Correction of Astigmatism by a Single-Focus Toric Intraocular Lens during Cataract Surgery: Refractive State and Visual Acuity

Purpose: the main purpose of study is to obtain a better visual outcome after implantation of a monofocal toric IOLs by accurate measurement, calculations and visual assessment.Methods. Fifty eyes with astigmatism of more than 2.5 D were included in a hospital-based prospective study. A biometric evaluation is done by Lenstar. Barette's toric calculation method is used to measure toric IOLs power. In a vertical position, preoperative axis marking was done by both bubble marker and direct slit beam. On table, in a horizontal position, axis marking was reassessed. After phacoemulsification, a monofocal Supra Phob toric IOL was implanted and rotated to match corneal axis marking. Best-corrected visual acuity was measured postoperatively at 1 and 3 months.Results. Reduction of mean of refractive astigmatism was reported postoperatively from 4.0 ± 0.79 preoperatively to 0.7 ± 0.28 at 1 month and 0.6 ± 0.27 at 3 months postoperatively. In whole, 96 % has residual astigmatism less than 1 D at 3 months postoperatively, while 8 % eyes had residual astigmatism more than 1 D. In whole, 76 % patients had IOLs rotation of less than or equal to 5°, 20 % patients had it between 6° and 10° and 4 % eyes had more than 10° at day 7 postoperatively, in which repositioning of IOLs was required.Conclusion. To reduce postoperative residual astigmatism after toric IOLs and to get better results, accurate measurement of parameters and proper calculation are essential.

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Efficacy of Burst Mode Torsional Phacoemulsification in Age-Related Cataract

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v15i1.48655 ◽

2020 ◽

Vol 15 (1) ◽

pp. 94-97

Author(s):

Md Abdullah Al Masum ◽

Md Kamrul Hasan Khan ◽

Zulfikar Hasan ◽

Natasha Kajmina

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Posterior Capsule ◽

Burst Mode ◽

Corrected Visual Acuity ◽

Age Related ◽

Corneal Wound ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Best Corrected Visual Acuity

Introduction: Torsional ultrasound energy and burst mode interrupted energy delivery system are recent advancementsin the technique of phacoemulsification surgery. It has been reported that both these advancementshelpto reduce corneal wound burn and thermal induced endothelial cell loss and thereby helps to achieve excellent early postoperative visual outcome Objectives: To evaluate the efficacy of burst mode torsional phacoemulsification surgery in age-related cataract. Materials and Methods: Prospective observational study of 120 cases that underwent phacoemulsificationcataract surgery in which torsional energy was used in burst mode. Phacoemulsification was performed by “vertical –chop” technique. Intraoperatively corneal wound burn, Descemet’s membrane detachment, posterior capsule ruptureetc.were evaluated. Postoperatively corneal oedema, best corrected visual acuity, cystoid macular oedema were evaluated. Postoperatively eyes were examined at day 1, 1 week, 6 weeks and 3 months. Results: Mean age of the patients was 57.28± 8.20 years. Most of the patients 81(67.5%) had nuclear sclerosis grade-II cataract.Intraoperatively, moderate wound burn occurred in 02(1.6%) eyes, localized Descemet’s membrane detachmentin 03(2.5%) eyes and posterior capsule rupture occurred in 03(2.5%) cases. Postoperatively, moderate and severe corneal edema was found in 06(5.0%) and 04(3.3%) eyes respectively at day 1. At the end of 3 months follow-up, 114(95%) eyes maintained a best corrected visual acuity of ≥ 6/18, of which 109(90.8%) eyes achieved ≥ 6/9. Conclusion: Burst mode torsional phacoemulsfication is a very effective and advanced technique of cataract surgery. Intraoperative complications are very less and visual outcome is excellent. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 94-97

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Retro-pupillary iris fixated intraocular lens: A boon to aphakia

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.082 ◽

2021 ◽

Vol 7 (2) ◽

pp. 415-418

Author(s):

