scholarly journals Two Different Corneal Incision Designs for Correcting Corneal Astigmatism During Cataract Surgery With Multifocal Intraocular Lens Implantation

2021 ◽  
Author(s):  
Dan Liu ◽  
Cong Fan ◽  
Chunyan Li ◽  
Jian Jiang
Keyword(s):  
Cataract Surgery ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Corneal Incision ◽  
Multifocal Iol ◽  
Clear Corneal Incision ◽  
Corneal Aberrations ◽  
Multifocal Intraocular Lenses ◽  
Post Surgery ◽  
The Mean

Abstract Background: Multifocal intraocular lenses (IOLs) is very intolerant to residual corneal astigmatism and patients with more than 1.0 D of residual corneal astigmatism are not suitable candidates for implantation of multifocal IOLs. The purpose of this study was to evaluate the efficacy of a single clear corneal incision (CCI) or an opposite clear corneal incision (OCCI) made on a steep meridian for correction of low to moderate corneal astigmatism during implantation of multifocal IOLs.Methods: This is a retrospective cohort study. A total of 80 patients with pre-operative total corneal astigmatism, ranging between 0.5 and 2.0 diopters (D), who underwent cataract surgery and received multifocal IOLs were included. Correction of corneal astigmatism was done via single CCIs on steep meridians in patients with 0.5–1.2 D total corneal astigmatisms, and OCCIs in patients with 1.3–2.0 D total corneal astigmatisms. Visual acuity, corneal astigmatism, ocular aberrations, corneal aberrations, and subjective vision quality were evaluated after surgery.Results: At 12-weeks post-surgery, the mean uncorrected distance vision acuity (UDVA) was 0.06±0.09 logarithm of the minimum angle of resolution (logMAR) and 0.03±0.09 logMAR, and the mean uncorrected near vision acuity(UNVA) was 0.08±0.11 logMAR and 0.09±0.09 logMAR in the CCI and OCCI groups, respectively. The change in corneal astigmatism was 0.52 ± 0.22D and 1.06 ± 0.23D in the CCI and OCCI groups, respectively (P<0.001). Total corneal higher-order aberrations (HOAs) and trefoil increased in both groups (P<0.05); however, there was no difference in the change in total corneal HOAs between the two groups (P>0.05). Conclusions: CCI and OCCI made on a steep axis could be an option for correction of mild-to-moderate astigmatism during cataract surgery with multifocal IOL implantation.

scholarly journals Two Different Corneal Incision Designs for Correcting Corneal Astigmatism During Cataract Surgery With Multifocal Intraocular Lens Implantation

2021 ◽  
Author(s):  
Dan Liu ◽  
Cong Fan ◽  
Chunyan Li ◽  
Jian Jiang
Keyword(s):  
Cataract Surgery ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Corneal Incision ◽  
Multifocal Iol ◽  
Clear Corneal Incision ◽  
Corneal Aberrations ◽  
Multifocal Intraocular Lenses ◽  
Post Surgery ◽  
The Mean

Abstract Background: Multifocal intraocular lenses (IOLs) is very intolerant to residual corneal astigmatism and patients with more than 1.0 D of residual corneal astigmatism are not suitable candidates for implantation of multifocal IOLs. The purpose of this study was to evaluate the efficacy of a single clear corneal incision (CCI) or an opposite clear corneal incision (OCCI) made on a steep meridian for correction of low to moderate corneal astigmatism during implantation of multifocal IOLs.Methods: This is a retrospective cohort study. A total of 50 patients with pre-operative total corneal astigmatism, ranging between 0.5 and 2.0 diopters (D), who underwent cataract surgery and received multifocal IOLs were included. Correction of corneal astigmatism was done via single CCIs on steep meridians in patients with 0.5–1.2 D total corneal astigmatisms, and OCCIs in patients with 1.3–2.0 D total corneal astigmatisms. Visual acuity, corneal astigmatism, ocular aberrations, corneal aberrations, and subjective vision quality were evaluated after surgery.Results: At 12-weeks post-surgery, the mean uncorrected distance vision (UCDV) was 0.06±0.09 logarithm of the minimum angle of resolution (logMAR) and 0.03±0.09 logMAR, and the mean uncorrected near vision (UCNV) was 0.08±0.11 logMAR and 0.09±0.09 logMAR in the CCI and OCCI groups, respectively. The change in corneal astigmatism was 0.52 ± 0.22D and 1.06 ± 0.23D in the CCI and OCCI groups, respectively (P<0.001). Total corneal higher-order aberrations (HOAs) and trefoil increased in both groups (P<0.05); however, there was no difference in the change in total corneal HOAs between the two groups (P>0.05). Conclusions: CCI and OCCI made on a steep axis could be an option for correction of mild-to-moderate astigmatism during cataract surgery with multifocal IOL implantation.

