Rotational Stability of Monofocal and Trifocal Intraocular Toric Lenses With Identical Design and Material but Different Surface Treatment

Hydrophobic Trifocal Toric Intraocular Lens Outcomes in Japanese Eyes After Cataract Surgery

Purpose

To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism.

Methods

A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery.

Results

Sixty-five eyes (98.48%) were within ±0.50D of spherical equivalent, and all were within ±1.00D (mean: 0.00±0.21D). Moreover, 63 eyes (95.45%) had ≤0.50D of residual astigmatism, and all had ≤1.00D (mean: -0.08±0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥20/25 UNVA and DCNVA, respectively.

Conclusion

Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.

Visual and Refractive Outcomes of a New Hydrophobic Trifocal Toric Intraocular Lens

Purpose

To evaluate the visual outcomes and efficacy of astigmatism correction using a new hydrophobic trifocal toric intraocular lens (IOL).

Methods

This study involved 62 eyes implanted with the FineVision HP Toric IOL. The visual and refractive outcomes were assessed preoperatively and 6 weeks after the surgery. Specifically, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA) at 80 and 60 cm and uncorrected near visual acuity at (UNVA) at 40 cm were evaluated. The rotational stability of the lens was also assessed.

Results

Sixty-one eyes (98.39%) were within ±1.00D and 55 eyes (88.71%) were within ±0.50 D of spherical equivalent, with a mean value of 0.09±0.39 D. 51 (82.26%) and 61 (98.39%) eyes had a UDVA of ≥20/20 and ≥20/25, respectively, and for CDVA these values were as follows: 59 (95.16%) and 62 eyes (100%), respectively. The mean UDVA and CDVA were 0.01±0.06 and -0.01±0.04logMAR, respectively. Greater than or equal to unaided 20/20 vision was achieved at 40 cm in 42 (67.74%), UIVA at 60 cm in 42 (67.74%) and 50 eyes (80.65%) at 80 cm. Those achieving ≥20/25 were 56 (90.32%, 40 cm), 59 (95.16%, 60 cm), and 62 eyes (100%, 80 cm). Postoperative mean values were 0.04±0.07, 0.03±0.07, and 0.00±0.07logMAR for UCNVA, UIVA at 60 cm, and UIVA at 80 cm, respectively. The mean rotation of the IOL was 5.8 degrees.

Conclusion

This hydrophobic trifocal toric IOL provides good refractive outcomes with excellent visual acuity across multiple distances, providing a full range of focus.

Comparison of clinical outcome after implantation of two toric intraocular lenses with different haptic type: a prospective randomized controlled trial

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.

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.

Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies

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.

Repositioning Rates of Toric IOLs Implanted in Cataract Surgery Patients: A Retrospective Chart Review

Purpose

To determine the incidence of postoperative repositioning of toric intraocular lenses (IOLs) due to clinically significant rotation.

Patients and Methods

This study included consecutive cataract patients with pre-existing astigmatism who had undergone cataract surgery with toric IOL implantation by a single experienced surgeon. Case records of patients who were recommended to undergo toric IOL repositioning surgery due to clinically significant postoperative IOL rotation from the implanted axis were identified. The need for a secondary intervention to manage residual astigmatism was based upon postoperative residual astigmatic error ≥0.75 D, the patient's qualitative dissatisfaction with the level of postoperative distance vision, dilated post-op examination, and confirmation of the significant potential for astigmatism reduction.

Results

Case records of 993 eyes implanted with AcrySof toric (N = 362), Tecnis Toric I (N = 53), Tecnis Toric II (N = 308), or enVista Toric IOLs (N = 270) were included. Postoperative toric IOL repositioning was recommended in 16 eyes (1.6%). The repositioning rate was highest in the eyes implanted with Tecnis Toric I (5.7%), followed by AcrySof Toric (2.2%), enVista Toric IOLs (1.1%), and Tecnis Toric II (0.6%).

Conclusion

This real-world analysis of eyes implanted with toric IOLs revealed that the rate of surgical IOL repositioning due to clinically significant IOL rotation was lower than 2% for enVista and Tecnis Toric II IOLs. When needed and with appropriate planning, toric IOL repositioning can be very successful.

Rotational Stability of Toric Capsular Bag-Fixated Intraocular Lenses in Duet Procedure for Reversible Trifocality

PURPOSE

To evaluate the long-term rotational stability of capsular bag-fixated toric intraocular lenses (IOLs) in polypseudophakic eyes of patients who underwent duet procedure for reversible trifocality.