Subramanya K Giliyar ◽

Ravi Bypareddy ◽

Kamakshi N Moger ◽

Vinutha Moger ◽

Deeksha Bekal

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Intraocular Lens ◽

Simple Procedure ◽

Visual Outcome ◽

Secondary Outcome ◽

Corrected Visual Acuity ◽

Corneal Decompensation ◽

Best Corrected Visual Acuity ◽

Capsular Support

To evaluate post operative visual outcome and complications of retro-pupillary iris fixated Intracoular lens (IOL) in aphakia. This is a prospective interventional case study conducted at our tertiary eye care centre from March 2018 to February 2019 All monocular aphakias secondary to any cause with no capsular support, good iris diaphragm support and BCVA of better than 6/60 were included. Patients who required combined procedures like trabeculectomy and retinal procedure were excluded. Patients with poor endothelial count/ corneal decompensation, any posterior segment pathologies, pre existing glaucoma and any form of uveitis were also excluded from the study. Pre operative visual acuity, slit lamp examination and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris claw lens were done. The primary outcome was to assess the post operative visual acuity and secondary outcome was to analyse post operative complications at various intervals up to 6 months after surgery. Our study comprised of thirty eyes of 30 aphakic patients. RPIFIOL was inserted as primary intraocular lens in 18 patients (%) and secondary intraocular lens in 12 patients(%). Baseline best corrected visual acuity was 0.831±0.66 logMAR. Four patients had light perception at baseline. The mean best corrected visual acuity was 0.77±0.35 logMAR at month 1, 0.64±0.36logmAR at month 3 and 0.53±0.33logmAR at month 6 respectively. Mean intraocular pressure at baseline was 16mmHg. Mean intraocular pressure at month 1, 3 and 6 were 17mmHg, 16mmHg, and 16mmHg. Among the complications, twelve eyes (40%) had significant ovalisation of pupil at post operative month 1 which persisted at month 6, two eyes(6.66%) had transient ocular hypertension (OHT), and none of the eyes progressed to glaucoma. Choroidal detachment was noted in 2 eyes (6.66%), CME in 3 eyes (9.99%), 1 eye (3.33%) had retinal detachment and 2 eyes (6.66%) had one haptic disenclavation. Among the complications, ovalisation of pupil was the most common observed one. Retro-pupillary Iris fixated IOL is an effective, safe and simple procedure for management of aphakia in eyes with no posterior capsular support.

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MACULAR CHANGES AFTER CATARACT SURGERY: A PROSPECTIVE STUDY.

10.36106/ijsr/1903725 ◽

2019 ◽

pp. 1-3

Author(s):

Ritu Agarwal ◽

Piyush Gupta*

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Visual Outcome ◽

Macular Thickness ◽

Small Incision Cataract Surgery ◽

Corrected Visual Acuity ◽

Group A ◽

Group B ◽

A Prospective Study ◽

Final Visual Outcome

AIM: To evaluate and compare macular thickness changes after uneventful Phacoemulsification and Manual Small Incision Cataract Surgery in correlation with visual acuity. METHOD: Study was conducted on 250 cataract patients they were equally divided into Group A and Group B. Group A patients underwent Phacoemulsification and Group B underwent MSICS. In both groups macular thickness using OCTand Best Corrected Visual Acuity (BCVA) was recorded preoperatively and postoperatively at 1 day, 1, 3, 6 weeks, 3 and 6 months. Macular thickness changes were evaluated and compared with visual acuity. RESULTS: Macular thickness continued to increase from 1 week to 6 months postoperatively which was statistically significant. No correlation found between increased macular thickness and BCVA. CONCLUSION: Increase in macular thickness remained subclinical and there was no impact of increased macular thickness on the final visual outcome.

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Visual outcome following scleral fixated intraocular lens implantation

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v16i2.18478 ◽

2017 ◽

Vol 16 (2) ◽

pp. 63-68

Author(s):

