Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism

AIM:To investigate and compare the quality of life,satisfaction,contrast sensitivity,glare,depth perception,and intraocular lens(IOL)rotation in patients who underwent trifocal toric and bifocal toric IOLs.METHODS:A total of 80 eyes of 40 patients were included in this prospective study.Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL,respectively.Preoperative and postoperative 6-month measurements were recorded for both patient groups.Comprehensive anterior and posterior segment examinations,distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations.Patient satisfaction,contrast sensitivity,glare,intermediate-near and distance stereopsis and IOL rotation were also evaluated.RESULTS:No significant difference was found between the groups in terms of distance and near visual acuities(P=0.269,P=0.451).Intermediate visual acuity was significantly increased in the trifocal toric group(P<0.001).The visual function scale results were increased after surgery in both groups(P=0.001 and P<0.001),with no difference determined between them(P=0.158 and P=0.691).The number of patients wearing glasses was low in both groups and there was no significant difference between the groups(P>0.05).The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group(P=0.03).The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions(1.80±0.24 logU,1.74±0.20 logU).Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group(P=0.02,0.048,0.003,respectively).Although there was no significant difference for 3 meters stereopsis,the trifocal toric group had higher depth perception(P=0.577).Mean rotation was 5.76°±3.93°in the trifocal toric group and 12°±7.1°in the bifocal toric group.CONCLUSION:Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery.Moreover,the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system.METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of Acry Sof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes,T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), residual refractive cylinder and intraocular lens(IOL) axis rotation.Objective optical quality were measured using optical quality analysis system(OQAS Ⅱ, Visiometrics, Spain),included the cutoff frequency of modulation transfer function(MTFcutoff), objective scattering index(OSI),Strehl ratio, optical quality analysis system value(OV)100%, OV 20% and OV 9% [the optical quality analysis system(OQAS) values at contrasts of 100%, 20%, and 9%].RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18 ±0.11 and 0.07 ±0.08 log MAR; the mean residual refractive cylinder was 0.50 ±0.29 D; the mean toric IOL axis rotation was 3.62 ±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV9% were 22.862 ±5.584, 1.80 ±0.84, 0.155 ±0.038, 0.76 ±0.18,0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%,OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different(P 】0.05), except the residual refractive cylinder(P 【0.05).CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of Acry Sof toric IOL implantation. Implantation of an Acry Sof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.

Comparison of two different methods of preoperative marking for toric intraocular lens implantation： bubble marker versus pendulum marker

AIM： To compare the accuracy of two different methods of preoperative marking for toric intraocular lens（IOL） implantation, bubble marker versus pendulum marker, as a means of establishing the reference point for the final alignment of the toric IOL to achieve an outcome as close as possible to emmetropia.·METHODS： Toric IOLs were implanted in 180 eyes of110 patients. One group（55 patients） had preoperative marking of both eyes done with bubble marker（ASICO AE-2791TBL） and the other group（55 patients） with pendulum marker（Rumex 誖 3-193）. Reference marks were placed at 3-, 6-, and 9-o＇clock positions on the limbus. Slit-lamp photographs were analyzed using Adobe Photoshop（version 7.0）. Amount of alignment error（in degrees） induced in each group was measured.· RESULTS： Mean absolute rotation error in the preoperative marking in the horizontal axis was 2.42±1.71 in the bubble marker group and 2.83 ±2.31 in the pendulum marker group（P =0.501）. Sixty percent of the pendulum group and 70% of the bubble group had rotation error ≤3（P =0.589）, and 90% eyes of the pendulum group and 96.7% of the bubble group had rotation error ≤5（P =0.612）.·CONCLUSION： Both preoperative marking techniques result in approximately 3 of alignment error. Both marking techniques are simple, predictable, reproducible and easy to perform.