scholarly journals Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Ernest ◽  
Warren Hill ◽  
Richard Potvin
Keyword(s):  
Cataract Surgery ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Corneal Incision ◽  
Surgically Induced Astigmatism ◽  
Clear Corneal Incision ◽  
Refractive Outcomes ◽  
Induced Astigmatism ◽  
Surgically Induced ◽  
Corneal Incisions

Purpose. To compare the surgically induced astigmatism from clear corneal and square posterior limbal incisions at the time of cataract surgery.Methods. Surgically induced astigmatism was calculated for a set of eyes after cataract surgery using a temporal 2.2 mm square posterior limbal incision. Results were compared to similar available data from surgeons using clear corneal incisions of similar size.Results. Preoperative corneal astigmatism averaged 1.0 D and was not significantly different between the incision types. Surgically induced astigmatism with the 2.2 mm posterior limbal incision averaged0.25±0.14 D, significantly lower in magnitude than the aggregate surgically induced astigmatism produced by the 2.2 mm clear corneal incision (0.68±0.49 D).Conclusion. The 2.2 mm square posterior limbal incision induced significantly less, and significantly less variable, surgically induced astigmatism relative to a similar-sized clear corneal incision. This is likely to improve refractive outcomes, particularly important with regard to premium intraocular lenses.

scholarly journals Toric Intraocular Lenses for the Management of Corneal Astigmatism at the Time of Cataract Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Colm McAlinden ◽  
David Janicek
Keyword(s):  
Cataract Surgery ◽  
Human Error ◽  
Data Entry ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Vector Analysis ◽  
Corneal Incision ◽  
Toric Iol ◽  
Iol Power ◽  
The Mean

Aims/Background. To assess astigmatic outcomes with the use of toric intraocular lenses (IOLs) for patients with significant amounts of corneal astigmatism undergoing cataract surgery. Methods. This audit was conducted in a UK ophthalmology department and included 48 eyes of 42 patients. Surgery was performed during 2019 in patients with 2.50 diopters (D) or more corneal astigmatism. Anterior keratometry readings were used to determine the toric IOL power. Vector analysis using the Alpins method was used to assess changes in astigmatism pre to postoperatively. Results. There were 18 right and 26 left eyes included. In terms of gender, 61% of patients were female and 39% were male. The mean (±standard deviation (SD)) age was 70 (±11) years. The mean (±SD) axial length, K1, K2, and delta K was 23.55 (±1.4) mm, 42.71 (±1.39) D, 45.78 (±1.60) D, and 3.01 (±0.89) D, respectively. Postoperatively, the median spherical, cylinder, and spherical equivalent refraction was 0.00 D, −1.00 D, and 0.00 D, respectively. Postoperatively, 41% of the eyes had ≤0.50 D of spectacle astigmatism and 80% had ≤1.00 D. No patient required a secondary procedure to reposition the IOL from rotation. In vector analysis with the use of polar diagrams, there was a tendency for overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. Conclusions. Significant reductions in astigmatism can be achieved with the use of toric IOLs in patients undergoing cataract surgery. Further improvements may be possible with surgeon-specific determination of their surgically induced astigmatism and flattening effect from the main corneal incision. Furthermore, the use of an optical biometer that directly measures the posterior corneal curvature and permits automatic toric IOL power determination with modern formulas avoiding the need for manual data entry may reduce the risk of human error and improve visual and refractive outcomes.

scholarly journals Changes in ocular astigmatism after superotemporal versus temporal clear corneal incision cataract surgery

2021 ◽  
Author(s):  
Qi Fan ◽  
Dongjin Qian ◽  
Zhennan Zhao ◽  
Yongxiang Jiang ◽  
Yi Lu
Keyword(s):  
Cataract Surgery ◽  
Anterior Segment ◽  
Corneal Astigmatism ◽  
Corneal Incision ◽  
Clear Corneal Incision ◽  
Ocular Residual Astigmatism ◽  
Age Related ◽  
Postoperative Astigmatism ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity

Abstract Background The incision site to choose to manage postoperative astigmatism during cataract surgery is still debated. This study investigated corneal and internal astigmatism changes after superotemporal versus temporal clear corneal incision cataract surgery. Methods Patients included were diagnosed between December 2019 and January 2020 with age-related cataract with corneal astigmatism < 1.5 diopters (D) and were divided into two groups: Right Eye Group (R Group, superotemporal incision) and Left Eye Group (L Group, temporal incision). Uncorrected visual acuity, manifest refraction, corneal topography, anterior segment optical coherence tomography were performed pre- and 6 months postoperatively. Total ocular astigmatism, corneal astigmatism, surgically induced corneal astigmatism (SICA), non-corneal ocular residual astigmatism (N-CORA), postoperative intraocular lens (IOL) decentration, and tilt were analysed. Results Thirty-eight subjects were included: 21, R Group; 17, L Group. After surgery, the N-CORA decreased significantly from 1.17 ± 0.72D to 0.73 ± 0.47D in all patients (P = 0.001), 1.03 ± 0.52D to 0.70 ± 0.40D in the R Group (P = 0.005), and 1.35 ± 0.90D to 0.78 ± 0.55D in the L Group (P = 0.033). Significant differences between the R and L groups were found in the postoperative meridian of anterior corneal astigmatism (75.95 ± 52.50 vs 116.79 ± 47.29; P = 0.017), total corneal astigmatism (51.65 ± 42.75 vs 95.20 ± 57.32; P = 0.011), J45 change vector of SICA in the anterior cornea (-0.10 ± 0.18 vs 0.00 ± 0.11; P = 0.048), and total cornea surface (-0.14 ± 0.17 vs 0.03 ± 0.12; P = 0.001). IOL decentration, tilt, and the meridian of IOL tilt were not significantly correlated with N-CORA. Conclusions The N-CORA significantly decreased after cataract surgery. Superotemporal and temporal incisions can cause differences in the meridian components of oblique astigmatism but will not have a significant effect on the magnitude of corneal astigmatism.

scholarly journals Management of Dislocated Intraocular Lenses with Iris Suture

2016 ◽  
Vol 27 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Mun Y. Faria ◽  
Nuno P. Ferreira ◽  
Mario Canastro
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Clinical Signs ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Pigment Dispersion ◽  
Corneal Incision ◽  
The Mean

Purpose Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. Methods In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. Results A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Conclusions Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

Reading and Quality of Life Differences between Tecnis ZCB00 Monofocal and Tecnis ZMB00 Multifocal Intraocular Lenses

2017 ◽  
Vol 27 (4) ◽  
pp. 443-453 ◽  
Author(s):  
Francisco de Asís Bartol-Puyal ◽  
Paula Talavero ◽  
Galadriel Giménez ◽  
Irene Altemir ◽  
José M. Larrosa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cataract Surgery ◽  
Intraocular Lenses ◽  
Life Questionnaire ◽  
Near Vision ◽  
Multifocal Iol ◽  
Multifocal Intraocular Lenses ◽  
Optical Correction ◽  
Monofocal Iol

Purpose To compare the NEI-RQL-42 quality of life questionnaire and the Radner Vissum reading test outcomes after bilateral cataract surgery with implantation of Tecnis ZCB00 monofocal and Tecnis ZMB00 multifocal intraocular lens (IOL). Methods Forty-two eyes of 21 patients who had phacoemulsification were implanted with Tecnis ZCB00 IOL and 82 eyes of 41 patients were implanted with Tecnis ZMB00 IOL. They answered the NEI-RQL-42 questionnaire before cataract surgery and 3 months after it. The Radner Vissum test was performed 3 months after the surgery with optical correction for near vision in patients with monofocal IOL, but without it in patients with multifocal IOL. Results Regarding the NEI-RQL-42 test, the multifocal group obtained better results in items 2, 7, 8, 11, 13, 31, and 40, and in the following categories: near vision, dependence on correction, and suboptimal correction (p<0.05). The monofocal group only showed better results in item 17. As for the Radner Vissum test, the multifocal group obtained significantly better results in phrases 1, 3, 4, and 5, and in the number of incorrect syllables (p<0.05). Conclusions Patients with Tecnis ZMB00 multifocal IOL report a higher quality of life regarding the lack of need for optical correction for near vision in their daily activities, but halos in vision at night. Additionally, patients with multifocal IOL achieve similar or better reading quality at near vision and under photopic lighting conditions than patients with monofocal IOL with near vision optical correction.

scholarly journals Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery

2020 ◽  
Vol 13 (12) ◽  
pp. 1895-1900
Author(s):  
Wei Chen ◽  
Jian Wu ◽  
Yong Wang ◽  
Jing Zhou ◽  
Rong-Rong Zhu ◽  
...  
Keyword(s):  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Corneal Astigmatism ◽  
Corneal Incision ◽  
Surgically Induced Astigmatism ◽  
Clear Corneal Incision ◽  
Case Series Study ◽  
Induced Astigmatism ◽  
Surgically Induced ◽  
Corneal Incisions

