Analysis of Miscorrection after Implantation of the Toric Intraocular Lens

Hye Min Jeon; Kyung Heon Lee

doi:10.3341/jkos.2014.55.11.1636

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Jeon and Lee: Analysis of Miscorrection after Implantation of the Toric Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2014;55(11):1636-1641.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.11.1636

Analysis of Miscorrection after Implantation of the Toric Intraocular Lens

Hye Min Jeon, MD, Kyung Heon Lee, MD

Busan Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Kyung Heon Lee, MD, Busan Sungmo Eye Hospital, #409-1 Haeun-daero, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: sungmobusan@hanmail.net

Received 17 January 2014 Revised 3 April 2014 Accepted 16 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy and stability of AcrySof Toric intraocular lens (IOL) implants and to analyze the miscorrection that resulted after implantation.

Methods

This retrospective study included 422 eyes of 348 patients who underwent cataract surgery with implantation of the AcrySof toric IOL between December 2011 and June 2013. We evaluated uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry and refraction preoperatively and 3 months postoperatively. The axis of implanted AcrySof Toric IOL was measured using the KR-1W aberrometer before mydriasis. At 3 months postoperatively, patients with a residual cylindrical power of 0.50 diopters (D) or more, and having an IOL rotation of 10 degrees (°) or more were considered having miscorrection.

Results

UCVA (log MAR) improved from 0.58 ± 0.35 to 0.18 ± 0.26. Preoperative corneal astigmatism was 1.46 ± 0.72 D and postoperative refractive cylindrical power was 0.45 ± 0.30 D. The postoperative miscorrection was 50.5% in the T3 group, 35.7% in the T4 group, and 27.2% in the T5 group. The incidence of overcorrection was significantly higher in the T3 group than in the T4 and T5 group. In eyes with with-the-rule (WTR) astigmatism, overcorrection was found in 36.4% (32/88 eyes), while in eyes with against-the-rule (ATR) astigmatism, undercorrection was found in 37.6% of cases (44/117 eyes). There were five cases of IOL rotation at 3 months postoperatively.

Conclusions

AcrySof Toric IOL was effective in correcting corneal astigmatism and had good rotational stability. However, the incidence of miscorrection, especially for overcorrection, was higher with lower power toric IOL. Patients with WTR astigmatism tend to have overcorrection, while those with ATR show a tendency toward undercorrection, suggesting that these changes considered at the time of cataract surgery.

Keywords: Cataract surgery, Corneal astigmatism, Miscorrection, Toric intraocular lens

References

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Figure 1.

Percentage of eyes with with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism in each decade.

Figure 2.

Cumulative histogram of uncorrected visual acuity (UCVA) at 3 months postoperatively.

Figure 3.

Bar chart of postoperative astigmatic results. The eyes with with-the-rule (WTR) tend to overcorrection, while those with against-the-rule (ATR) show tendency toward undercorrection.

Table 1.

Preoperative descriptive data

	All eyes	T3	T4	T5
Eyes (n)	422	232	98	92
Patients (n)	348	202	77	69
Age (years)	64.71 ± 12.24	66.50 ± 10.70	64.95 ± 11.97	60.04 ± 14.74
OD/OS (n)	208/214	112/120	52/46	44/48
Sex (M/F) (n)	185/237	97/135	41/57	47/45
UCVA (log MAR)	0.58 ± 0.35	0.56 ± 0.36	0.57 ± 0.31	0.68 ± 0.38
BCVA (log MAR)	0.39 ± 0.32	0.38 ± 0.33	0.37 ± 0.27	0.45 ± 0.34
Spherical equivalent (diopter)	−1.29 ± 3.50	−0.40 ± 2.46	−1.14 ± 3.20	−2.97 ± 4.42
Autokeratometric cylinder (diopter)	1.46 ± 0.71	1.02 ± 0.41	1.96 ± 0.24	2.31 ± 0.73

Values are presented as mean ± SD unless otherwise indicated.

UCVA = uncorrected distance visual acuity; BCVA = best corrected distance visual acuity.

Table 2.

Comparison of postoperative miscorrection by the type of toric IOL

	T3	T4	T5	p-value
Over-correction (n, %)	46 (19.8)	10 (10.2)	6 (6.5)	0.002^∗
Under-correction (n, %)	66 (28.4)	24 (24.5)	19 (20.4)	0.267
Misalignment (n, %)	4 (1.7)	1 (1.0)	0 (0)	0.078
Total (n, %)	116 (50)	35 (35.7)	25 (27.2)

The incidence of overcorrection was significantly higher in T3 group than in T4 and T5 group.

IOL = intraocular lens.

^∗ Statistically significant difference.

Table 3.

Incidence of postoperative miscorrection by orientation of preoperative astigmatism in T3 group

Preoperative astigmatism	Postoperative miscorrection	N (%)
With-the-rule (88 cases)	Over-correction	32 (36.4)
	Under-correction	16 (18.2)
	Misalignment	1 (1.1)
	Total	49 (55.7)
Against-the-rule (117 cases)	Over-correction	9 (7.7)
	Under-correction	44 (37.6)
	Misalignment	2 (1.7)
	Total	55 (47.0)
Oblique (27 cases)	Over-correction	5 (18.5)
	Under-correction	5 (18.5)
	Misalignment	2 (7.4)
	Total	12 (44.4)

In eyes with with-the-rule (WTR) astigmatism, overcorrection was found in 32 eyes (36.4%), while in eyes with against-the-rule (ATR) astigmatism, undercorrection was found in 44 eyes (37.6%).

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