Chunu Shrestha ◽

Sabina Shrestha ◽

Aparajita Manoranjan

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Visual Outcome ◽

Posterior Chamber ◽

Visual Rehabilitation ◽

Post Surgery ◽

Corrected Visual Acuity ◽

The Common ◽

Best Corrected Visual Acuity ◽

Scleral Fixated Intraocular Lens

Introduction: Scleral fixated intraocular lens(SFIOL) implantation to correct aphakia offers superior visual rehabilitation in comparison to aphakic spectacles or contact lens. This study was done to evaluate a simplified technique of scleral fixation of posterior chamber intra-ocular lens (IOL) in terms of visual outcome and complications.Methods: This was a prospective study enrolling 23 eyes of 23 patients who underwent anterior vitrectomy followed by ab-externo sclera fixation of posterior chamber IOL using 10.0 polypropylene sutures from January 2016 to February 2017 in Nepal Eye Hospital.Scleral flap was made at 3 and 9'o clock meridian to cover the knots which prevent erosion of the knots through conjunctiva. Main outcome measures were post-operative best corrected visual acuity and post-operative complications.Result: Best corrected visual acuity were 6/6 - 6/18 in 86.9% (n=20), 6/24 - 6/60 in 8.7% (n=2) and worse than 6/60 in 4.3% (n=1)at six months followup. The mean spherical equivalent before surgery was +10.60 diopter and -1.14 diopter post-surgery. The common indicationsfor scleral fixated intraocular lens weretrauma in 60.86% (n=14), surgical aphakia in21.73% (n=5), spontaneous posterior dislocation of lens in 13.0% (n=3) and subluxated intraocular lens in 4.34% (n=1). The common complications were astigmatism in 91.30% (n=21), decentered IOL in 4.34% (n=1) and uveitis in 4.35% (n=1).Conclusion: Ab-externosclerated fixated intraocular lens is a safe and effective method for visual rehabilitation with low post-operative risk.

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Astigmatism correction in highly hyperopic patients - which way to choose?

Ophthalmology journal ◽

10.17816/ov201429-12 ◽

2014 ◽

Vol 7 (2) ◽

pp. 9-12 ◽

Cited By ~ 1

Author(s):

Sergey Yuryevich Astakhov ◽

Kirill Vladimirovich Khripun

Keyword(s):

Visual Acuity ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Fellow Eye ◽

Laser Iridotomy ◽

Astigmatism Correction ◽

Uncorrected Distance Visual Acuity ◽

Toric Iols ◽

Visual Results

Purpose. To assess the efficacy and safety of implanting a supplementary toric intraocular lens (IOL) in the ciliary sulcus in one eye and a toric IOL in the fellow eye in highly hyperopic patients with concomitant astigmatism. Methods. This study included highly hyperopic patients (axial length 21.3-22.0 mm) with concomitant regular corneal astigmatism. The group consist of 6 patients aged from 40 to 76 years. Supplementary IOL (Sulcoflex Toric 653T, Rayner) was implanted in the ciliary sulcus in the pseudophakic eye 1 month after previous phacoemulsification surgery. A toric IOL (AcrySof IQ Toric, Alcon) was implanted in the fellow eye. Postoperative follow-up visits were performed at 1 week, 1 month and 6 months. Results. Postoperatively, in all patients UDVA (uncorrected distance visual acuity) improved and remained stable throughout the follow-up period. Lower visual acuity in the eyes with toric IOLs is associated with errors in IOL calculation, occurring often in “short eyes”. Conclusion. Using different IOL types for astigmatism correction in highly hyperopic patients is justified and can give good visual results. A “short eye” is not a contraindication for supplementary IOL implantation, but it is necessary to perform laser iridotomy to minimize the risk of pupillary block.

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Clinical Study of Visual Outcome and Complications of Nd:YAG Laser Capsulotomy in Posterior Capsular Opacification Following Small Incision Cataract Surgery at a Tertiary Eye Care Centre in Rural Maharashtra - A Prospective Observational Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/268 ◽

2021 ◽

Vol 8 (19) ◽

pp. 1409-1413

Author(s):

Varsha Ramesh Dhakne ◽

Sourabh Hanumant Karad ◽

Samartha Babasaheb Waghambare ◽

Hanumant Tulshiram Karad ◽

Uttam Haribhau Nisale ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Nd:Yag Laser ◽

Visual Outcome ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Posterior Capsular Opacification ◽

