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Yin XL, Ji ZY, Li XX, Liang XM, Ji SX. Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review. Int J Ophthalmol 2024; 17:1370-1374. [PMID: 39026920 PMCID: PMC11246944 DOI: 10.18240/ijo.2024.07.23] [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: 10/27/2023] [Accepted: 04/01/2024] [Indexed: 07/20/2024] Open
Abstract
Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.
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Affiliation(s)
- Xiao-Lei Yin
- Department of Ophthalmology, the 305 Hospital of PLA, Beijing 100017, China
| | - Zhi-Yang Ji
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiu-Xin Li
- Department of Ophthalmology, the 305 Hospital of PLA, Beijing 100017, China
| | - Xue-Mei Liang
- Department of Medical Administration, the 305 Hospital of PLA, Beijing 100017, China
| | - Shu-Xing Ji
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing 400042, China
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Ha DH, Kim KW. Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties. Acta Ophthalmol 2024. [PMID: 38647407 DOI: 10.1111/aos.16694] [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: 02/07/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. METHODS We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. RESULTS Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. CONCLUSION Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.
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Affiliation(s)
- Dong Hee Ha
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
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Nicholson M, Singh VM, Murthy S, Gatinel D, Pereira S, Pradhan A, Vasavada S, Dandekar P, Naik M, Sharma S. Current concepts in the management of cataract with keratoconus. Indian J Ophthalmol 2024; 72:508-519. [PMID: 38389251 PMCID: PMC11149527 DOI: 10.4103/ijo.ijo_1241_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 02/24/2024] Open
Abstract
This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.
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Affiliation(s)
- Maneck Nicholson
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Vivek M Singh
- Department of Cataract and Refractive Surgery, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Telangana, India
| | - Somasheila Murthy
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
- Department of Cataract and Refractive Surgery, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Telangana, India
| | - Damien Gatinel
- Department of Cataract and Refractive Surgery, Rothschild Foundation, Paris, France
| | - Savio Pereira
- Department of Cataract and Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, India
| | | | - Shail Vasavada
- Department of Cataract and Refractive Surgery, Raghudeep Eye Clinic, Ahmedabad, India
| | - Prajakta Dandekar
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Mekhla Naik
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Supriya Sharma
- Department of Cataract and Refractive Surgery, Shantilal Shanghvi Eye Institute, Mumbai, India
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Rombold F, Niederdellmann C, Pariti R, Khayat B. Time Savings Using a Digital Workflow versus a Conventional for Intraocular Lens Implantation in a Corporate Chain Hospital Setting. Clin Ophthalmol 2024; 18:113-119. [PMID: 38226000 PMCID: PMC10789570 DOI: 10.2147/opth.s439930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Purpose To evaluate and compare the digital cataract workflow with the existing conventional workflow in terms of time savings for overall diagnostic procedures from preoperative measurements, data transfer, intraocular lens (IOL) power calculation, and axis marking for cataract surgery in a corporate hospital chain setting. Patients and Methods This prospective non-clinical study assessed the mean procedural times for preoperative assessments, calculation of IOL power, data transfer to operating devices, and total surgery for both digital and existing conventional workflows. Results Overall, 430 workflows (digital cataract workflow: 227; existing conventional workflow: 203) were included for time measurements. The digital cataract workflow resulted in shorter mean (± standard deviation [SD]) preoperative assessments with lesser variability among individual assessments than the existing workflow (14.15 ± 1.86 vs 21.41 ± 1.18 min, respectively); with a time saving of 35%. Similarly, the mean (± SD) time required for the subsequent assessment steps such as IOL calculation (2.19 ± 1.23 vs 3.17± 2.29 min; 30%), data transfer (0 vs 1.33 ± 0.25 min; 100%), IOL axis marking and alignment (0 vs 3.07 ± 0.53 min; 100%) were shorter with digital cataract workflow versus existing conventional cataract workflow. Briefly, the overall mean time from preoperative assessments to final surgery was 16.48 min with digital cataract workflow and 30.58 min with existing conventional workflow; resulting in a time saving of 46%. Conclusion The Zeiss digital cataract workflow demonstrated greater time savings at each step of the cataract surgery workflow compared to the existing conventional workflow. In addition, digitalization can lead to a more streamlined cataract surgery workflow that is more convenient and cost-effective than the existing conventional practices in a corporate chain hospital setting.
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Pašková B, Marešová K, Schreiberová Z, Malušková M, Karhanová M. Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:146-153. [PMID: 38413224 DOI: 10.31348/2024/10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability. MATERIAL AND METHODS 30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction. RESULTS mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5. CONCLUSION TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.
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Korpole NR, Kurada P, Kuzhuppilly NIR, Korpole MR. Comparison of clinical outcomes of Eyecryl toric and Alcon toric intra-ocular lenses - A real world study. Indian J Ophthalmol 2023; 71:2972-2977. [PMID: 37530267 PMCID: PMC10538847 DOI: 10.4103/ijo.ijo_3403_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/07/2023] [Accepted: 05/27/2023] [Indexed: 08/03/2023] Open
Abstract
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.
