Search Results (13)

Background and Objectives: To assess refractive and visual outcomes following phacoemulsification using a novel algorithm for toric intraocular lens (IOL) surgery. Setting: Private practice, Spain. Design: Prospective observational study. Materials and Methods: The algorithm was designed to control the topographic position of the principal meridians (flat and steep) after cataract surgery in eyes without associated corneal pathology or previous corneal surgery. It is well known that a toric IOL must be positioned along the steep meridian. Therefore, it is crucial to predict both the postoperative position of the steep meridian and its magnitude. Data from patients who were planned for refractive lens exchange or cataract surgery using the Pešić-Barraquer algorithm and implantation of a toric IOL in eyes with different degrees of astigmatism were used to assess the effect of residual astigmatism on 6-month postoperative monocular uncorrected and corrected distance logMAR visual acuity values (UDVA and CDVA). Vector analysis was performed with J0 and J45 evaluations, and centroid errors in postoperative refractive astigmatism prediction error were calculated in the spectacle plane using the “Astigmatism Double-Angle Plot Tool”. Results: Three hundred and six eyes of 250 patients with a mean age of 69.0 years ± 8.6 were enrolled in the study. The mean preoperative corneal astigmatism measured with Pentacam was 1.43 D ± 0.83 (SD). One hundred and eighty-four eyes (60.13%) had “against-the-rule” (ATR) astigmatism, 67 (21.90%) had “with-the-rule” (WTR) astigmatism, and 55 (17.97%) eyes had “oblique” corneal (OBL) astigmatism preoperatively. The mean absolute astigmatic prediction error in residual astigmatism was 0.31 D ± 0.28. Eyes with preoperative ATR corneal astigmatism had lower mean absolute errors compared to the eyes with WTR astigmatism (0.29 D ± 0.26 and 0.34 D ± 0.31, respectively). Centroid error in predicted residual astigmatism was 0.08 D ± 0.41 @4°. All eyes achieved residual refractive astigmatism within the 1.00 D range, and 55.23% had no residual astigmatism in the spectacle plane. Mean postoperative refractive astigmatism at the spectacle plane was 0.24 D ± 0.29. There were no postoperative complications. Additional statistical analysis of 310 eyes confirmed that when the main incision is not placed on one of the three meridians (flat, steep, or 45-degree bisector), the axis of astigmatism induced by the incision is significantly altered. Exploratory subgroup analyses demonstrated comparable prediction accuracy across incision positions, preoperative astigmatism types, and surgeons, further supporting the robustness of the proposed algorithm. Conclusions: In addition to enabling more accurate prediction of postoperative refractive residual astigmatism in patients undergoing toric IOL implantation, our newly proposed algorithm provides surgical pearls to facilitate preoperative and intraoperative management of corneal astigmatism, highlighting the importance of precise incision placement for optimal refractive outcomes. Full article

Background/Objective: Whereas conventional flanged intrascleral fixation is limited to 3-piece intraocular lenses (IOLs), we developed and evaluated a novel haptic-extended flange technique for single-piece acrylic IOLs, including presbyopia-correcting and toric lenses. Methods: In this technique, a 6-0 polypropylene suture is secured along the lateral aspect of the single-piece IOL haptic to extend its length, followed by intrascleral flange fixation. Uncorrected visual acuity (UCVA) from far to near, corrected distance visual acuity (CDVA), and refraction were evaluated at 1 month postoperatively. IOL tilt and decentration were assessed using anterior segment optical coherence tomography. Results: This study included a consecutive series of 10 eyes of 10 patients (mean age: 58.3 ± 16.2 years), comprising 5 eyes with multifocal IOL, 2 eyes with multifocal toric IOL, 2 eyes with enhanced monofocal IOL, and 1 eye with monofocal IOL. All IOLs were securely fixed; the mean IOL tilt was 5.74 ± 2.93° and the mean decentration was 0.35 ± 0.19 mm. All eyes achieved CDVA of 20/20 or better, and all eyes with multifocal IOLs achieved UCVA at 40 cm of 20/25 or better. No early postoperative complications attributable to the surgical procedure were observed. In a case associated with atopic dermatitis, retinal detachment occurred 4 months after surgery. Conclusions: In this preliminary case series, haptic-extended flange fixation enabled early stabilization of selected single-piece acrylic IOLs with favorable short-term visual and anatomic outcomes. Larger studies with longer follow-up are needed to confirm long-term safety, durability and comparative effectiveness. Full article