Combination of Toric and multifocal intraocular lens implantation in bilateral cataract patients with unilateral astigmatism

AIM： To assess the binocular visual function in bilateral cataract patients with unilateral astigmatism after combined implantations of Toric with multifocal intraocular lens （IOL）, and to compare with that of Toric and monofocal IOL implantation.METHODS： All the 30 patients with unilateral astigmatism suffered bilateral cataract were randomly divided into two groups： Toric plus multifocal IOL group and Toric plus monofocal IOL group. Uncorrected and corrected visual acuity at distance （5.0 m）, intermediate distance （0.6 m）, and near （0.33 m）, contrast sensitivity, and stereopsis were assessed 6mo after surgery. Patients were also surveyed for visual disturbances and spectacle dependence.RESULTS： Binocular uncorrected visual acuity （LogMAR） of Toric/multifocal IOL eyes at distance, intermediate, near were 0.05±0.05, 0.24±0.10, and 0.14±0.06 respectively. The values of Toric plus monofocal IOL eyes were 0.06±0.07, 0.26±0.08, and 0.37±0.10 respectively. These values did not indicate significant differences between two groups with exception of near visual acuity. In the photopic condition （with or without glare）, the contrast sensitivity of multifocal IOL eyes was significant lower than the monofocal IOL eyes in 18 cpd. In the mesopic condition, the contrast sensitivity of multifocal group was significant lower than monofocal group in 12 cpd, and in mesopic glare condition, this significant difference was found both in 6 cpd and 12 cpd. The stereopsis of Toric/multifocal IOL eyes decreased slightly （100±80 seconds of arc, t=2.222, P=0.136）. Mean near vision for patient satisfaction was statistically significantly higher in Toric/multifocal IOL group patients versus than that in Toric/monofocal IOL group （80% vs 25.5%, P=0.000）. Visual disturbance was not noticed in either group.CONCLUSION： Although the combination of Toric and multifocal IOL implantation results in compromising stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.

Toric markers-assisted implantation of the scleral-fixated intraocular lens

AIM：To evaluate the efficacy of toric intraocular lens markers-assisted implantation of the scleral-fixated intraocular lens（SFIOL）.METHODS：From October 2010 to December 2013,all patients who had undergone secondary SFIOL implantation were assigned to group 1 and 2,in group 1SFIOL was performed with the assist of radial keratotomy（RK）-marker,and in group 2 SFIOL was performed with the assisted of toric intraocular lens markers（T-and axis markers）.Patients＇ demographic data and information on baseline preoperative visual acuity,indication for surgery and latest postoperative visual acuity were collected and analyzed.The haptic and optic positions were determined by ultrasound biomicroscopy.The optic tilt angle and decentration distance were measured.RESULTS：The study evaluated 43 eyes of 43 patients ranging in age from 3 to 66 y.Group 1 comprised 24 eyes（24 patients） and group 2,19 eyes（19 patients）.Uncorrected reoperative acuity was improved on all the eyes postoperatively.The improved postoperative acuity was significantly more in group 2 than that in group 1（1.11 ±0.38 vs 0.82 ±0.45 logMAR;F=4.85,P=0.03）.Ultrasonic biomicrograph examination showed that the rate of haptic asymmetry was significantly higher in group 1（42%,10/24） than that in group 2（11%;2/19）（Chi square=3.68,P=0.04）.The mean tilted degree in group 1was significantly higher than that in group 2（P=0.04）.Mean decentration distance in group 1 was greater than that in group 2（P=0.03）.CONCLUSION：During SFIOL the toric markers help the surgeon identify the placement of fixation more precisely than that with the use of RK marker.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM:To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens(IOL)in eyes with low degrees of corneal astigmatism.METHODS:Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL(FineVision PODFT,PhysIOL s.a.,Liege,Belgium)were enrolled.Phacoemulsification with femtosecond laser,capsular tension ring insertion and intraoperative aberrometry were performed in all cases.All IOLs used showed a cylinder power of 1.00 D.Main outcome measures were refractive error and corrected-distance visual acuity(CDVA)and uncorrected-distance visual acuity(UDVA)values.Eyes were evaluated at 4 mo post-surgery.RESULTS:Totally 50%of eyes showed a spherical equivalent(SE)within±0.13 D and all of them within±0.50 D.The mean SE and refractive cylinder were-0.02±0.23 and-0.16±0.22 D,respectively.Vector analysis revealed that 100%of eyes were within±0.50 D for the SE and cylindrical components(J0 and J45).Refractive changes were not correlated with keratometric changes(P>0.05)showing that the reduction in astigmatism comes from the trifocal toric IOL.Of 81%and 96%of eyes showed UDVA and CDVA of 20/20,respectively.The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02(about 20/20),respectively.CONCLUSION:Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Toric Intraocular Lens vs. Peripheral Corneal Relaxing Incisions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