AIM: To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. METHODS: This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. RESULTS: Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P<0.01). The surgically-induced astigmatism was 1.02±0.54 D. The correction index (ratio of target induced astigmatism and surgically-induced astigmatism: 0.72±0.36) as well as the magnitude of error (difference between surgically-induced astigmatism and target induced astigmatism: -0.29±0.51) represented a slight under correction. For angle of error, the arithmetic mean was 1.11±13.70, indicating no significant systematic alignment errors. CONCLUSION: Femtosecond-assisted steepest-meridian clear corneal incision is a fast, customizable, adjustable, precise, and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

scholarly journals ASTIGMATISM;

2019 ◽  
Vol 26 (01) ◽  
Author(s):  
MOHAMMAD Alam
Keyword(s):  
Cataract Surgery ◽  
Analytical Study ◽  
Intraocular Lenses ◽  
Slit Lamp ◽  
Corneal Incision ◽  
Clear Corneal Incision ◽  
Age Related ◽  
Iol Power ◽  
Age Range ◽  
Study Setting

Objectives: To evaluate the management of pre-existing astigmatism with 3.2 mm corneal incision on steeper axis during phacoemulsification cataract surgery. Study Design: Analytical study. Setting: Patients undergoing cataract surgery with phacoemulsification in K.D.A Teaching Hospital KMU-IMS Kohat. Period: January, 2016 to July, 2016. Materials and Methods: 50 patients with age related cataract were selected. Out of them 23 (46%) were male and 27 (54%) were female. All the patients were in age range from 49 to 76 years with mean age of 63.2% years. Proper examination with slit lamp was done. Informed consent was obtained from each patient. Proper proforma was made for documentation. Biometry was done for IOL power. Preoperative keratometry was done with Topcon autoref-keratometer. Patients with traumatic eyes, previously operated eyes, vascularised and opacified cornea were excluded from the study. Pupils of patients were dilated properly with tropicamide eye drop.  Phacoemulsification with 3.2 mm clear corneal incision at steeper axis with intraocular lenses implantation was carried out on all patients by single surgeon under topical anesthesia. Postoperative keratometry was done on the same keratometer and observer to avoid bias at the end of two months. Results: Preoperative astigmatism was present in range of 0.12 diopter cylinder to 3.71 diopter cylinder with mean 1.56 diopter cylinder. At the end of two months mean astigmatism of 0.98 diopter cylinder with range 0.2 diopter cylinder to 2.0 diopter cylinder was noted postoperatively with mean reduction of 0.58 diopter cylinder. Conclusion: Phacoemulsification with 3.2 mm clear corneal incision at steeper axis can correct astigmatism significantly with good emmetropic results.

COMPARISON OF ASTIGMATIC OUTCOMES AFTER PHACOEMULSIFICATION WITH SUPERIOR, TEMPORAL OR OBLIQUE CLEAR CORNEAL INCISIONS: A RANDOMIZED PROSPECTIVE TRIAL

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Kapil Chopra ◽  
Neelima Mehrotra ◽  
Akhil Agarwal ◽  
Arvind Ram ◽  
B. D. Sharma ◽  
...  
Keyword(s):  
Prospective Trial ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Chi Square ◽  
Corneal Incision ◽  
Vector Method ◽  
Clear Corneal Incision ◽  
Chi Square Test ◽  
Randomized Prospective Trial ◽  
Induced Astigmatism

<bold>Introduction :</bold> A variety of modalities are available presently to deal with astigmatism in relation to phacoemulsification surgery. Of these, toric intraocular lenses are expensive, limbal Paper Submission Daterelaxing incisions are unpredictable and both of these cater to a limited dioptric range and type of astigmatism. Simply planning the incision according to pre-existing corneal astigmatism is an economical and rationale way of addressing this issue. To compare residual post operative astigmatism after phacoemulsification with foldable IOL’simplantation with different sites of clear corneal incision in patients with pre-existing astigmatism. <bold>Material and Methods:</bold> Study was done to evaluate residual corneal astigmatism after July 2016 phacoemulsification with foldable intraocular lens implantation from Jan 13 to May 14. A total of 90 eyes of 85 patients were selected having visually significant cataract. Incision was planned on steeper axis on basis of preoperative keratometric values and divided into 3 groups namely, WTR who received superior clear corneal incision (CCI),ATR who received temporal and OBQ received superotemporal or superonasal CCI respectively. Surgically induced astigmatism (SIA) was also calculated by SIA calculator using vector method. Statistical analysis used is Kruskal Wallis test, Chi-square test, F-test. <bold>Results:</bold> Residual corneal astigmatism among the three groups was found to be nonsignificant. Comparison of mean preoperative and postoperative corneal astigmatism between 3 groups came out be statistically significant. <bold>Conclusion:</bold> Study concludes that preoperative astigmatism should always be assessed and addressed peroperatively by suitable incision sites to provide best results.

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