Background/Objectives: Toric intraocular lens (IOL) implantation is the standard approach for correcting corneal astigmatism during cataract surgery and refractive lens exchange (RLE). Evidence on outcomes in eyes with high corneal astigmatism (≥2.00 diopters, D), particularly in heterogeneous real-world settings, remains limited. This study evaluated visual, refractive, and astigmatic vector outcomes of toric IOL implantation in a consecutive high-astigmatism cohort and investigated predictors of residual astigmatic error. Methods: This single-center, single-surgeon retrospective analysis of prospectively collected data included 161 eyes (118 patients) with preoperative corneal astigmatism ≥ 2.00 D undergoing cataract surgery or RLE with toric IOL implantation (June 2023–December 2025). Primary outcomes at one month included visual acuity, manifest refraction, and Alpins vector analysis at the corneal plane. Secondary analyses comprised refractive stability assessment (n = 75 eyes, median seven months), comparison of astigmatic outcomes between emmetropia-targeted and intentional myopia-targeted eyes, and multivariate regression of predictors of residual astigmatic error. Results: Mean postoperative UDVA and CDVA were 0.19 ± 0.24 and 0.09 ± 0.15 logMAR, respectively. Spherical equivalent prediction error was −0.19 ± 0.42 D (69.6% within ±0.50 D of target). Mean residual cylinder was 0.52 ± 0.49 D; 62% and 88.8% of eyes achieved ≤0.50 D and ≤1.00 D, respectively. Vector analysis demonstrated a mean difference vector of 0.53 ± 0.44 D, a correction index of 1.04 ± 0.20, and near-zero centroid deviation (0.03 D @ 43°), indicating the absence of systematic directional prediction error. Refractive outcomes were stable at medium-term follow-up. Astigmatic correction accuracy was equivalent between emmetropia-targeted and intentional myopia-targeted eyes (p > 0.05 for all primary metrics). Multivariate regression identified IOL cylinder power (β = 0.051, p = 0.031) and oblique astigmatism orientation (β = 0.299 vs. WTR, p = 0.032) as independent predictors of greater residual astigmatic error. No sight-threatening complications occurred. Conclusions: Toric IOL implantation provides safe, predictable, and stable correction of high corneal astigmatism in a real-world mixed cohort. Astigmatic accuracy is maintained regardless of intended spherical refractive strategy, supporting the use of toric IOLs in highly myopic patients targeted for residual myopia. Oblique astigmatism orientation is an independent predictor of reduced correction accuracy, consistent with known limitations of current toric calculators for this meridian. Full article

Purpose: The aim of this study was to develop a concept for adjustment planning of intraocular lens orientation axes after cataract surgery with implantation of toric intraocular lenses (tIOLs) and to predict the spectacle refraction after tIOL re-alignment. Methods: This calculation concept based on paraxial spherocylindrical vergence transformations uses the actual spherocylindrical refraction at the spectacle plane, corneal power, and the labelled power and measured axis of the implanted tIOL to minimise the refractive cylinder by simulating the rotation of the tIOL in the eye. The axial lens position is derived from simple prediction models using anterior chamber depth and lens thickness or axial length from preoperative biometry or the equivalent tIOL power. The new target axis is predicted together with the spherocylindrical refraction after re-alignment of the tIOL. Results: To show the applicability of this calculation model, we provide four clinical working examples: example 1 deals with keratometric power values; example 2 deals with keratometric curvature values, including surgically induced astigmatism and a statistical posterior astigmatism correction for the cornea (both examples with a thin cornea model); example 3 deals with corneal curvature data for the front and back surface; and example 4 deals with keratometric power data and corneal back surface power data, including surgically induced astigmatism (both examples with a thick cornea model). Conclusions: The effect of tIOL axis adjustment after cataract surgery can be predicted based on actual refraction, corneal power, tIOL power and the measured axis, and a simulation of the tIOL axis rotation enables the best orientation with the lowest refractive cylinder at the spectacle plane to be found. Full article