Purpose:.To compare toric intraocular lens implantation(ToricIOL).with peripheral corneal relaxing incisions(PCRIs) for astigmatism correction in patients undergoing cataract surgery.Methods: 54 patients(54 eyes) with more than 0.75 diopter(D).of preexisting corneal astigmatism were classified as group A(0.75-1.50D) or group B(1.75-2.50D). The patients were randomized to undergo Toric-IOL or PCRIs in the steep axis with spherical IOL implantation..Log MAR uncorrected visual acuity(Log MAR UCVA), Log MAR best corrected vi sual acuity.(Log MAR BCVA),.error of vector(|EV|), surgery induced refraction correction.(|SIRC |),.and correction rates(CR) were measured 1 month and 6 months postoperatively.Results: At 6 months postoperatively, all 54 eyes had LogMAR BCVA≤0.2. Patients who underwent PCRIs and ToricIOL with Log MAR BCVA≤0.1 showed no significant differences in group A(P=1.00) or in group B(P=0.59). Group A showed no significant differences in Log MAR UCVA(P =0.70), |EV|(P=0.13), |SIRC|(P=0.71), and CR(P=0.56)in patients underwent PCRIs and Toric-IOL. However, group B showed significant differences in Log MAR UCVA(P <0.01), |EV|(P<0.01)), |SIRC|(P<0.01), and CR(P<0.01).The Log MAR UCVA and |EV | between 1 and 6 months showed no significant differences in patients in group A. However, in group B, they are significant differences.Conclusion:.The efficacy and stability of Toric-IOL and PCRIs were equal in low astigmatic patients..Toric-IOL achieved an enhanced effect over PCRIs in higher astigmatic patients.PCRIs had the more refractive regression than Toric-IOL in 6months.

The impact of posterior corneal astigmatism on the surgical planning of toric multifocal intraocular lens implantation

Purpose:To investigate the influence of posterior corneal astigmatism on the prediction accuracy of toric multi­focal intraocular lens(IOL)calculation.Methods:The keratometric astigmatism measured by Lenstar LS 900(KCA_(L)),keratometric astigmatism(KCAp)and total corneal astigmatism(TCA)measured by Scheimpflug camera(Pentacam HR)were documented and analyzed accordingly.Three deduction models using different parameters were compared.Model 1:KCA_(L)+keratometric comeal surgically induced astigmatism(KCSIA,0.30 D@50°);Model 2:KCA_(P)+KCSIA);Model 3:TCA 4-total CSIA(TCSIA,0.23 D@50°).The prediction errors of each model as the difference vector between the actual and the intended residual astigmatism were compared.Results:Seventy-six eyes implanted with toric multifocal IOLs were included in this study.The vector differences of the actual KCSIA and TCSIA were statistically significant in the total sample and against-the-rule(ATR)sub­group(both P<0.05).Model 1 deduced the smallest mean values of prediction error,while that of Model 3 were smaller than that of Model 2,both in the total sample and the ATR subgroups(all P<0.05).Meanwhile,in the total sample and ATR subgroups,the centroid vector magnitudes of Model 3 were smaller than that of Model 1(0.31±0.76 D and 0.39±0.76 D).Conclusions:The calculation of toric multifocal IOL should be individualized especially in the ATR eyes for the impact of PCA on the estimation of the preoperative comeal astigmatism and the CSIA.

Toric IOL矫正角膜散光效果的影响因素分析

白内障超声乳化联合人工晶状体(IOL)植入术是目前治疗白内障的有效方法之一,随着白内障手术技术的发展,传统白内障手术已从复明手术逐渐转变为屈光手术。散光矫正型人工晶状体(Toric IOL)的临床应用有效减小了患者的角膜散光,改善了患者的术后视觉效果。Toric IOL的矫正效果受多元因素的共同作用,包括术前生物测量的准确性,个体化选择合适的Toric IOL计算公式,植入轴位的精确度,手术切口的设计以及Toric IOL的旋转稳定性等。文章将对影响Toric IOL矫正角膜散光效果的因素做一综述。

