This article is more than 5 years old. Information may no longer be current.
Alignment of toric IOLs is key
Click Here to Manage Email Alerts
 The markings on the Alcon AcrySof Toric IOL are carefully aligned with the anterior corneal stromal marks at the 6 o'clock position. |
Corneal astigmatism must be addressed during or after cataract surgery in order to provide the best vision for our patients with the least dependence on glasses. For most patients with lower degrees of astigmatism, I typically use limbal relaxing incisions to address the corneal astigmatism and provide sharp vision without glasses. But for larger degrees of astigmatism, such as 2 D or more of corneal cylinder, I usually prefer to implant a toric IOL. The toric IOL can correct the astigmatism quite accurately, provided that the lens is properly aligned. For a 10° rotation of the toric lens, about 30% of its effect is lost. Accuracy is key.
Byron Stratas, MD, taught me a technique of using a cystotome to perform anterior corneal stromal puncture at the axis of alignment. This provides an accurate alignment mark that does not wash away or drift. And it can be done at the slit lamp before the surgery, with a high degree of accuracy. Then, intraoperatively, I simply align the toric IOL markings with the corneal anterior stromal markings, and I'm done. Care is taken to remove all viscoelastic from behind the IOL and to gently press the IOL against the posterior capsule to tack it in place. A strong red reflex from the operating microscope helps with visualizing these markings and ensuring proper alignment. The result is an accurate correction of the astigmatism and a happy patient with sharp distance vision without glasses. Thanks, Byron, for the great idea.