Femtosecond laser marking system helps reduce astigmatism, improve vision
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BOSTON — The use of iris registration-guided femtosecond laser-assisted capsular marks during toric IOL implantation resulted in reduced astigmatism and good vision outcomes after cataract surgery, according to a study.
At the American Society of Cataract and Refractive Surgery meeting, P. Dee Stephenson, MD, FACS, presented the results of a retrospective study of 365 eyes that underwent cataract surgery with the Ally femtosecond laser system (Lensar). Toric IOL alignment was performed with iris registration-guided capsular marks placed on the capsular rim with IntelliAxis-L (Lensar) and confirmed with ORA intraoperative aberrometry (Alcon).
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“Iris registration compensates for cyclotorsion and aligns the capsular marks on the intended axis,” according to the presentation. “The capsular marks remain visible during the early postoperative period and can, therefore, help recognition of toric IOL rotation and facilitate repositioning, if needed.”
Outcomes measured included corneal astigmatism before surgery compared with refractive astigmatism after surgery, as well as mean uncorrected distance visual acuity (UDVA) and spherical equivalent after surgery.
ORA confirmed the preoperatively calculated spherical equivalent IOL power in 45% of eyes and influenced a change in the preoperative calculations in 43% of eyes. The surgeon implanted the preoperatively calculated IOL power in only 12% of eyes.
There was a statistically significant reduction in astigmatism after toric IOL implantation. Preoperative corneal astigmatism was 0.82 D compared with postoperative refractive astigmatism of 0.31 D (P < .001). All eyes achieved 0.5 D of residual astigmatism or less after surgery, while 50.7% achieved 0.25 D or less, and 26.8% had no residual cylinder. The vectoral mean of astigmatism after surgery was 0.21 D compared with 0.45 D preoperatively.
All eyes achieved UDVA of 20/50 or better after cataract surgery, while 98.9% achieved 20/30 or better, and 50.4% achieved 20/20 or better.
IntelliAxis-L offers the advantage of having a visual guide for toric IOL alignment and postoperative assessment of rotational stability, as well as a reduction in parallax error.
“The alignment of toric IOL using IntelliAxis-L-guided capsular marks in the present study was in agreement with the pseudophakic intraoperative aberrometry measurement,” the presentation said. “Besides accurate corneal measurements and IOL power calculations, precise toric IOL alignment on the intended axis using IntelliAxis-L capsular marks contributed to the excellent outcomes.”
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Stephenson PD, et al. Iris registration-guided femtosecond laser capsular marks to guide toric IOL alignment with intraoperative aberrometry. Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
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