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Intraoperative aberrometry enhances accuracy of accommodating IOL with LRIs
Postoperative manifest refraction was within 1 D of the target in almost all cases.
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Intraoperative wavefront aberrometry enabled accurate and predictable accommodating IOL implantation and limbal relaxing incision placement, according to a study.
At the American Society of Cataract and Refractive Surgery meeting in San Francisco, Robert J. Weinstock, MD, discussed visual and refractive outcomes of the Crystalens AO accommodating IOL (Bausch + Lomb) combined with manual limbal relaxing incisions (LRIs).
The ORA and ORange intraoperative wavefront aberrometer (WaveTec Vision) were used to capture aphakic measurements, determine IOL power and guide LRI placement when LRIs were indicated. Data on a subgroup of patients who underwent intraoperative measurements with just the ORA were also presented. The IOLMaster (Carl Zeiss Meditec) was used to measure preoperative biometry.
“The Crystalens AO accommodating IOL in conjunction with the LRIs, guided by intraoperative wavefront aberrometry to help choose the axis and length of the LRI, followed by repeated measurements to look at the correction of astigmatism and titrating it on the fly while you’re operating, delivers excellent outcomes,” Weinstock said.
Robert J. Weinstock
Study
The study included 228 eyes of 153 patients. Manual LRIs were performed in 35% of eyes.
The procedure involved standard lens removal, aphakic readings with the aberrometer, LRI placement and IOL implantation. Readings from the ORA were compared with preoperative biometry measurements taken with the IOLMaster.
“I make a decision on the fly for which power lens to use, depending on the ORA suggestion,” Weinstock said. “Additionally, we look at the cylinder value of the aphakic reading, compare that to the preoperative astigmatism, plan our LRIs and do the LRI treatments based on the readings from the ORA. Then we look at the outcomes of the pseudophakic readings to additionally augment the LRI.”
Primary outcome measures were residual refractive astigmatism and manifest refraction spherical equivalent compared with the intended targets.
Results and conclusions
Study results showed that postoperative manifest refraction spherical equivalent was within about 0.5 D of the target in 75% of eyes and within about 1 D in 98% of eyes. Mean residual cylinder was 0.26 D at final follow-up; 51% of eyes had no residual cylinder, and 89% had less than 0.5 D of residual cylinder. Final mean postoperative uncorrected distance visual acuity was 20/30.
Outcomes were more predictable in the ORA subgroup, which comprised 132 patients, according to Weinstock.
“When we look at the ORA subgroup … we see that the predictability of the readings on the table really outstripped that of preoperative biometry,” Weinstock said. “That’s looking at the postoperative result compared to what ORA predicted the postoperative result would be vs. what the preoperative biometry predicted what the postoperative result would be.”
Postoperative manifest refraction was within 0.5 D of the target in 83% of eyes. Mean residual cylinder was 0.22 D, down from 0.77 D preoperatively. Residual cylinder was lower than 0.5 D in 91% of eyes.
Uncorrected distance visual acuity was better than 20/30 in 85% of eyes and better than 20/40 in 92%.
“You can still see that cataract surgery, even with all of this technology, has its limitations,” Weinstock said. “Only 33% of my patients were 20/20 or better, and 56% were 20/25. So, we definitely have room for improvement, and all of these technologies will hopefully continue to make it better for us to achieve these outcomes.” – by Matt Hasson