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Park, Kim, and Kim: Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(11): 1225-1233.

Published online: 15 November 2017

DOI: https://doi.org/10.3341/jkos.2017.58.11.1225

Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision

Yooyeon Park, MD, Man Soo Kim, MD, PhD, Eun Chul Kim, MD, PhD

Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

Address reprint requests to Eun Chul Kim, MD, PhD. Department of Ophthalmology, The Catholic University of Korea Bucheon St. Mary's Hospital, #327 Sosa-ro, Bucheon 14647, Korea. Tel: 82-32-340-2125, Fax: 82-32-340-2661, eunchol@hanmail.net

Received 27 April 2017       Revised 30 August 2017       Accepted 24 October 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population.

Methods

The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively.

Results

The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, −2.48 ± 1.84 D to −0.98 ± 0.92 D; LRI group, −2.02 ± 1.03 D to −1.65 ± 0.86 D; control group, −1.69 ± 0.88 D to −1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046).

Conclusions

Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.

Keywords: Corneal astigmatism, Limbal relaxing incision, Tecnis ZCT toric intraocular lens, Toric intraocular lens implantation

Figures and Tables

Figure 1

Pre- and postoperative uncorrected distance visual acuity of treatment groups (logMAR). All group showed significant improvement in uncorrected visual acuity. Toric IOL group showed the most difference compared to the other group. POD = postoperative day; M = months; IOL = intraocular lens; LRI = limbal relaxing incision.

jkos-58-1225-g001
Figure 2

Pre- and postoperative best corrected visual acuity of treatment groups (logMAR). All group showed significant improvement in best corrected visual acuity. POD = postoperative day; M = months; IOL = intraocular lens; LRI = limbal relaxing incision.

jkos-58-1225-g002
Figure 3

Pre- and postoperative cylindrical change of treatment groups (n = 100). Positive values represent keratometric astigmatism of each group, and negative values are refractive cylinder. POD = postoperative day; mo = months; IOL = intraocular lens; LRI = limbal relaxing incision.

jkos-58-1225-g003
Figure 4

Scatter plots of the J0 and J45 vectors (in diopters [D]), calculated by power vector analysis of (A) toric IOL group, (B) LRI group, and (C) control groups. Black diamonds and gray squares indicate preoperative values and 2-months postoperative values, respectively. Preop = preoperative; Postop = postoperative; IOL = intraocular lens; LRI = limbal relaxing incision.

jkos-58-1225-g004
Figure 5

Pre- and postoperative cylindrical change of treatment groups with keratometric astigmastism under 2.5 D (n = 85). Positive values represent keratometric astigmatism of each group, and negative values are refractive cylinder. POD = postoperative day; mo = months; IOL = intraocular lens; LRI = limbal relaxing incision.

jkos-58-1225-g005
Table 1

Preoperative demographic and biometric data of the subjects (n = 100)

jkos-58-1225-i001

Values are presented as mean ± standard deviation unless otherwise indicated.

IOL = intraocular lens; LRI = limbal relaxing incision; D = diopters.

*One-way analysis of variance (ANOVA) test for age, Flat K, Steep K and Kruskall Wallis test for spherical IOL power, sphere, cylinder, spherical equivalent, each analyzing method used according to data normality.

Table 2

Preoperative and postoperative visual acuity (logMAR) according to the treatment groups

jkos-58-1225-i002

Values are presented as mean ± standard deviation unless otherwise indicated.

UDVA = uncorrected distance visual acuity; IOL = intraocular lens; LRI = limbal relaxing incision; BCVA = best corrected visual acuity.

*Repeated measures analysis of variance (ANOVA) test; †Kruskall Wallis test.

Table 3

Preoperative and postoperative change of biometric data (D) of the treatment groups with keratometric astigmatism under 2.5 D

jkos-58-1225-i003

Values are presented as mean ± standard deviation unless otherwise indicated.

IOL = intraocular lens; LRI = limbal relaxing incision.

*Wilcoxon signed rank test; †Kruskall Wallis test.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2015R1A1A1A05028023).

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