DESIGN

Retrospective interventional case series.

METHODS

We included 34 eyes of 20 patients who underwent duet procedure with implantation of a monofocal toric IOL (RayOne toric, Hoya XY1AT, or a Tecnis ZCT800) into the capsular bag and a trifocal-diffractive Sulcoflex IOL into the ciliary sulcus. All toric IOLs were implanted with image-guided navigation. The manifest refraction and uncorrected and distance corrected visual acuity at far, intermediate, and near distance were measured. The position of the axis of the toric IOL was determined with the Pentacam device (Oculus GmbH) by evaluating retroillumination images. The results were compared with the preoperatively planned axis position.

RESULTS

The median follow-up was 27 months. The spherical equivalent of manifest refraction was -0.04 ± 0.34 diopters (D) postoperatively, and the refractive cylinder was -0.14 ± 0.22 D on average. Binocular uncorrected and corrected distance visual acuity were 0.05 ± 0.11 logMAR and 0.02 ± 0.09 logMAR, respectively. The mean deviation from the calculated cylinder axis was 3.8° ± 3.5° with a median of 2.8° and a maximum deviation of 15.0°. Ninety-four percent of all eyes showed a deviation of less than 10°.

CONCLUSIONS

The long-term axial alignment of capsular bag-fixated toric IOLs in polypseudophakic eyes was comparable to the results reported for single implantation of toric IOLs. The polypseudophakic approach did not affect the rotational stability of capsular bag-fixated IOLs.

Clinical outcomes of trifocal toric intraocular lenses

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Long-term trifocal toric intraocular lens outcomes in Asian eyes after cataract surgery

PURPOSE

To determine the visual and refractive outcomes of trifocal toric intraocular lens (IOL) implantation in Asian eyes with cataract and astigmatism.

SETTING

Asian Eye Institute, Makati City, Philippines.

DESIGN

Prospective study.

METHODS

187 eyes were implanted with the FineVision POD FT IOL and followed for 2 years. The measurements included subjective refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), defocus curve, photopic and mesopic contrast sensitivity, and rotational stability.

RESULTS

The mean spherical equivalent and cylinder values were, respectively, -0.07 ± 0.34 diopters (D) and -0.48 ± 0.31 D at the 2-year follow-up. At this same follow-up, 69.4% of patients had monocular CDVA and 79.3% had binocular UDVA ≤0.0 logMAR. For intermediate vision, monocular DCIVA reached 74.1%, while binocular UIVA was 86.2% ≤ 0.1 logMAR. Near vision showed 63% for monocular DCNVA and 70.7% for binocular UNVA ≤0.1 logMAR. The mean values at this follow-up were 0.02 ± 0.08, 0.08 ± 0.10, and 0.10 ± 0.12 logMAR for CDVA, DCIVA, and DCNVA, respectively. At the visual acuity threshold of ≤0.20 logMAR, the binocular defocus curve extended up to -3.75 D. Stable contrast sensitivity values were obtained at the different follow-ups. The mean IOL rotation was ≤2 degrees.

CONCLUSIONS

The FineVision POD FT IOL yielded good visual outcomes at far, near, and intermediate distances with accurate refractive outcomes and good rotational stability in Asian eyes.

Rotational stability of a new toric intraocular lens with an advanced optical profile

PURPOSE

To examine the rotational stability of a new toric intraocular lens (IOL), the TECNIS Eyhance Toric II, over a course of 3 months.

SETTING

Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria.

DESIGN

Prospective unmasked single-center study.

METHODS

50 eyes of 50 patients with cataract and regular corneal astigmatism ≥0.75 diopters (D) were included. The TECNIS Eyhance Toric II IOL was implanted in 1 eye of each study patient. Images of the alignment axis of the IOL were taken intraoperatively, as well as at 1 hour, 1 week, and 3 months postoperatively. For the measurement of toric IOL rotation, images were superimposed on the basis of ocular landmarks. Uncorrected and corrected distance (4 m) and intermediate (66 cm) visual acuities were assessed at the 3-month visit.

