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Proper alignment key to using toric IOLs in cataract surgery, surgeons report
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BARCELONA — With proper alignment, toric IOLs can provide sufficient correction of astigmatism to allow for spectacle independence after cataract surgery, according to surgeons speaking here at the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery Meeting.
"We were very excited when we were offered toric IOLs in 2006 because we saw a possibility for correcting astigmatism at the same time of cataract surgery," said Margaret Kearns, MD, who runs a private practice in Sydney.
"We now use [such lenses] in about 50% of our cataract procedures, and it has given to us a real change in the quality of our results," she said.
Dr. Kearns reported results for 144 consecutive eyes treated by two surgeons who implanted either Alcon's toric AcrySof T3, T4 or T5 IOLs or the Rayner toric IOL. The final refractive cylinder was 0.5 D or less in 88% of patients, she said.
"The performance of both these lenses is excellent," Dr. Kearns said. "We now do very few laser enhancements, and patient satisfaction is high."
However, Dr. Kearns emphasized the importance of correctly marking the toric axis on the cornea before implanting the lens.
"We sit the patient at the slit lamp and mark the axis with a 30-gauge needle," she said.
Noel Bauer, MD, of Maastricht Hospital, The Netherlands, presented additional data on outcomes for patients implanted with AcrySof toric IOLs. Specifically, he discussed results for 53 consecutive cases implanted with the T3, T4 or T5 models.
"An UCVA (uncorrected visual acuity) of 20/25 or better was achieved in 80% of the patients," he said, adding that the average residual refractive cylinder ranged between 0.43 D and 0.75 D.
Dr. Bauer noted that the implantation procedure differs from standard cataract surgery in three minor aspects: the toric IOL calculations, iris marking and lens alignment.
"Marking is very important," he said. "We use a corneal reference marker of our own design that makes three reference marks on the cornea. Preoperative and also intraoperative marking are necessary."
"Misalignment is the main issue. IOL-related rotation is small, and most of the misalignment is surgery-related due to errors in pre- or intraoperative marking," Dr. Bauer said.