飞秒激光辅助超乳联合Toric IOL植入术矫正高度近视白内障合并角膜规则散光

目的:通过飞秒激光技术,量化撕囊口直径,测量高度近视白内障合并角膜散光患者术后远、中、近视力,近立体视功能等指标,评估Toric IOL在高度近视的可行性及必要性。方法:前瞻性病例对照研究。选择我院双眼高度近视白内障合并角膜规则散光,并双眼均接受飞秒激光辅助白内障手术的患者,按人工晶状体不同分为两组:A组:Toric IOL组20例40眼,B组:IQ IOL组20例40眼。对比两组患者术前角膜散光、等效球镜及术后7d,1、3mo最佳矫正远视力、裸眼中视力、近视力、实际残留散光、近立体视锐度、全眼高阶像差、全眼球差等指标。结果:高度近视白内障合并角膜散光患者植入Toric IOL,较IQ组,显著改善了术后7d,1、3mo裸眼中、近视力,Titmus近立体视锐度及残留散光度(均P<0.05),减少了术后对眼镜的依赖程度;而术后7d,1、3mo两组最佳矫正远视力、全眼高阶像差及全眼球差无差异(均P>0.05)。结论:高度近视白内障合并角膜散光患者植入Toric IOL,能有效矫正角膜规则散光,提高术后裸眼中、近视力及近立体视功能,减少高度近视患者术后对眼镜的依赖程度,提升双眼立体视功能。

飞秒激光辅助与传统超乳手术联合Toric人工晶状体植入治疗白内障的对比研究

目的 对比研究飞秒激光辅助下白内障手术和传统超乳手术联合Toric人工晶状体(intraocular lens, IOL)植入治疗白内障的临床效果。方法 选取2023-01~06月于作者医院就诊的正常眼轴白内障患者(22 mm≤眼轴长<24 mm)48例,按随机数字表法分成飞秒组(n=16)和传统组(n=32)。观察手术前后最佳矫正视力(best corrected visual acuity, BCVA)、散光分布,应用OPD-SCANⅢ视觉质量分析仪检测斯特列尔比(strchl)、表面不对称指数(surface asymmetry index, SAI)、角膜规则指数(surface regularity index, SRI)、球差(sphericalaberration, SA)、不规则散光指数(irregular astigmatism index, IAI)及眼高阶相差,应用TOPCON KR-1W视觉质量分析仪检测4 mm直径瞳孔内3阶相差(4s3)、4 mm直径瞳孔内4阶相差(4s4)、4 mm直径瞳孔下总相差(4Total)、6 mm直径瞳孔内3阶相差(6s3)、6 mm直径瞳孔内4阶相差(6s4)、6 mm直径瞳孔内5阶相差(6s5)、6 mm直径瞳孔内6阶相差(6s6)、6 mm直径瞳孔下3阶及5阶相差之和(6s3+s5)、6 mm直径瞳孔内4阶及6阶相差之和(6s4+s6)、6 mm直径瞳孔内总相差(6Total)。并对术后角膜指数及眼高阶相差与strchl进行相关性分析。结果 术后3个月,飞秒组BCVA为(0.06±0.07)logMAR,传统组为(0.16±0.21)logMAR,较术前显著提高(P<0.05)。术后3个月散光分布,飞秒组为(0.83±0.53)D,传统组为(0.67±0.46)D,较术前明显减少(P<0.05)。术后3个月,两组患者BCVA、散光分布及strchl值比较差异均无统计学意义(P均>0.05)。术后3个月,飞秒组患眼strchl值与角膜Total相差呈负相关,与眼内Total、High相差呈负相关(P<0.05);传统组患眼strchl值与角膜s3+s5+s7相差呈负相关,与全眼High、s3+s5+s7相差呈负相关(P<0.05)。两组患者术后角膜、全眼各项高阶相差情况比较差异均无统计学意义(P均<0.05)。术后3个月,飞秒组患者strchl值与全眼4s3、4s4及4Total呈负相关(P<0.05);传统组患眼strchl值与全眼4s3、4s4及4Total呈负相关,与6s3、6s4、6s6、6s3+s5、6s4+s6、6Total呈负相关(P<0.05)。结论 飞秒激光辅助下白内障手术和传统超乳手术联合Toric IOL植入治疗白内障临床效果确切。对于合并规则角膜散光的白内障患者,飞秒激光辅助下白内障手术联合Toric IOL植入是安全有效的,在解决患眼白内障的同时还能矫正患者角膜散光,术中保持Toric IOL的囊袋居中性、IOL光学面不倾斜以及减少术源性损伤是保障术后视觉质量的前提。

