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Mukhija R, Vanathi M, Verma M, Raj N, Gupta N, Tandon R. Comparative evaluation of intraoperative aberrometry and Barrett's toric calculator in toric intraocular lens implantation. Indian J Ophthalmol 2023; 71:1918-1923. [PMID: 37203056 PMCID: PMC10391498 DOI: 10.4103/ijo.ijo_2092_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real-time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation. Methods This was an institution-based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar-LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version-21 was used; P < 0.05 considered significant. Results Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (-0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (-0.14 ± 0.32D) than IA (0.001 ± 0.33D) (-0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one-month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, -0.57 ± 0.26D, and -0.18 ± 0.27D, respectively. Conclusion Both IA and BTC give reliable and comparable refractive results for tIOL implantation.
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Affiliation(s)
- Ritika Mukhija
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Murugesan Vanathi
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meena Verma
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nimmy Raj
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Lens and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chang YH, Pu C, Lin KK, Lee JS, Hou CH. Prediction of residual astigmatism in cataract surgery at different diameter zones using optical biometry measurement. Sci Rep 2022; 12:4305. [PMID: 35277574 PMCID: PMC8917119 DOI: 10.1038/s41598-022-08253-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
The studies for astigmatism prediction error at different diameters using optical biometry are scant. We investigated patients who underwent cataract surgery with monofocal, nontoric intraocular lens (IOL) from 2017 through 2019 in a medical center. Patients with prior refractive surgeries, corneal opacity, or surgical complications were excluded. Corneal astigmatism (CA) was measured using AL-Scan at 2.4- and 3.3-mm diameter zones and calculated using the Barrett toric calculator preoperatively and postoperatively. The mean absolute error and centroid prediction error for the two zones were computed using double-angle plots. In total, 101 eyes of 76 patients were analyzed. Mean patient age was 68.7 ± 9.3 years and mean preoperative CA power was 0.7 ± 0.5 D. The overall centroid prediction error a 3.3 mm (0.09 ± 0.58 D@25) was significantly lower than that at 2.4 mm (0.09 ± 0.68 D@87) on the X-axis (P = 0.003). The 3.3-mm measurement also had a lower centroid prediction error than the 2.4-mm did for eyes with against-the-rule (ATR) and oblique astigmatism (P = 0.024; 0.002 on X-axis, respectively). The 3.3-mm measurement provided a more accurate CA estimation than the 2.4-mm did, particularly for ATR astigmatism. Diameter zone and astigmatism type should be considered crucial to precise astigmatism calculation.
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Affiliation(s)
- Yin-Hsi Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan, ROC.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan, ROC.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiahn-Shing Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan, ROC.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiun-Ho Hou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan, ROC. .,Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Huang YT, Lin CJ, Lai CT, Hsia NY, Tien PT, Bair H, Chen HS, Chiang CC, Lin JM, Chen WL, Wu WC, Tsai YY. Astigmatism Management with Astigmatism-Correcting Intraocular Lens Using Two Toric Calculators - A Comparative Case Series. Clin Ophthalmol 2021; 15:3259-3266. [PMID: 34385813 PMCID: PMC8352642 DOI: 10.2147/opth.s325234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background To compare refractive outcomes after phacoemulsification and toric IOL implantation using two different toric calculators for initial astigmatism assessment in a real-world setting. Methods This was a retrospective, comparative, interventional case series. Patients over 30-year-old who underwent phacoemulsification and toric IOL implantation (AcrySof® Toric IOL) by the same surgeon between 2017 and 2018 were included. Eyes with irregular astigmatism, previous corneal refractive surgery, intraocular surgery, corneal pathology, macular pathology and pupil abnormalities were excluded. IOL toricity was determined by using a calculator provided by the AcrySof Toric calculator before 2018 and Barrett Toric Calculator after 2018. Patient demographics, corneal topography, vector and preoperative and postoperative refraction were collected and analyzed at three months postoperative. Results Thirty-two eyes of 32 patients were included in the final analysis. 