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Timing key to success of repositioning misaligned toric IOLs
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IOL repositioning due to misalignment of toric IOLs should be performed between 1 and 3 weeks after primary surgery, according to a study.
The data of 6,431 eyes implanted with toric IOLs at eight surgical sites in Japan were retrospectively reviewed. Forty-two eyes (0.653%) underwent repositioning surgery at an average of 9.9 ± 7.5 days.
The average degree of misalignment was 32.9°, ranging between 10° and 74°. Mean refractive cylinder was 2.4 D, ranging between 0.5 D and 6.5 D.
After repositioning, misalignment was reduced by 24.1° and refractive cylinder to 1.1 D. The accuracy of reorientation was related in this study to the timing of repositioning and should be done neither too early nor too late, the authors noted. In two eyes that were reoperated 1 day after primary surgery, the IOL re-rotated significantly, requiring a third intervention. Conversely, although successfully performed in most cases, realignment after 3 or more weeks was more difficult because the capsule had already contracted around the IOL and the risk of damaging the zonules was higher.
“Therefore, on the basis of our data suggesting improved accuracy after 1 week and our anecdotal experience that finds rotation to be more challenging later on, we suggest that if repositioning surgery is considered it should be performed between 1 and 3 weeks after primary IOL implantation,” the authors said. – by Michela Cimberle
Disclosure: Oshika reports receiving grants and personal fees from Alcon, Abbott Medical Optics, Santen, Senju, Otsuka, Nidek and Kowa. Please see the study for all other authors’ relevant financial disclosures.
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