RESULTS

There was no significant difference in the rotational position between the intraoperative and 3 month timepoints, with a mean rotation of 1.34 ± 1.46 degrees, in 27 examined eyes. ( P = 0.313). No patients had to undergo repositioning of the toric IOL. A significant reduction of refractive cylinder occurred from preoperatively 1.8 ± 1.1 to 0.40 ± 0.42 D at the 3-month visit ( P = .001; n = 43). The corrected distance visual acuity improved significantly from 0.28 ± 0.16 logMAR preoperatively to -0.01 ± 0.13 logMAR at 3 months postoperatively ( P = .001; n = 43).

CONCLUSIONS

The TECNIS Eyhance Toric II showed a good visual performance with no significant rotation over a course of 3 months and, therefore, an excellent rotational stability. The intraocular lens showed a good safety profile with no adverse events.

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design

PURPOSE

To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL).

SETTING

Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier.

DESIGN

Single-center retrospective study.

METHODS

This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery.

RESULTS

Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was ≤ 6̊ (1 month) and ≤ 10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D.

CONCLUSION

The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

Optimal Timing of Repositioning Surgery for a Plate-Haptic Toric Intraocular Lens: A Multicenter Retrospective Study

PURPOSE

To evaluate risk factors for significant rotation and determine optimal timing for repositioning surgery following a plate-haptic toric intraocular lens (IOL) implantation.

METHODS

This retrospective study enrolled patients who underwent the plate-haptic toric IOL implantation at seven hospitals in Shanghai. IOL rotation and residual astigmatism were compared before and after repositioning surgery. Risk factors for significant IOL rotation after cataract surgery were identified by stepwise multiple linear regression analysis. Spearman's and linear regression analyses were performed to identify factors associated with IOL rotation after repositioning. The receiver operator characteristic (ROC) curve was used to analyze the optimal timing for repositioning surgery.

RESULTS

Among 2,745 eyes implanted with the toric IOL, 46 eyes (1.68%) of 45 patients underwent repositioning surgery. Axial length and lens thickness were significantly associated with IOL rotation before repositioning. After repositioning surgery, IOL rotation and residual astigmatism were significantly reduced (all P < .001). IOL rotation after repositioning was negatively associated with the timing of repositioning surgery (all P < .001). The ROC curve showed that the optimal cut-off for the timing of repositioning surgery was 15 days or greater.

CONCLUSIONS

The prevalence of repositioning surgery after the plate-haptic toric IOL implantation was 1.68%, and the optimal timing for repositioning surgery was recommended to be 2 to 3 weeks after cataract surgery. [J Refract Surg. 2023;39(2):120-126.].

Post-Market Evaluation of Rotational Stability and Visual Performance of a New Toric Intraocular Lens with Frosted Haptics

PURPOSE

To evaluate 3-month rotational stability, and visual and refractive outcomes of a toric intraocular lens (IOL) with frosted haptics.

PATIENTS AND METHODS

A post-market, prospective, multi-center, single-arm, open-label study conducted at seven clinical sites in the United States. Two hundred and two eyes of 133 subjects with unilateral or bilateral cataracts and corneal astigmatism were implanted with the Tecnis Toric II IOL, Models ZCU150 to 600 (Johnson & Johnson Surgical Vision, Inc.). Lens axis misalignment/rotation, visual acuity, manifest refraction, and surgeon and patient satisfaction were evaluated 3 months postoperatively. Lens rotation was determined with operative and postoperative visit photographs and was analyzed by two independent masked analysts.

RESULTS

Mean absolute lens rotation was 0.82° ± 1.00° and 0.94° ± 0.71° at 1 day (n = 189 eyes) and 3 months (n = 185 eyes), respectively. Absolute lens rotation was ≤5° in 98.9% and 100% of eyes at 1 day and 3 months, respectively. At 3 months, postoperative monocular uncorrected and corrected distance visual acuities were 0.004 ± 0.115 LogMAR (20/20) and -0.066 ± 0.092 LogMAR (20/17), mean spherical equivalent was -0.25 D ± 0.35 D and residual refractive cylinder was +0.27 D ± 0.33 D. Surgeons were satisfied/very satisfied with overall clinical outcomes and rotational stability in 99% of eyes, and with uncorrected distance vision in 98.5% of eyes.

CONCLUSION

The study results demonstrate that the Tecnis Toric II IOL has excellent rotational stability with a high percentage of study eyes being within 5° of intended orientation. The study lens demonstrated excellent uncorrected distance visual acuity, reduction of cylinder, and exceptional patient and surgeon satisfaction.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.].

