Preop assessment, lens choice, surgical technique determine outcomes with lifestyle IOL

Issue: December 25, 2010

Postoperative outcomes of cataract surgery with lifestyle IOL implantation hinge on meticulous patient selection, preoperative assessment, lens choice and surgical strategy, a surgeon said.

Rosa Braga-Mele, MD, FRCSC, presented pearls on patient selection and surgical parameters at OSN New York 2010.

"Patient selection is key," Dr. Braga-Mele said. "The patient needs to be matched to the IOL. ... Explain all possible outcomes. Turn a complication into an expectation. Under-sell and over-deliver."

A patient with less than 2.5 D of astigmatism is suitable for a multifocal or accommodating IOL. Limbal relaxing incisions should be performed for more than 0.75 D of astigmatism.

An AcrySof ReSTOR with a +3 D addition (Alcon) is suitable for intermediate vision; an AcrySof ReSTOR with a +4 D addition or a Tecnis multifocal IOL (Abbott Medical Optics) is ideal for near vision. A toric IOL with monovision should be considered for high astigmatism.

Preoperatively, the clinician should perform accurate biometry, manual keratometry, topography or immersion A-scan, and assess dry eye signs and symptoms. Preoperative and postoperative NSAIDs minimize the risk of cystoid macular edema, and fourth-generation topical antibiotics cut the risk of postoperative endophthalmitis, Dr. Braga-Mele said.

Wound construction and placement are critical. Smaller incisions are more stable and minimize postoperative astigmatism.

A centered capsulorrhexis with a diameter of 5 mm can optimize lens placement. Dispersive or cohesive viscoelastics protect the corneal endothelium and enhance chamber stability.

Optimizing phacoemulsification power modulation and fluidics enhances surgical efficiency and maximizes postoperative outcomes, Dr. Braga-Mele said.

Dr. Braga-Mele, OSN Cataract Surgery Section Editor, is a consultant for Alcon, Abbott Medical Optics and Bausch + Lomb.