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Affiliation(s)
- Nilay Reddy Korpole
- Department of Ophthalmology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Padma Kurada
- Drishti Eye Centre, Plot No. 114A, Lane Opp. SBI, Srinagar Colony Main Road, Ameerpet, Hyderabad India
| | - Neetha I R Kuzhuppilly
- Department of Ophthalmology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhukar Reddy Korpole
- Drishti Eye Centre, Plot No. 114A, Lane Opp. SBI, Srinagar Colony Main Road, Ameerpet, Hyderabad India
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Diao C, Lan Q, Liao J, Lu P, Zhou Z, Li L, Zeng S, Yao G, Huang W, Chen Q, Lv J, Tang F, Li M, Xu F. Influence of decentration of plate-haptic toric intraocular lens on postoperative visual quality. BMC Ophthalmol 2023; 23:332. [PMID: 37474888 PMCID: PMC10360333 DOI: 10.1186/s12886-023-03061-6] [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: 02/25/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND To evaluate the influence of decentration of plate-haptic toric intraocular lens (IOLs) on visual quality. METHODS This study enrolled 78 eyes of 78 patients. Patients in group A were implanted with toric IOLs, and patients in group B were implanted with monofocal IOLs. All patients were divided into group A1 and B1 (decentration below 0.3 mm) and group A2 and B2 (decentration above 0.3 mm). The uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), modulation transfer function cutoff (MTF cutoff), objective scatter index (OSI), strehl ratio (SR), optical interference and patients' satisfaction were measured in different pupils at three months postoperatively. The associations between decentration and visual quality were analyzed by Spearman correlation. RESULTS There were no significant differences in UDVA, BCVA, MTF cutoff, OSI, SR, optical interference and patients' satisfaction among subgroups. The differences in decentration between groups A and B were not statistically significant. In group A2, the total higher order aberrations (tHOAs) at pupil sizes of 3 mm (P = 0.046), 5 mm (P = 0.014), spherical aberrations at pupil sizes of 3 mm (P = 0.011), 4 mm (P = 0.014), 5 mm (P = 0.000), secondary astigmatism at pupil sizes of 3 mm (P = 0.002), 4 mm (P = 0.005) were higher than in group B2. Compared to group A1, group A2 had higher spherical aberrations at pupil sizes of 4 mm (P = 0.042), 5 mm (P = 0.001), 6 mm (P = 0.038), secondary astigmatism at pupil sizes of 3 mm (P = 0.013), 4 mm (P = 0.005), 6 mm (P = 0.013). Group B2 has higher coma and secondary astigmatism than group B1 at 6-mm pupil (P = 0.014, P = 0.045). Significant positive correlations were found between spherical aberrations and the decentration of group A1 and A2 at 6-mm pupils. CONCLUSION The decentration above 0.3 mm negatively affected visual quality due to increased tHOAs, spherical aberrations, coma and secondary astigmatism aberrations, the influence become larger with increasing pupil diameter. And toric IOLs are more affected by decentration than monofocal IOLs.
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Affiliation(s)
- Chunli Diao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Qianqian Lan
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jing Liao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Peng Lu
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Zhou Zhou
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Lanjian Li
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Siming Zeng
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Gang Yao
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Wei Huang
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Qi Chen
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jian Lv
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Fen Tang
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Min Li
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Fan Xu
- Department of Ophthalmology, Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi, Guangxi Academy of Medical Sciences, Guangxi Zhuang Autonomous Region, Guangxi, China.
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Blau-Most M, Levy A, Assia EI, Kleinmann G. Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy. Ophthalmol Ther 2023; 12:1747-1755. [PMID: 37052875 PMCID: PMC10164209 DOI: 10.1007/s40123-023-00700-5] [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: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 04/14/2023] Open
Abstract
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.
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Affiliation(s)
- Michal Blau-Most
- Ein-Tal Eye Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Levy
- Ein-Tal Eye Center, Tel Aviv, Israel
| | - Ehud I Assia
- Ein-Tal Eye Center, Tel Aviv, Israel
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kleinmann
- Ein-Tal Eye Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Ophthalmology, E. Wolfson Medical Center, 62 Halohamim St., POB 5, 5810001, Holon, Israel.
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Propensity-matched comparison of postoperative stability and visual outcomes of toric intraocular lens with or without a capsular tension ring and updated meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 261:989-998. [PMID: 36201025 DOI: 10.1007/s00417-022-05851-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the contribution of capsular tension ring (CTR) to postoperative stability and visual outcomes of a plate-haptic toric intraocular lens (IOL). METHODS This prospective cohort study was performed among patients underwent toric IOL (AT TORBI 709 M) implantation with or without CTR at the Eye and ENT hospital between April 2020 and November 2021. Propensity score matching (PSM) was performed to balance baseline factors. Postoperatively, uncorrected distance visual acuity (UCVA) and residual astigmatism, as well as IOLs' rotation, tilt, and decentration, were analyzed. Grouped multiple linear regression analysis was used to model predictive factors of rotation in each group. Additionally, a meta-analysis of data from 4 publications (284 eyes) and current study was performed to evaluate the effect of CTR co-implantation on toric IOL rotation. RESULTS After PSM, 126 eyes from each group were included for further analysis. Postoperatively, UDVA was 0.31 ± 0.38 logMAR and 0.27 ± 0.36 logMAR in the CTR and NCTR groups, respectively (P = 0.441), and residual astigmatism was 0.75 ± 0.52 D and 0.86 ± 0.65 D, respectively (P = 0.139). The rotation of toric IOL was significantly smaller in the CTR group than in the NCTR group (4.63 ± 6.27 vs. 10.93 ± 16.05 degrees, P < 0.001). The regression models of the two groups and the coefficients of LT were significantly different (P < 0.001 and P = 0.001, respectively). Furthermore, the meta-analysis confirmed that CTR co-implantation reduced toric IOL rotation (MD, - 1.59; 95% CI, - 3.10 to - 0.09; P = 0.038). CONCLUSION CTR enhances rotational stability of toric IOL by reducing the impact of LT, and CTR co-implantation is recommended in patients with lens thickness (LT) ≥ 4.5 mm, white-to-white (WTW) ≥ 11.6 mm, or high preexisting astigmatism.
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