Simultaneous Presbyopia and Astigmatism Correction with a Novel Trifocal Toric Intraocular Lens—A One-Year Follow-Up

The current investigation evaluates the efficiency of the trifocal toric Liberty 677MTY intraocular lens (IOL) in correcting preoperative corneal astigmatism in cataract patients demanding spectacle independence. The retrospective evaluation included 28 eyes of 15 patients with preoperative corneal astigmatism of at least 1.0 Dioptre (D). All patients were followed up for one year postoperatively. Residual refractive errors and visual acuities at multiple distances were measured. Binocular visual acuity and contrast sensitivity defocus curves were plotted. Visual functions and patient satisfaction were assessed. The efficiency of astigmatism correction was determined using the vector analysis method. The mean spherical equivalent refraction (SEQ) improved from 2.72 ± 1.62 D to 0.10 ± 0.48 D. The cylindric refraction decreased from 1.18 ± 0.45 D to 0.16 ± 0.31 D. Vector analysis proved efficient astigmatism correction with a centroid of 0.10 ± 0.34 D at 161°. Ninety-two percent of eyes resulted within 0.5 D from the target refraction. Visual acuities were 0.1 logMAR or better from +1.0 to −3.5 D defocus values. Visual tasks could be performed without major difficulties. Our patients were highly satisfied. Refractive and visual outcomes with the investigated presbyopia-correcting toric IOL are predictable and the lens provides excellent trifocal vision.

Impact of Material and Lens Design on Repositioning Surgery of Toric Intraocular Lenses: A Single-Arm Meta-Analysis

Aim

To analyze the pooled incidence rate in repositioning surgery by considering different materials and designs.

Methods

All published studies investigating the repositioning surgery of toric intraocular lenses (IOLs) before September 1, 2020, were searched and evaluated. The R3.5.2 software was used to extract the data, and a single arm meta-analysis was performed.

Results

19 cases from 18 published studies articles were included in the meta-analysis. The pooled incidence rate in repositioning surgery was 2% (I² = 53%, P_{heterogeneity}<0.01). Plate and silicone IOLs had significantly higher incidence rates (6% for each) than loop (2%) and hydrophobic acrylate (2%). Incidence rates of Acrysof, Staar, TECNIS, PhysIOL SA, T-flex 623T, and Microsil 6116TU groups were 1% (95% CI [1%–2%]), 6% (95% CI [4%–9%]), 3% (95% CI [2%–4%]), 1.40% (1/71), 3.03% (1/33), and 4.76% (1/21), respectively.

Conclusions

The pooled incidence rate of repositioning surgery in IOLs was 2%. Materials and designs would be risk factors for the rotational stability of the toric IOLs. Pooled incidence rates of the hydrophobic acrylate and loop group were lower than those of the silicone and plate group. Product identity is the main driver of heterogeneity.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

PURPOSE

To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS).

METHODS

This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group.

RESULTS

The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos.

CONCLUSIONS

This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Influence of frosted haptics on rotational stability of toric intraocular lenses

We investigated the unfolding property and rotational stability of a new toric intraocular lens (IOL); TECNIS toric II (toric-II, ZCW, Johnson & Johnson) that is an improved version of TECNIS toric IOL (toric-I, ZCV). Both IOLs are based on an identical platform, except for the frosted haptics with toric-II IOL. The study consisted of two parts; experimental study and clinical, retrospective, case series. Experimental study indicated that the overall time from IOL ejection to unfolding to 11 mm was significantly shorter with toricII than toric-I IOLs (p = 0.032), due to the earlier separation of the haptics from the optic with toric-II IOL. Clinical study included 131 eyes of 99 patients who had undergone phacoemulsification and toric IOL implantation. At 3 months postoperatively, toric-II IOL showed significantly better rotational stability than toric-I IOL, including smaller residual manifest astigmatism (p = 0.018), less amount of axis misalignment from the intended axis (p = 0.04), lower incidence of misalignment > 10º (p = 0.0044), and less degree of prediction errors (p = 0.043). Postoperative uncorrected distance visual acuity tended to be better in the toric-II than in the toric-I groups, with marginal statistical difference (p = 0.057). TECNIS toric II IOL with the frosted haptics showed significantly better rotational stability than its predecessor, probably due to quicker unfolding and greater friction with the capsular bag.

Atomic force microscopy comparative analysis of the surface roughness of two posterior chamber phakic intraocular lens models: ICL versus IPCL

BACKGROUND

To compare the anterior surface roughness of two commercially available posterior chamber phakic intraocular lenses (IOLs) using atomic force microscopy (AFM).

