Effect of Toric Intraocular Lens Implantation on Astigmatism in Cataract Surgery

Yong Jae Cha; Mee Kum Kim; Won Ryang Wee

doi:10.3341/jkos.2019.56.10.1544

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Cha, Kim, and Wee: Effect of Toric Intraocular Lens Implantation on Astigmatism in Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2019;56(10):1544-1551.

Published online: 29 August 2019

DOI: https://doi.org/10.3341/jkos.2019.56.10.1544

Effect of Toric Intraocular Lens Implantation on Astigmatism in Cataract Surgery

Yong Jae Cha, M.D¹, Mee Kum Kim, M.D, PhD^1,^2,, Won Ryang Wee, M.D, PhD^1,²

¹Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

²Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Address reprint requests to Mee Kum Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-2665, Fax: 82-2-741-3187 E-mail: kmk9@snu.ac.kr

‗ This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

‗ This study was supported for grant by Abbott Medical Optics (AMO, Santa Ana, CA, USA) (grant number 06-2013-3210).

Received 20 March 201524 June 2015 Accepted 22 September 2015

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 of Tecnis^® toric intraocular lens (IOL) implantation for the correction of astigmatism and rota-tional stability during cataract surgery in patients with cataract and astigmatism.

Methods

We prospectively analyzed 17 eyes of 14 patients with 1 to 4 diopters (D) of corneal astigmatism who underwent pha-coemulsification and Tecnis^® toric IOL implantation at Seoul National University Hospital from June 2013 to May 2014. Informed consent was obtained from all participants before the clinical trial. We evaluated the changes in visual acuity, refraction, astigma-tism, IOL axis and higher order aberration for 3 months postoperatively. Power vector analysis was used to analyze astigmatism.

Results

The mean uncorrected visual acuity (log MAR) significantly improved from 0.58 ± 0.34 to 0.26 ± 0.43 at 3 months postoperatively. The mean refractive astigmatism was significantly decreased by 77.9% from a mean value of -2.67 ± 0.89 D to -0.59 ± 0.48 D at 3 months postoperatively. According to power vector analysis, M, B, J_0, and J₄₅ were significantly reduced after the surgery. The mean difference between achieved and intended IOL axis was 3.26 degrees clockwise at postoperative 3 months, which was statistically insignificant. Most of the rotational changes were observed within a month after the surgery.

Conclusions

Phacoemulsification and Tecnis^® toric IOL implantation in patients with cataracts and astigmatism showed efficacy for the correction of astigmatism and rotational stability.

Keywords: Astigmatism, Cataract, Tecnis®toric IOL, Vector analysis

References

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Figure 1.

Image analysis for the rotation of the cylindrical axis on the toric intraocular lens.

Figure 2.

Changes in visual acuity. There were statistically significant improvements in visual acuity at postoperative 1 week, 1 month, and 3 months compared with pre-operative values. log MAR = logarithm of the minimum angle of reso-lution; Preop = preoperative.

Figure 3.

Change in refractive astigmatism. There were stat-istically significant decreases in refractive astigmatism at post-operative 1 week, 1 month, and 3 months compared with pre- operative values. Preop = preoperative.

Figure 4.

Changes in the corneal astigmatism between pre- and post- operation. There is no significant changes between the follow-ups. Preop = preoperation.

Figure 5.

Changes in spherical equivalents between pre- and post- operation. Preop = preoperation.

Figure 6.

Diagram showing refractive astigmatism in diopters measured before surgery and 1 week, 1 month, and 3 months after implanting a single-piece toric acrylic intraocular lens. Astigmatism is shown as vectors at J₀ and J₄₅. Each ring repre-sents 1 diopter.

Figure 7.

Absolute amount of rotation of a single-piece toric acrylic intraocular lens (IOL) compared with preoperative IOL axis. There was significant rotation between 1 week and 1 month after surgery. However, axis was stable after 1 month.

Table 1.

Demographics and preoperative status of the enrolled patients

Demographics	Data
No. of eyes (patients)	17 (14)
Mean age (years, range)	64.5 (32-84)
Sex (male:female)	4:13
Laterality (right:left)	9:8
UCVA (log MAR)	0.58 ± 0.34
Spherical equivalent (diopters)	-0.65 ± 3.52
Axial length (mm)	24.08 ± 1.26
WTR versus ATR	10:7

Values are presented as mean ± SD unless otherwise indicated. UCVA = uncorrected visual acuity; WTR = with the rule; ATR = against the rule.

Table 2.

Vector analysis of astigmatism

	Preop	Postop 1 week	Postop 1 month	Postop 3 months
M	-3.43 ± 6.57 D	-0.66 ± 0.97 D	-0.47 ± 0.94 D	-0.66 ± 0.94 D
p-value		0.038^*	0.060	0.305
J₀	-0.55 ± 1.26 D	-0.26 ± 0.34 D	-0.20 ± 0.19 D	-0.12 ± 0.28 D
p-value		0.286	0.198	0.028^*
J₄₅	0.18 ± 0.41 D	0.05 ± 0.29 D	0.001 ± 0.27 D	-0.09 ± 0.17 D
p-value		0.021^*	0.034^*	0.131
B	4.61 ± 5.92 D	1.03 ± 0.74 D	0.88 ± 0.67 D	0.82 ± 0.59 D
p-value		0.008^*	0.002^*	0.003^*

Values are presented as mean ± SD unless otherwise indicated. p-value by Wilcoxon’s signed-ranks test. Preop = preoperation; Postop = postoperation; J₀=x-coordinate of the astigmatism vector; J₄₅=y-coordinate of the astigmatism; M = spher-ical equivalent refraction; B = total dioptric power.

^* Statistically significant values.

Table 3.

Post-operative high order aberration of the enrolled patients

High order aberration	Mean ± SD
Mean postoperative 3 months vertical coma (μ m)	-0.17 ± 0.12
Mean postoperative 3 months horizontal coma (μ m)	-0.29 ± 0.20
Mean postoperative 3 months SA (μ m)	0.16 ± 0.12
Mean postoperative 3 months HOA RMS (μ m)	0.36 ± 0.16

Values are presented as mean ± SD.

SA = spherical aberrations; HOA = high-ordered aberration; RMS = root mean square.

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