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Toric phakic implantable Collamer lens proves safe, effective and stable
J Refract Surg. 2009;25(5):403-409.
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Implantation of a toric phakic IOL safely and effectively corrected myopic astigmatism, with long-term stability.
The authors studied refractive outcomes, safety and stability of the STAAR Toric Implantable Collamer Lens (TICL).
Data on TICL outcomes and safety are rare, requiring the collection of more updated results, the study authors said.
“Because maintenance of the intended TICL axis is crucial to achieve the desired astigmatic correction, this study was undertaken to evaluate the clinical outcomes, especially postoperative astigmatism and rotational and footplate stability, of implantation with the STAAR TICL,” they said.
The prospective study included 30 eyes of 20 patients with myopic astigmatism. Patients had a mean age of 32.9 years. All 30 eyes had preoperative myopia of more than 6 D. All eyes underwent TICL implantation with an injector through a 3.2-mm temporal clear corneal incision. TICL size was based on horizontal sulcus-to-sulcus diameter measured by ultrasound biomicroscopy.
At mean follow-up of 7.6 months, mean postoperative refractive astigmatism was 0.73 ± 0.47 D, down from 2.43 ± 1.24 D preoperatively, a reduction of 70.1%. Uncorrected visual acuity was 20/20 in 67% of eyes, 20/25 in 86.7% of eyes and 20/32 or better in 100% of eyes.
No eyes had to undergo additional surgery to rotate the TICL back into position, the authors said.
To achieve a good outcome and a satisfied patient with any form of refractive surgery, it is necessary to correct both defocus and astigmatism. This can be achieved in the case of an implanted refractive IOL with either corneal surgery such as a limbal or corneal relaxing incision, with bioptics using LASIK or PRK, once the refraction is stable, or with a toric IOL. The toric IOL option is attractive because it avoids corneal refractive surgery intraoperatively or postoperatively. In simple terms, it allows correction of the patient’s total refractive error in a one-step procedure. This paper supports the premise that a toric phakic IOL can be effective in the correction of both defocus and astigmatism. However, to achieve the highest level of patient satisfaction, one must achieve a refractive outcome that leaves less than 0.5 D of residual defocus and astigmatism. The results in this study fall slightly short of this goal. In the future, a wider selection of IOL powers or customization of IOLs with intraoperative confirmation of proper axis of placement with a microscope-based wavefront device can be expected to further enhance our outcomes.
– Richard L. Lindstrom, MD
OSN Chief
Medical Editor