代谢性白内障与老年性白内障手术联合TORIC晶体植入的临床疗效对比研究

目的 探讨代谢性白内障与老年性白内障行超声乳化摘除联合Toric晶体植入术临床疗效及安全性比较。方法 随机选取我院2021年1月~2024年3月收治的42例(52眼)代谢性白内障合并角膜规则散光患者(散光≥1.0D),另随机选取同时期收治的45例(52眼)老年性白内障合并角膜规则散光患者(散光≥1.0D),均采取白内障超声乳化联合Toric晶状体植入手术治疗,分别比较两组患者术后1d,1w,1mo,3mo时的视力、散光的矫正及并发症情况。结果 代谢性白内障组的52眼中,术后1d、1w、1mo,3mo时的裸眼视力0.5以上者分别为21眼、30眼、35眼,45眼;而同样时间点散光残留低于0.75D者分别为25眼、33眼、35眼、47眼。老年性白内障组52眼中,术后1d、1w、1mo,3mo时的裸眼视力0.5以上者分别为32眼,41眼、45眼、47眼;而同样时间点散光残留低于0.75D者分别为36眼,44眼、46眼,48眼。两组患者在术后1d,1w,1mo时视力恢复(χ^(2)=4.656,χ^(2)=3.488,χ^(2)=5.417)以及残留散光(χ^(2)=4.789,χ^(2)=6.053,χ^(2)=6.755)比较差异有统计学意义(P<0.05),而两组患者在术后3mo时视力以及残留散光上比较差异无统计学意义(χ^(2)=0.377,P>0.05)。两组患者在术后高眼压发生上比较差异无统计学意义(χ^(2)=0.122,P>0.05)。两组患者在术后1mo并发黄斑囊样水肿并发症上比较差异有统计学意义(χ^(2)=5.626,P<0.05)。结论 伴有角膜规则散光的代谢性白内障与老年性白内障,同样实施白内障超声乳化联合Toric晶体植入,两者术后早期视力恢复及散光矫正效果有差异,而远期手术疗效则无明显差异。

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery

AIM: To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens(IOL) implantation during femtosecond laserassisted cataract surgery(Femto phaco) and conventional phacoemulsification surgery(Conventional phaco).METHODS: In a prospective cohort study, Conventional phaco and Femto phaco(anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), and manifest refraction were assessed during 1 d, 1 wk, and 1 mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1 wk and 1 mo follow-ups.RESULTS: There were no significant differences in UDCA or CDVA between two groups at 1 mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group(P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group.CONCLUSION: The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.

高度角膜散光白内障患者植入Toric IOL的临床观察

目的:评估高度角膜散光患者植入高度数环曲面人工晶状体(AcrySof Toric intraocular lens,Toric IOL)术后的视力和屈光结果。方法:对21例24眼高度角膜散光的白内障患者行回顾性系列研究,术前角膜散光≥2.5D,植入AcrySof Toric IOL(T6,T7,T8或者T9)。研究数据包括术前和术后3mo的裸眼远视力(uncorrected distance visual acuities,UCDVA)、最佳矫正远视力(best-corrected distance visual acuities,BCDVA)、术前角膜散光、术后残留散光和散光轴向的偏离情况。结果:术后3mo的UCDVA中75%(18/24)患眼视力>0.5,显著高于术前BCDVA,两组差异有统计学意义(χ2=50.12,P<0.05)。术前角膜散光是3.45±0.63D。术后3mo残留的散光是0.72±0.23D。两者差异具有统计学意义(t=0.128,P<0.01)。术后67%(16/24)的眼残留散光<0.75D,83%(20/24)的眼<1.00D。术前预计矫正散光3.12±0.54D,术后实际矫正散光3.05±0.66D,两者差异无统计学意义(t=1.659,P>0.05)。人工晶状体术后3mo和1wk之间的旋转度数是3.2°±2.1°。结论:植入高度数Toric IOL是一种安全的、有效的和可预测的治疗白内障合并高度角膜散光的方法。

