Early experience of phacoemulsification cataract surgery with Toric IOLS

Hany EL-DefrawyTariq AyoubHadi Zambarakji

Magnitude of the problem

The prevalence of astigmatism increases with age

Approximately 50% of the population older than 60 years has more than 1D of astigmatism

22% of cataract surgery candidates have pre-existing astigmatism exceeding 1.5 D (Hoffer KJ,1980), (Ferrer-Blasco et al 2009)

What are the treatment options?

Peroperative Postoperative

Surgical options

Astigmatic keratotomy Limbal relaxing incisions PRK LASIK Toric IOLs

What are the Disadvantages of other modalities?

LRI Astigmatic keratotomy PRK LASIK

Purpose: To evaluate toric IOL efficacy in treating corneal astigmatism

Method: Retrospective pilot study of 7 patients (11 eyes) who underwent phacoemulsification and Toric IOL at WX

• Inclusion criteria1. Visually significant cataract2. Regular corneal astigmatism 3D or more3. Pharmacologic mydriasis of at least 6 mm to allow

intraoperative and postoperative visualisation of axis marks4. Intact capsular bag for in the bag implantation at the end of

surgery• Exclusion criteria1. Corneal scarring2. Advanced glaucoma3. Significant macular disease4. Irregular astigmatism

Preoperative assessment

1. Complete ophthalmic examination

2. Logmar UCVA and BCVA

3. Manifest Refraction

4. Slitlamp examination

5. Keratometry and Biometry using IOLMaster

6. Toric cylindrer power and axis placement was provided by manufacturer.

Postoperative follow up

All patients were evaluated at one day to assess the lens position

A refraction was done at one day and one month

One patient required reposition of the IOL

Toric IOL

1. Reversible and adjustable

2. Predictable and effective

Surgical tips

Preoperative reference marking ? Intraoperative reference marking Incision location Meticulous removal of OVD with attention to

avoid rotation of the IOL Lens alignment

Post operative spherical error

Postoperative cylinder

Mean -0.069 -0.91

Standard deviation

0.63 0.56

Range -1.25 to 0.75 -2.25 to -0.25

Preoperative spherical error

Preoperative cylinder

Mean -2.55 -3.20

Standard deviation

5.28 0.93

Range -14 to 4.25 -5 to 1.5

Results

Paired T testP =0.141>0.05

Paired T testP<0.001

Refraction(pre-Operation)

-6

-5

-4

-3

-2

-1

0

-15 -13 -11 -9 -7 -5 -3 -1 1 3 5Spherical

Cylindrical

Refraction(post-Operation)

-2.5

-2

-1.5

-1

-0.5

0

-1.5 -1 -0.5 0 0.5 1Spherical

Cylindrical

Refraction(pre & post-Operation)

-6

-5

-4

-3

-2

-1

0

-15 -13 -11 -9 -7 -5 -3 -1 1 3 5Spherical

Cylindrical

Spherical(pre) Cylindrical(pre) Spherical(post) Cylindrical(post)

Paired T testP<0.001

Drawbacks of this study

Small sample size and not powered Non comparative We did not assess the IOL position after 1

month A recent study showed the toric IOL

misalignment from the intended axis occurs mostly during the first month (Mingo Botin etal J Cataract and refractive surgery 2010)