METHODS

Four phakic IOLs were used for this prospective, experimental study: two Visian ICL EVO+ V5 lenses and two iPCL 2.0 lenses. All of them were brand new, were not previously implanted in humans, were monofocal and had a dioptric power of - 12 diopters (D). The anterior surface roughness was assessed using a JPK NanoWizard II® atomic force microscope in contact mode immersed in liquid. Olympus OMCL-RC800PSA commercial silicon nitride cantilever tips were used. Anterior surface roughness measurements were made in 7 areas of 10 × 10 μm at 512 × 512 point resolution. The roughness was measured using the root-mean-square (RMS) value within the given regions.

RESULTS

The mean of all anterior surface roughness measurements was 6.09 ± 1.33 nm (nm) in the Visian ICL EVO+ V5 and 3.49 ± 0.41 nm in the iPCL 2.0 (p = 0.001).

CONCLUSION

In the current study, we found a statistically significant smoother anterior surface in the iPCL 2.0 phakic intraocular lenses compared with the VISIAN ICL EVO+ V5 lenses when studied with atomic force microscopy.

Comparison of visual and refractive outcomes of 2 trifocal intraocular lenses

PURPOSE

To compare clinical outcomes after cataract surgery and bilateral implantation of 2 diffractive trifocal toric intraocular lenses (IOLs).

SETTING

Hospital da Luz, Lisbon, Portugal.

DESIGN

Double-arm, randomized, prospective case series.

METHODS

A total of 60 patients were randomly allocated to receive bilateral implantation of either the FineVision Pod FT toric IOL (PhysIOL) or the AcrySof IQ PanOptix toric IOL (Alcon). Visual and refractive outcomes, contrast sensitivity, IOL misalignment, and quality of vision outcomes (QoV questionnaire) were evaluated at 3 months postoperatively. Surgically induced astigmatic changes were evaluated by vector analysis.

RESULTS

Each group (FineVision toric and AcrySof IQ PanOptix toric) comprised 30 patients (60 eyes). No significant differences between groups were found regarding uncorrected and corrected distance and near visual outcomes (P ≥ .333). Mean postoperative distance-corrected intermediate visual acuity at 60 cm was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR) and 0.09 ± 0.11 logMAR in the PanOptix and Pod FT group, respectively (P = .032). Mean IOL axis misalignment was 1.59 degrees ± 2.15 degrees (PanOptix group) and 1.89 degrees ± 3.31 degrees (Pod FT group) (P = .821). Mean magnitude of error of astigmatic correction was -0.09 diopters (D) and -0.11 D in the PanOptix group and Pod FT group, respectively (P = .333). Contrast sensitivity, QoV scores for the presence of photic phenomena, and the level of spectacle independence were similar in both groups (P > .05).

CONCLUSIONS

Both trifocal toric IOLs allowed complete patient visual restoration, and good spectacle independence and good visual quality outcomes. The PanOptix IOL provided superior intermediate visual acuity for distances around 60 cm.

Refractive enhancements for residual refractive error after cataract surgery

PURPOSE OF REVIEW

Advances in cataract surgery have allowed surgeons to achieve superior refractive outcomes but have also led to higher patient expectations. Despite ever-evolving technology, residual refractive errors still occur. Postcataract refractive enhancements may be required to deliver satisfactory visual outcomes. This review aims to discuss the potential causes of residual refractive errors and the various enhancement modalities to correct them.

RECENT FINDINGS

A thorough preoperative workup to detect and address underlying pathologic causes of impaired vision should be performed prior to enhancement or corrective procedures. Corneal-based procedures are the safest and most accurate methods of correcting mild cases of residual refractive error. Hyperopic, high myopic, and high astigmatic errors are best managed with lens-based enhancements. Piggyback intraocular lenses (IOLs) are safer and more effective compared with IOL exchange. Toric IOL rotation and IOL exchange are ideally performed in the early postoperative period.

SUMMARY

A multitude of options exist for effective correction of residual refractive errors. The choice on how to best manage these patients depends on many factors such as the cause of refractive error, type of IOL used, ocular comorbidities, and patient preference.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with low degrees of corneal astigmatism.