AcrySof Toric IOL的临床应用研究

目的:评价AcrySof Toric IOL在囊袋内的稳定性及矫正角膜散光的效果。方法:选择2010-04/2012-04在我院接受白内障超声乳化及AcrySof Toric IOL植入并且完成6mo随访的患者20例23眼。观察术前、术后裸眼视力(UCVA)、术前角膜散光、术后残余散光、IOL旋转度、晶状体偏中心情况、晶状体倾斜情况及囊袋情况。结果:术后6mo,100%患眼UCVA≥0.6,69.6%(16/23)患眼UCVA≥0.8。术前角膜散光平均为2.31±0.70D,术后6mo残余散光为0.45±0.30D,二者差异有统计学意义(t=15.045,P=0.000)。术后6mo时17眼(73.9%)偏离预定轴位,平均偏差5.36°±0.32°,其中2例偏差>10°,最大偏差15°;术后6mo时12眼(52.2%)出现晶状体偏中心,8眼(34.8%)<0.5mm,3眼(13.0%)为≥0.5mm而≤1mm,1眼(4.3%)>1mm;术后6mo时20眼(87.0%)晶状体无倾斜,3眼(13.0%)出现倾斜,倾斜均少于5°。结论:AcrySofToricIOL可使患者获得良好的裸眼远视力,有效的矫正患者的角膜散光,同时具有良好的位置稳定性,预测性强,是一种有效的矫正角膜规则散光的治疗方法。

LENTIS Comfort Toric人工晶状体植入术后视觉质量分析

目的:探讨白内障手术中植入LENTIS Comfort Toric人工晶状体后的视觉质量。方法:回顾性对照临床研究,收集数字化导航辅助下白内障超声乳化摘除联合人工晶状体植入术患者40例40眼,植入LENTIS Comfort Toric(MF15T)人工晶状体为A组(24眼),植入单焦点Toric人工晶状体为B组(16眼);观察术后3mo不同距离视力、术后散光质心值、脱镜率、离焦曲线变化以及人工晶状体稳定性等。结果:两组患者术后均无严重并发症出现,两组术后3mo远视力无差异(P>0.05);A组中视力、近视力明显优于B组(P<0.01);A组术后脱镜率为99%,B组为45%(P<0.05);两组术后3mo散光质心值均较术前改善,但组间无差异(P>0.05);术后3mo A组离焦曲线于+0.50、-1.75D分别出现峰值,形成平台并平缓下降,B组于+0.25、-0.25D出现峰值后呈陡峭趋势下降。术后1d A组出现1眼(4%)人工晶状体轴位旋转大于10°;B组出现6眼(38%)人工晶状体轴位旋转大于10°,2眼(33%)顺时针旋转,4眼(67%)逆时针旋转;两组均无人工晶状体移位发生。结论:两种人工晶状体均可矫正散光,其中LENTIS Comfort Toric人工晶状体能为白内障合并散光人群提供个性化的选择,可同时解决散光和获得全程视力,术后光学干扰发生率低,稳定性更好,视觉质量及满意度高。

Verion导航系统和传统标记器法行Toric IOL轴向标记的精确性比较

目的:比较采用Verion导航系统和传统标记器法行Toric IOL轴向标记的精确性。方法:前瞻性随机对照研究。选取2016-06/2019-12在我院行白内障超声乳化联合Toric IOL植入术的年龄相关性白内障患者47例56眼随机分为两组:导航组术前Verion导航系统采集眼前节图像,设定Toric目标轴向27眼,标记器组术前使用Toric标记器标记水平0°、180°,术中根据标记环标记Toric目标轴向29眼。术后1h,1wk,1、3mo患者散瞳后眼前节照相,Photoshop软件分析两组患者实际轴向和目标轴向的偏差值,并记录患者裸眼视力(UCDVA)、最佳矫正视力(BCDVA)以及残余散光度。结果:术后1h,3mo导航组患者IOL实际轴向和目标轴向的偏差值小于标记器组(1.5°±1.8°vs 3.1°±2.1°;1.9°±1.6°vs 3.3°±2.4°,均P<0.05)。术后3mo,导航组和标记器组平均UCDVA(LogMAR)比较无差异(0.04±0.08 vs 0.06±0.07,P=0.338);残余散光度比较无差异(-0.39±0.32 vs-0.45±0.31D,P=0.491)。结论:Verion导航和手动标记方法标记Toric IOL轴向都有较高的准确性,尽管导航组并未显示出UCDVA和残余散光度方面的优势,但是IOL轴向偏差导航组显著小于标记器组,导航标记下植入Toric IOL轴向更精准。