Visual outcome and refractive status with monofocal toric intraocular lens implantation to correct astigmatism during cataract surgery

Comparison of clinical outcomes of Eyecryl toric and Alcon toric intra-ocular lenses - A real world study

Purpose

To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra-ocular lenses (IOLs).

Methods

This retrospective, observational study included 143 eyes of 141 patients who underwent phaco-emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post-op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed.

Results

The mean pre-op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post-op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post-op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post-op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02).

Conclusion

Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post-operative outcomes in terms of UCVA and residual astigmatism. The post-op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group.

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy

INTRODUCTION

Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD.

METHODS

A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism.

RESULTS

The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was - 0.29 ± 0.43 vs. - 0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93° ± 2.42° vs. 0.23 D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28° ± 0.57° vs. 0.03 D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (P = 0.44) (D diopters).

CONCLUSION

The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism

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.

The efficacy of ultrasonic emulsification with IOL implantation in patients with primary angle-closure glaucoma combined with cataract

PURPOSE

This study aimed to investigate the clinical efficacy of ultrasonic emulsification plus IOL implantation in patients with primary angle-closure glaucoma and cataract.

METHODS

The clinical data of 81 patients (91 eyes) with primary angle-closure glaucoma comorbid with cataract in our hospital were retrospectively analyzed and divided into two groups based on surgical modality. Group A (n=40, 45 eyes) underwent trabeculectomy and group B (n=41, 46 eyes) underwent ultrasonic emulsification and IOL implantation. The success rate, best corrected visual acuity, intraocular pressure, anterior chamber depth, anterior chamber angle, visual field, cornea's endothelial cell count, complications, and patient satisfaction were compared between the two groups.

RESULTS

The surgical success rate in group B was 97.83%, significantly higher than 86.67% in group A (P < 0.05); Compared with group A, group B had higher best-corrected visual acuity and lower intraocular pressure (P < 0.05) as well as higher central and peripheral anterior chamber depths at 3 months postoperatively (P < 0.05); After surgery, group A had significantly lower postoperative cornea's endothelial cell count (P < 0.05). Compared with group A, MS was higher and MD was lower in group B at 3 months postoperatively (P < 0.05); the complication rate in group B was 8.70%, lower than 28.89% in group A (P < 0.05).

CONCLUSION

The clinical efficacy of ultrasonic emulsification combined with IOL implantation is remarkable in patients with primary angle-closure glaucoma and cataract, which is conducive to improving postoperative visual acuity, lowering intraocular pressure, increasing the atrial angle, and improving visual field defects. It is also with high safety, but has little effect on cornea's endothelial cell count.