Corrected Visual Acuity ◽

Nd:Yag Laser Capsulotomy ◽

Best Corrected Visual Acuity

BACKGROUND Posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. Nd:YAG (Neodymium yttrium aluminium garnet) laser posterior capsulotomy presents the advantages of a non-invasive, effective, relatively safe technique to manage intact posterior capsule that opacifies postoperatively. With this background we want to study the visual outcome and complications following Nd-YAG laser posterior capsulotomy in posterior capsular opacification following small incision cataract surgery (SICS). METHODS The study includes 64 patients attending outpatient department of a tertiary eye care hospital at Latur from June 2018 to May 2019 who have undergone SICS with PMMA PC IOL (polymethyl methacrylate posterior chamber intraocular lens) implantation and clinically diagnosed with posterior capsular opacification. 64 eyes with PCO were subjected to Nd:YAG laser posterior capsulotomy after detailed slit lamp bio microscopic examination pre- and post-capsulotomy. Follow-up was done at 1 hour, 1 week, 2 weeks and 4 weeks and patients were examined for visual outcome and any complications at each visit. RESULTS There were 16 males (25 %) and 48 females (75 %) with a mean age of 65 years. Posterior capsule opacification occurs within 3 years accounting for 46.9 % of the cases. Elschnig pearls type of PCO was more common when compared to fibrous type of PCO. Best corrected visual acuity (BCVA) before Nd:YAG laser capsulotomy was less than 6 / 60 in 35 patients (54.7 %) and within 6 / 60 to 6 / 24 in 23 patients (35. 9 %) with 6 patients (9.4 %) accounting for visual acuity between 6 / 24 to 6 / 18. After Nd - YAG Laser Capsulotomy, 46.9 % gained best corrected visual acuity of 6 / 18 or better, 39.1 % cases improved 6 / 12 and better and BCVA of 6 / 9, 6 / 6 was observed in 11 cases and 1 case respectively. Only 12 out of 64 patients had complications. Raised intraocular pressure (IOP) was found in 4 patients. Intraocular lens (IOL) pitting was found in 8 patients. CONCLUSIONS Nd:YAG laser capsulotomy is a safe, effective and a non-invasive procedure which avoids all the complications of surgical capsulotomy in patients of posterior capsule opacification. KEYWORDS Posterior capsule opacification (PCO), Nd:Yag Laser Capsulotomy, Best Corrected Visual Acuity (BCVA), Central Subfield Macular Thickness (CSMT)

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Visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a teaching hospital in Malaysia: a 5-year experience

10.21203/rs.2.140/v1 ◽

2018 ◽

Author(s):

Hussein Waheeda-Azwa ◽

Ibrahim Norihan ◽

Evelyn Li Min Tai ◽

Yee Cheng Kueh ◽

Ismail Shatriah

Keyword(s):

Visual Acuity ◽

Surgical Outcome ◽

Age Of Onset ◽

East Asian ◽

Visual Outcome ◽

Strabismus Surgery ◽

Factors Influencing ◽

Corrected Visual Acuity ◽

Post Operative Period ◽

Best Corrected Visual Acuity

Abstract Background: The available data on strabismus surgery in South East Asian countries is scarce. This study aimed to identify visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a South East Asian cohort. Methods: A retrospective review of patients who underwent horizontal strabismus surgery between 2013 and 2017 in Hospital Universiti Sains Malaysia was conducted. Surgery was considered successful if the post-operative deviation was within 10 prism dioptres at six months post-operative period. Factors influencing outcome of surgery at six months were identified. Chi-square and Fisher exact test were used in data analysis. Results: 98 patients were included. Both genders were equally affected. Exotropia (58.2%) was the most common type. 65.3% of patients had alternating strabismus, while 51.0% had angle of deviation more than 45 prism diopters. Amblyopia was documented in 14.3% of patients. Those operated upon below 10 years of age comprised 64.3%. Ninety four patients completed follow-ups at six months after the surgery. The success rate was 81.6%. Approximately 92% of the patients had best corrected visual acuities of 6/12 and better at six months post-operative period. There was no significant association between age of onset, gender, presence of amblyopia, type of deviation, amount of deviation and post-operative best corrected visual acuity with surgical outcome at six months post-operative period (p>0.05). Conclusions: The success rate was good. Post-operative best corrected visual acuity was promising. Age of onset, gender, presence of amblyopia, type of deviation, amount of deviation and post-operative best corrected visual acuity did not influence the outcome of horizontal strabismus surgery in our review. Keywords: Visual outcome, horizontal strabismus surgery, factors influencing surgical outcome

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Toric intraocular lens for correction of high corneal astigmatism in cataract patients

International Eye Research ◽

10.18240/ier.2020.02.04 ◽

2020 ◽

Vol 1 (2) ◽

pp. 83-88

Author(s):

