculations Based on Total and Standard Keratometry. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Site of clear corneal incision in cataract surgery and its effects on surgically induced astigmatism. Sci Rep 2020; 10:3955. [PMID: 32127591 PMCID: PMC7054299 DOI: 10.1038/s41598-020-60985-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/17/2020] [Indexed: 11/22/2022] Open
Abstract
Clear corneal incision (CCI) is a commonly used surgical approach in cataract surgery. In this prospective study, we evaluated the effect of CCI site on surgically induced astigmatism (SIA) and other postoperative astigmatic changes. CCIs were constructed based on the steep meridian of the total corneal refractive power in the 4.0-mm-zone (TCRP4.0), and patients were divided into four groups: temporal, superotemporal, superonasal, and superior according to the site of the incision. TCRP4.0 analysis demonstrated a statistically significant reduction of astigmatism with superior incisions (P < 0.001), and the combined mean polar values for SIA changed significantly in the temporal (Hotelling T2 = 1.977), superotemporal (Hotelling T2 = 0.544), superonsal (Hotelling T2 = 1.066), and superior incision groups (Hotelling T2 = 1.134) (all P < 0.001). The posterior axis alignment should be considered in cataract surgery with CCI, and the SIA is affected by axis rotation, and incision orientation.
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Woltsche N, Werkl P, Posch-Pertl L, Ardjomand N, Frings A. Astigmatismus. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-00440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Der Astigmatismus ist der weltweit häufigste Refraktionsfehler vor Hypermetropie und Myopie. Man unterscheidet den äußeren vom inneren Astigmatismus. Der äußere Astigmatismus kann weiter in „mit der Regel“, „gegen die Regel“ und „schräg“ unterteilt werden. Die Summierung des äußeren und inneren Astigmatismus ergibt den refraktiven Zylinder. Astigmatismus wurde lange als zweidimensionales Phänomen gesehen, doch erst die dreidimensionale Betrachtung hat den Blick auf bestehende Analyseverfahren (Topo- und Tomographie) erweitert. Die Vektoranalyse nach Alpins ist hierbei eine bekannte Methode zur Therapieplanung. Zur Therapie des Astigmatismus stehen konservative Optionen wie Brille oder torische Kontaktlinse sowie unterschiedlichste chirurgische Verfahren wie photorefraktive Keratektomie, Femtosekundenlaser-assistierte Keratotomie, Laser-in-situ-Keratomileusis, „small-incision lenticule extraction“ und die Implantation torischer Intraokularlinsen zur Verfügung.
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Comparison of Outcomes after Phacoemulsification with Two Different Corneal Incision Distances Anterior to the Limbus. J Ophthalmol 2019; 2019:1760742. [PMID: 31531233 PMCID: PMC6721498 DOI: 10.1155/2019/1760742] [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: 03/20/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare visual performance and visual quality outcomes after phacoemulsification with two different clear corneal incision (CCI) distances anterior to the limbus in senile cataract patients. Methods Retrospective case series. Patients who had undergone phacoemulsification were divided into two groups according to the CCI distances anterior to the limbus. The CCI distances in group A range from 1 mm to 1.5 mm, while those in group B range from 0.5 mm to 1 mm. The visual acuity, refraction, surgically induced astigmatism (SIA), corneal aberrations, anterior segment parameters, and subjective vision quality were evaluated. Results This study enrolled 54 eyes, with 27 eyes per group. Both groups had significant improvement in postoperative uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) (P < 0.05). There were no statistically significant between-group differences in postoperative UDVA, CDVA, SIA, corneal aberrations, anterior segment parameters, or VF-QOL questionnaire performance (P > 0.05). Conclusions The phacoemulsification with CCI distances ranging from 0.5 mm to 1.5 mm is an effective and safe therapy to senile cataract. The CCI distance anterior to the limbus that ranges from 0.5 mm to 1.5 mm is recommended for routine phacoemulsification.
