Rotational stability and clinical outcomes of a new one piece toric intraocular lens with anchor-wing haptics

Background To evaluate the safety and efficacy of a new toric intraocular lens (IOL) with anchor-wing haptics. Methods The new toric IOL with anchor-wing haptics (NS60YT, NIDEK Co., Ltd.) was implanted in eligible patients with age-related cataracts with preoperative corneal astigmatism of 1.0 D or greater at a university hospital and two private hospitals in Japan. The following IOL cylinder powers were evaluated: 1.50 D (NS60YT3), 2.25 D (NS60YT4), 3.00 D (NS60YT5) and 4.50 D (NS60YT7). All patients were assessed out to 12 months postoperatively. The primary endpoint was visual acuity (VA) with spherical addition at 6 months postoperatively, and the primary analysis calculated the proportion of eyes with VA with spherical addition of 0.1 logMAR or better. The magnitude of rotation was compared to the intended axis of IOL implantation at each postoperative examination. Adverse events were evaluated for the safety analysis. Results This study enrolled 64 eyes of 53 patients. At 6 months postoperatively, for all IOL powers, VA with spherical addition of 0.1 logMAR or better was achieved in 90% [95% confidence interval (CI): 80–96] of eyes. The mean IOL rotation was 5.3 ± 4.3° at 12 months postoperatively. The mean magnitude of rotation ranged from 1.9° to 2.5° between each postoperative examination from 1 day to 12 months. There were no vision-threatening intraoperative or postoperative complications for the duration of the study. Conclusions The NS60YT IOL remained stable after implantation and was efficacious for treating 1.00 D or greater astigmatism in patients with senile cataracts. Trial registration This study was registered at ClinicalTrials.gov (NCT03242486) on August 8, 2017 - Retrospectively registered.

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.

The Effect of Toric Intraocular Lens Implantation in Irregular Corneal Steep and Flat Meridian

Purpose. To evaluate the effect of toric intraocular lens implantation in cataract patients with irregular corneal steep and flat meridian. Methods. Data of 112 eyes of 78 patients who underwent toric intraocular lens implantation were analyzed retrospectively. Steep meridian deviations (not 180°) and steep and flat meridian deviations (not 90°) were classified as 0, 1–9, 10–19, 20–29, 30–39, and over 30°. Meridian deviation was measured with a sagittal map of a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany) using PicPickTools (NGWIN, Seoul, Korea). Results. Residual astigmatism (D) of 0 (0.51 ± 0.13, 0.55 ± 0.15) and 1–9 (0.61 ± 0.16, 0.66 ± 0.19) groups were significantly lower than that of 10–19 (0.92 ± 0.24, 0.90 ± 0.28), 20–29 (0.10 ± 0.32, 1.01 ± 0.35), and over 30° groups (1.12 ± 0.37, 1.14 ± 0.40) both in steep meridian deviations and horizontal and vertical meridian deviations at 6 months ( P < 0.05 ). Postoperative mean UCVA (logMAR) of 0 (0.09 ± 0.04, 0.09 ± 0.05) (logMAR) and 1–9 (0.10 ± 0.04, 0.11 ± 0.08) groups was significantly improved compared to that of 10–19 (0.14 ± 0.05, 0.17 ± 0.10), 20–29 (0.18 ± 0.08, 0.21 ± 0.10), and over 30° groups (0.20 ± 0.09, 0.22 ± 0.11) both in steep meridian deviations and horizontal and vertical meridian deviations at 6 months ( P < 0.05 ). Conclusions. Correction of astigmatism with toric intraocular lens implantation is not accurate in corneas with steep meridian deviations and steep and flat meridian deviations of more than 10°. Therefore, care should be taken when we perform toric intraocular lens implantation in patients with irregular corneal meridian.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

Purpose: To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). Methods: This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. Results: The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group ( p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and −1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. Conclusions: This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients’ satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Long-term changes in the refractive effect of a toric intraocular lens on astigmatism correction

Purpose To examine the long-term changes in the astigmatism-correcting effect of a toric intraocular lens (IOL) after stabilization of surgically induced astigmatic changes due to cataract surgery. Methods Unilateral eyes of 120 patients that received a toric IOL for against-the-rule (ATR) or with-the-rule (WTR) astigmatism were enrolled. Manifest refractive and anterior corneal astigmatism, and ocular residual astigmatism which is mainly derived from internal optics were examined preoperatively, at approximately 2 months postoperatively (baseline) and at 5 ~ 10 years postbaseline. The astigmatism was decomposed to vertical/horizontal (Rx) and oblique components (Ry), which was compared between baseline and 5 ~ 10 years postbaseline. Results In the eyes having ATR astigmatism, the mean Rx and Ry of the manifest refractive and corneal astigmatism significantly changed toward ATR astigmatism between the baseline and 5 ~ 10 years postbaseline (p ≤ 0.0304), but those of ocular residual astigmatism did not change significantly between the 2 time points. In the eyes having WTR astigmatism, the Rx and Ry of refractive, corneal, and ocular residual astigmatism did not change significantly between the 2 time points. Double-angle plots revealed an ATR shift in refractive and corneal astigmatism and no marked change in the ocular residual astigmatism in the eyes with ATR astigmatism, and there is no change in this astigmatism in the eyes with WTR astigmatism. Conclusion The long-term changes with age in the effect of a toric IOL significantly deteriorated due to an ATR shift of corneal astigmatism in the eyes having ATR astigmatism, while it was maintained in eyes having WTR astigmatism, suggesting that ATR astigmatism should be overcorrected.