Irene Simo ◽

◽

Laura Remón ◽

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Medical Engineering ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Corrected Visual Acuity ◽

Uncorrected Visual Acuity ◽

Before And After ◽

The Mean ◽

Axis Rotation

AIM: To evaluate the efficacy of Bi-Flex toric intraocular lens (T-IOL; Medicontur, Medical Engineering, Ltd., Inc.) implantation to correct preexisting astigmatism in patients having cataract surgery. METHODS: This retrospective consecutive study included 22 eyes of 16 patients with more than 2.50 diopters (D) of corneal preexisting astigmatism having cataract. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction and keratometric and topographic cylinder were measured. Postoperative the toric IOL axis was evaluated using vector analysis. RESULTS: Postoperatively, subjective refractive cylinder was reduced significant (P<0.05) from 4.05±1.53 D to 1.35±0.86 D. The component J0 reduced in magnitude from -0.81±2.02 D to -0.12±0.62 D (P<0.05). Both, UCVA and BCVA improved significantly at 1mo after surgery (P<0.05 in both cases). After the surgery, the UCVA and BCVA were 0.24±0.19 and 0.06±0.08, respectively. The mean toric IOL axis rotation was 2.95±5.25 degree, with rotation less than 10 degrees in 86.36% of eyes. No differences in mean keratometric values obtained before and after surgery were found (P>0.05 for J0 and J45). CONCLUSION: Implantation of the Bi-Flex toric IOL is a safe and effective method to correct the preexisting regular astigmatism (greater than 2.50D).

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Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations

Vision ◽

10.3390/vision4030041 ◽

2020 ◽

Vol 4 (3) ◽

pp. 41 ◽

Cited By ~ 1

Author(s):

Zahra Ashena ◽

Sundas Maqsood ◽

Syed Naqib Ahmed ◽

Mayank A. Nanavaty

Keyword(s):

Visual Acuity ◽

Visual Function ◽

Negative Impact ◽

Spherical Aberration ◽

Visual Outcome ◽

Intraocular Lenses ◽

Wavefront Aberrations ◽

Complicated Cataract ◽

Toric Iols ◽

Intraocular Lens Tilt

Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2–3° tilt and a 0.2–0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients’ satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt.

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Phacoemulsification Without Hydro-procedure: A Novel Technique to Deal with Posterior Polar Cataracts.

10.21203/rs.3.rs-1142851/v1 ◽

2021 ◽

Author(s):

Narayan Bardoloi ◽

Sandip Sarkar ◽

Himanshu Das ◽

Pankaj Suresh Burgute

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Visual Outcome ◽

Postoperative Outcomes ◽

Novel Technique ◽

Corrected Visual Acuity ◽

Study Population ◽

The Mean ◽

Best Corrected Visual Acuity ◽

Posterior Polar Cataract

Abstract Purpose: To describe a new phacoemulsification technique without hydro-procedures in patients of posterior polar cataract (PPC) and determine the posterior capsular rate (PCR) and postoperative outcomes.Methods: After capsulorhexis, we insert the phacoemulsification probe inside the eye and shave the cortex and epinucleus within the capsulorhexis area. Then the phaco probe is buried deep into the center, and an anteroposterior crack is fashioned. Then the probe is placed at 7’ o clock to chop away a triangular piece of the nucleus. A similar maneuver is done at a 4' o clock position to take out another piece. The phacoemulsification tip and the chopper are now positioned at the cracked site of the lower fragments. Using the 2 instruments, the fragments are now pushed away and easily emulsified.Results: We conducted a retrospective study with 115 eyes of 77 patients. The mean age of the study population was 51.87 + 14.19 years (range 22-87 years). Out of 77 patients, 39 (50.64%) patients had unilateral PPC, and 38 (49.35%) had bilateral PPC. PCR occurred in 9 eyes (7.82%). Two patients had fragment drop, and only 1 (0.87%) patient was left aphakic. Best-corrected visual acuity (BCVA) at postoperative day 30 was 20/20 or better in 102 (88.69%) eyes, 20/32-20/80 was in 11(9.56%) eyes, and BCVA 20/80-20/200 was in 2 (1.73%) eyes.Conclusion: Phacoemulsification without hydro-procedure is a novel technique that can be successfully implemented in PPC cases and expect an excellent visual outcome.

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