METHODS

Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL (FineVision PODFT, PhysIOL s.a., Liege, Belgium) were enrolled. Phacoemulsification with femtosecond laser, capsular tension ring insertion and intraoperative aberrometry were performed in all cases. All IOLs used showed a cylinder power of 1.00 D. Main outcome measures were refractive error and corrected-distance visual acuity (CDVA) and uncorrected-distance visual acuity (UDVA) values. Eyes were evaluated at 4mo post-surgery.

RESULTS

Totally 50% of eyes showed a spherical equivalent (SE) within ±0.13 D and all of them within ±0.50 D. The mean SE and refractive cylinder were -0.02±0.23 and -0.16±0.22 D, respectively. Vector analysis revealed that 100% of eyes were within ±0.50 D for the SE and cylindrical components (J0 and J45). Refractive changes were not correlated with keratometric changes (P>0.05) showing that the reduction in astigmatism comes from the trifocal toric IOL. Of 81% and 96% of eyes showed UDVA and CDVA of 20/20, respectively. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02 (about 20/20), respectively.

CONCLUSION

Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Clinical outcomes of Ankoris toric intraocular lens implantation using a computer-assisted marker system

PURPOSE

To report the clinical outcomes of patients who underwent cataract surgery with implantation of Ankoris monofocal toric intraocular lens (IOL) (PhysIOL SA, Liège, Belgium) using the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA).

METHODS

We conducted a retrospective case series of patients who underwent routine cataract extraction and implantation of Ankoris toric IOL using the Zeiss Callisto eye between January 2018 and December 2018 by four senior surgeons. Patients' medical records were reviewed, and clinical outcomes including postoperative refraction, visual acuity outcomes, IOL position and deviation from planned axis were collected.

RESULTS

Fifty-six eyes of 56 patients were included, 48% were female, and the mean age was 70 ± 8 years. Patients with pseudoexfoliation syndrome, glaucoma or keratoconus were excluded from the study. Pre-operative mean corneal astigmatism was 2.38 ± 0.78 diopters (D), and mean implanted IOL cylindrical power was 3.06 ± 1.07 D. IOL rotation 30 days postoperatively was within 5° in 82% of eyes and between 6° and 10° in 10.8% of eyes. Mean postoperative refractive astigmatism 30 days postoperatively was 0.22 ± 0.36 D; in 84% of eyes the postoperative refractive astigmatism was ≤ 0.50 D. IOL rotation significantly increased between day 1 to day 7 postoperatively (1.91 ± 3.15° to 3.18 ± 3.3°, P = 0.001). However, no significant rotation had occurred between day 7 and day 30 postoperatively (P = 0.093).

CONCLUSION

Cataract surgery with implantation of Ankoris monofocal toric IOL using the Zeiss Callisto Eye marking system is predictable and effective in reducing refractive astigmatism.

Early-stage clinical outcomes and rotational stability of TECNIS toric intraocular lens implantation in cataract cases with long axial length

Background

A major focus of toric intraocular lens (IOL) implantation is the rotational stability, especially in the patients with long axial length (AL). In this study, we aimed to evaluate the clinical outcomes after implantation of TECNIS toric IOL in eyes with long AL and identify factors influencing their early-stage stability with preoperative corneal astigmatism.

Methods

The study population consisted of 64 eyes from 52 cataract patients, and these patients had preoperative corneal astigmatism between 1.0 and 3.7 diopters (D) and underwent phacoemulsification and TECNIS toric IOL implantation. Ophthalmic biological measurements were carried out preoperatively, including AL, anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL), anterior chamber volume (ACV), sulcus-to-sulcus (STS) and keratometric value (K). Clinical examinations, including visual acuity, manifest refraction, keratometry, digital anterior segment photographs with pupillary dilation, were performed at 1 and 3 months after surgery.

Results

The mean best corrected distance visual acuity (BCDVA) was improved from 0.93 ± 0.35 logarithms of the minimal angle of resolution (logMAR) preoperatively to 0.07 ± 0.10 logMAR postoperatively at 3 months after surgery. The mean residual astigmatism (RAS) was 0.91 ± 0.74D at 3 months, which was significantly decreased compared with the preoperative corneal astigmatism of 1.71 ± 0.55 D. The mean absolute rotation of TECNIS toric IOL at 1 and 3 months was 7.42 ± 11.32 degree (°) (0–79°) and 7.48 ± 11.19°(0–79°), respectively. The mean area of capsulorhexis and the overlapped area between capsulorhexis and IOL optic intraoperatively was 21.04 ± 3.30 mm² and 7.40 ± 2.87 mm².A positive correlation was found between IOL rotation and the area of capsulorhexis (p = 0.017) at 3 months after surgery. No correlation was found between IOL rotation and AL (p = 0.876), ACD (p = 0.387), LT (p = 0.523), VL (p = 0.546), ACV (p = 0.480), STS (p = 0.884), K1 (p = 0.429), K2 (p = 0.644), average of K1 and K2 (p = 0.520), intraoperative IOL axial direction (p = 0.396), preoperative corneal astigmatism (p = 0.269) or the overlapped area between capsulorhexis and IOL optic intraoperatively (p = 0.131) .