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Abstract
Astigmatism is the most frequent refractive error worldwide followed by hyperopia and myopia. Internal astigmatism has to be differentiated from external astigmatism. Furthermore, external astigmatism can be divided into "with the rule", "against the rule" and "oblique". The summation of internal and external astigmatism results in the refractive cylinder. Astigmatism has for a long time been regarded as a two-dimensional phenomenon; however, only a three-dimensional consideration expanded the view on existing analytical methods (topography and tomography). Alpins' vector analysis is a commonly used method for treatment planning. Multiple options exist for treatment of astigmatism with conservative approaches, such as eyeglasses or toric contact lenses as well as various surgical procedures, such as photorefractive keratectomy, femtosecond laser-assisted keratotomy, laser in-situ keratomileusis, small incision lenticule extraction and toric intraocular lens implantation.
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Affiliation(s)
- N Woltsche
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich.
| | - P Werkl
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - L Posch-Pertl
- Univ.-Augenklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - N Ardjomand
- Sehzentrum für Augenlaser & Augenchirurgie, Leechgasse 58, 8010, Graz, Österreich
| | - A Frings
- Univ.-Augenklinik Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.,UCL Institute of Ophthalmology, 11-43 Bath St, EC1V 9EL, London, Großbritannien.,Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, EC1V 2PD, London, Großbritannien
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Park W, Kim MS, Kim EC. Accuracy of Astigmatic Correction Using Toric Intraocular Lens by Position and Size of Corneal Incision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wookyung Park
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Man Soo Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Xue S, Zhao G, Yin X, Lin J, Li C, Hu L, Leng L, Yang X. Effect of incision on visual outcomes after implantation of a trifocal diffractive IOL. BMC Ophthalmol 2018; 18:171. [PMID: 30005634 PMCID: PMC6045830 DOI: 10.1186/s12886-018-0846-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/06/2018] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate visual acuity, corneal astigmatism and corneal higher-order aberrations (HOAs) after implantation of trifocal diffractive IOLs operated with either a corneal steep-axis incision or 135° incision. Method This prospective study enrolled patients randomly assigned to different groups. According to preoperative corneal astigmatism, 101 eyes of 77 patients were assigned into group A1 (0 ~ 0.50 D) or A2 (0.51 ~ 1.00 D) with a corneal steep-axis incision or group B1 (0 ~ 0.50 D) or B2 (0.51 ~ 1.00 D) with a 135° incision. Visual acuity, corneal astigmatism and corneal higher-order aberrations (HOAs) were followed-up for 3 months. Results Corneal astigmatism in group A2 significantly decreased 3 months after surgery (P < 0.01) and was significantly lower than that in group B2 1 day, 2 weeks, 1 month, and 3 months postoperatively (all values of P < 0.01). The following parameters were better in group A2 than in group B2: uncorrected intermediate visual acuity (UIVA) at 1 day, 2 weeks, 1 month, and 3 months (P = 0.00, 0.00, 0.01, 0.01, respectively);uncorrected distance visual acuity (UDVA) at 1 day and 2 weeks (P = 0.00, 0.01); and uncorrected near visual acuity (UNVA) at 1 day, 2 weeks, and 1 month postoperatively (P = 0.00, 0.01, 0.02, respectively). Conclusions After a corneal steep-axis incision, patients with preoperative corneal astigmatism of 0.51 D to 1.00 D exhibited reduced corneal astigmatism and achieved better UIVA and early postoperative UDVA/UNVA. Trial registration Retrospectively Registered Trials ISRCTN10086721, 23/06/2018.
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Affiliation(s)
- Shasha Xue
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Guiqiu Zhao
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China.
| | - Xiaoni Yin
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Jing Lin
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Cui Li
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Liting Hu
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Lin Leng
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
| | - Xuejiao Yang
- The Affiliated Hospital of Qingdao University, No.16, Jiangsu Road, Qingdao, China
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