0.1D for surgically induced astigmatism was used. Group 1 included 14 eyes assessed with the original (AcrySof) toric IOL calculator, and group 2 included 18 eyes assessed with the Barrett toric IOL calculator. In group 1, postoperative astigmatism less than −1.00D, −0.75 D, and −0.5D was achieved in 88.2%, 76.1% and 53.7% of eyes, respectively, while, in group 2, 89% eyes achieved postoperative residual astigmatism less than 0.5D and all eyes achieved postoperative residual astigmatism less than 0.75D. The proportion of patients with lower postoperative astigmatism was significantly higher in Group 2 (p< 0.05 by chi-square test), a pattern that still held when we divided patients into multiple groups. Vector analysis with the Alpins methods also supported better outcomes in the Barrett group (0.71 D vs 0.35 D). Conclusion The Barrett Toric calculator resulted in better results in the prediction of residual astigmatism than original (AcrySof) toric calculators.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Stanford University School of Medicine, Stanford, CA, USA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Langenbucher A, Schrecker J, Schwemm M, Eppig T, Schröder S, Szentmáry N. [Monte Carlo simulation of biometric effect sizes and their influence on the translational ratio of corneal astigmatism in the cylinders of toric intraocular lenses]. Ophthalmologe 2021; 118:569-577. [PMID: 32767100 PMCID: PMC8187219 DOI: 10.1007/s00347-020-01199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hintergrund und Zielsetzung Torische Kapselsacklinsen bieten heutzutage eine zuverlässige Option der permanenten Korrektur eines Hornhautastigmatismus. Zur Ermittlung der für den gewünschten Ausgleich erforderlichen Linsenstärke kann der Operateur entweder auf die in seinem Biometriegerät implementierten Berechnungsmodi oder auf den vom Linsenhersteller angebotenen Kalkulationsservice zurückgreifen. In vielen Fällen wird dabei allerdings keine klassische Linsenberechnung aus biometrischen Daten durchgeführt, sondern nur mit einer vereinfachten Abschätzung gearbeitet, die den Hornhautastigmatismus in den Torus der tIOL übersetzt. Dieses dann zumeist als durchschnittlicher Standardwert genutzte Übersetzungsverhältnis kann jedoch eine erhebliche Schwankungsbreite aufweisen, sodass im ungünstigsten Fall eine Unterkorrektur des refraktiven Zylinders um bis zu 12,5 % oder eine Überkorrektur um bis zu 17 % resultieren kann. Ziel dieser Studie war es aufzuzeigen, welche biometrischen Einflussgrößen das Verhältnis zwischen dem zu korrigierenden Hornhautastigmatismus und dem für dessen Vollkorrektur notwendigen Torus einer Kapselsacklinse bestimmen. Methoden Aus der WEB-Plattform IOLCon wurden 16.744 Datensätze extrahiert, und anhand der präoperativen biometrischen Größen und dem postoperativen sphärischen Äquivalent wurde zunächst die axiale Position der Kapselsacklinse formelunabhängig abgeleitet. Anschließend wurde, basierend auf der Propagation sphärozylindrischer Vergenzen, der entsprechende Brechwert einer emmetropisierenden Kapselsacklinse ermittelt. Das Übersetzungsverhältnis als Quotient aus dem Torus der Linse und dem Hornhautastigmatismus wurde mit einer Monte-Carlo-Simulation auf seine potenziellen Einflussgrößen hin untersucht. Ergebnisse Die Monte-Carlo-Simulation zeigt, dass nicht von einem konstanten Übersetzungsverhältnis ausgegangen werden kann. Für die hier zugrunde gelegten klinischen Fälle ergibt sich ein mittleres Übersetzungsverhältnis von 1,3938 ± 0,0595 (Median 1,3921) mit einer Spannweite von 1,2131 bis 1,5974. Den größten Einfluss hat hierbei die axiale Position der Kapselsacklinse – je weiter posterior sich diese befindet, desto höher ist das Übersetzungsverhältnis. Aufgrund der Korrelation der axialen Linsenposition mit der Augenlänge kann die Augenlänge als indirekte Einflussgröße gewertet werden. Der Äquivalentbrechwert sowie der Astigmatismus der Hornhaut besitzen keinen nennenswerten Effekt auf das Übersetzungsverhältnis. Diskussion In einer ganzen Reihe von Berechnungsmodulen wird die Kalkulation des Torus der Kapselsacklinse dahingehend vereinfacht, dass dieser mittels eines einfachen konstanten Umrechnungsfaktors aus dem gemessenen Hornhautastigmatismus abgeleitet wird. Die vorliegende Studie zeigt jedoch, dass diese Vereinfachung zu deutlich fehlerhaften Ergebnissen führen kann. Dementsprechend wird eine individuelle Berechnung des Torus der IOL aus gemessenen biometrischen Größen (z. B. mittels Vergenzpropagation, Matrizen oder mittels Full-aperture-Raytracing) empfohlen.
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Affiliation(s)
- Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland.
| | - Jens Schrecker
- Klinik für Augenheilkunde, Rudolf-Virchow-Klinikum, Glauchau, Deutschland
| | - Michael Schwemm
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - Timo Eppig
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - S Schröder
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66424, Homburg, Deutschland
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Kirrberger Str., Gebäude 22, 66421, Homburg, Deutschland.,Klinik für Augenheilkunde, Semmelweis-Universität, Mária u. 39, 1085, Budapest, Ungarn
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