Conclusions

The large CCC was a risk factor for toric IOL rotation. An appropriately smaller sized CCC was conducive to increase the rotational stability of TECNIS toric IOL implantation in cataract cases with long AL.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Refractive and Visual Outcomes and Rotational Stability of Toric Intraocular Lenses in Eyes With and Without Previous Ocular Surgeries: A Longitudinal Study

PURPOSE

To evaluate visual and refractive outcomes and rotational stability of toric intraocular lens (IOL) implantation in eyes with previous ocular surgeries.

METHODS

This controlled, longitudinal cohort study included a total of 133 eyes (59 study cases with a history of corneal, vitreoretinal, and/or glaucoma surgery and 74 randomly selected controls without a history of ocular surgery) that had cataract and corneal astigmatism treated with toric IOL implantation. Postoperative outcomes were recorded at postoperative 1 month and 3 to 12 months.

RESULTS

Refractive prediction errors were within ±1.00 diopter (D) of target in 93.5% and 88.4% of the study cases at postoperative 1 month and 3 to 12 months, respectively. They were within ±0.50 D of target in 56.5% and 60.5% of the cases during the same follow-up intervals, respectively. Study cases showed statistically significantly inferior uncorrected distance visual acuity (UDVA) compared to controls at 1 month postoperatively (0.27 ± 0.24 and 0.17 ± 0.21 logMAR, respectively, P = .027) but not during the later follow-up (0.19 ± 0.19 and 0.16 ± 0.19 logMAR, respectively, P = .431). Corrected distance visual acuity (CDVA) was slightly lower in the study cases than in controls at 1 month postoperatively (0.13 ± 0.16 and 0.07 ± 0.14, respectively, P = .005) and subsequent follow-up months (0.10 ± 0.13 and 0.03 ± 0.10, respectively, P < .001). Of the examined study cases, 93.9% and 88.4% had IOL axes within 5° of intended axis at postoperative 1 month and 3 to 12 months, respectively.

CONCLUSIONS

Toric IOLs provided significant and sustained improvement in visual acuity and refraction in eyes with a history of prior ophthalmic surgery. Refractive outcomes achieved postoperatively were comparable to those in eyes without a prior history of ophthalmic surgery, although the rate of visual recovery may be different. [J Refract Surg. 2019;35(12):781-788.].

Keratoconic eyes with stable corneal tomography could benefit more from custom intraocular lens design than normal eyes

We investigated whether eyes with keratoconic corneal tomography pattern could benefit more from aberration correction with custom intraocular lenses (IOLs) than normal cataractous eyes despite the effect of misalignment on the correction of aberrations. Custom IOLs (cIOLs) were calculated for twelve normal and twelve keratoconic eyes using personalized numerical ray tracing models. The Stiles-Crawford weighted root-mean-square spot-size (wRMS) at the virtual fovea was evaluated for cIOLs and aberration-neutral IOLs (nIOLs) in a simulated clinical study with 500 virtual IOL implantations per eye and per IOL. IOL misalignment (decentration, tilt, rotation) and pupillary ectopia (4.5 mm iris aperture) were varied upon each virtual implantation. The nIOLs achieved average wRMS of 16.4 ± 4.3 μm for normal, and 92.7 ± 34.4 μm for keratoconic eyes (mean ± standard deviation). The cIOLs reduced the average wRMS to 10.3 ± 5.8 μm for normal, and 28.5 ± 18.6 μm for keratoconic eyes. The cIOLs produced smaller wRMS than nIOLs in most virtual implantations (86.7% for normal and 99.4% for keratoconic eyes). IOL misalignment resulted in larger wRMS variations in the keratoconus group than in the normal group. Custom freeform IOL-optics-design may become a promising option for the correction of advanced aberrations in eyes with non-progressive keratoconic corneal tomography pattern.