Background/Objectives: Cataract surgery often reveals preexisting corneal astigmatism, which can be corrected using a toric intraocular lens (T-IOL). However, postoperative T-IOL rotation may compromise correction. We investigated T-IOL rotation, focusing on deployment time and proximity to the posterior capsule (PC), using intraoperative optical coherence tomography (iOCT). Methods: Six different T-IOL models were inserted into acrylic simulated lens capsule models under different tacking durations (5 s, 30 s, and 60 s) and temperature conditions (23 °C, 28 °C, and 32 °C). The selection criteria for porcine lenses for examination required that they match human lens dimensions, typical of those used to train cataract surgeons. T-IOL misalignment due to vibration was assessed. Additionally, the impact of temporary intraocular pressure (IOP) reduction on T-IOL proximity to the PC was measured using iOCT in porcine eyes. Results: Tacking time and temperature independently affected T-IOL deployment, with shorter tacking durations and higher temperatures leading to faster deployment. Among lenses tested under identical tacking time and temperature conditions, iSert Micro Toric Aspheric 1-Piece IOL (355T3) had the slowest expansion time, while Avansee™ Preload 1-Piece Toric (YP-T3) had the fastest. Porcine eyes with a corneal white-to-white major axis < 16.0 mm fell within the 95% confidence interval for matching human lens size. Temporarily reducing IOP during surgery improved T-IOL adhesion to the PC, reducing both the occurrence and degree (from 14.0° to nearly 0°) of postoperative rotation. Conclusions: Optimal T-IOL deployment, temporary IOP reduction during surgery, and enhanced adhesion to the PC can reduce the risk and degree of T-IOL rotation. Intraoperative iOCT aids in monitoring T-IOL positioning, which is essential to prevent rotation. Accumulated fluid between the T-IOL and PC may contribute to rotation, which requires further investigation. These findings provide practical strategies for enhancing T-IOL stability and improving the effectiveness of astigmatism correction in cataract surgery. Full article

Purpose: This study aimed to assess the efficacy of for PODEYE TORIC intraocular lenses (IOL). Methods: This study was a retrospective, non-randomized, interventional case series. Inclusion criteria comprised diagnosis of an age-related cataract and a corneal astigmatism equal to or higher than 0.9 D and undergoing implantation of toric IOLs (TIOL). A single toric lens model (PodEye Toric, BVI) was used in all cases. Results: The study includes 51 eyes of 35 patients with TIOL implantation with a mean follow-up time of 45.7 (±36.5) days. Fourteen patients were targeted for mono-vision. Eight eyes had previously undergone refractive surgery (five post Myopic Lasik/PRK, two post RK/AK and one post RK). The mean postoperative adjusted spherical equivalent (SEQ) was −0.57 D ± 0.31 and the residual postoperative refractive astigmatism was −0.49 D ± 0.50. Only 2% of patients had a preoperative subjective astigmatism lower than 1.0 D whereas postoperatively, 94% of the patients had a residual astigmatism of 1.0 D or lower. The average deviation from the planned axis was 2.66 ± 0.26 degrees. None of the IOLs rotated to 10° or higher and 88% remained at 5° or less on the intended IOL axis. Twenty-six (63%) of IOL rotations were counterclockwise. Conclusions: PODEYE TORIC intraocular lenses provide exceptional refractive precision, reliable rotational stability, and consistently strong postoperative vision outcomes. Full article

Objectives: To compare intraocular lens (IOL) position and refractive outcomes between eyes that underwent sole phacoemulsification with those that underwent combined 25-gauge phacovitrectomy with a plate-haptic toric IOL implantation. Methods: This retrospective study included 60 eyes of 60 patients. Of these, 30 eyes underwent 25-gauge phacovitrectomy, while the other 30 eyes received phacoemulsification alone. In both groups, a plate-haptic toric intraocular lens (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted. The main outcome measures were the refractive outcome, the refraction prediction error (PE), the difference in the postoperative anatomical lens position (ALP) change, and rotational stability. Results: The mean spherical equivalent decreased considerably from −2 ± 4.4 diopters (D) to −0.6 ± 1.4 D after phacovitrectomy (p = 0.05) and −0.7 D ± 5.5 D to −0.1 ± 1.1 D after phacoemulsification (p = 0.5). The prediction error (PE) was comparable between the two groups for all formulas (Haigis-T: p = 0.8, Barrett TK Toric: p = 0.8, Z CALC: p = 0.7). No significant difference in absolute ALP change and postoperative rotational stability was observed between the phacovitrectomy and phacoemulsification group (1.4 mm vs. 1.4 mm, p = 0.96; 2.9° vs. 2.1°, p = 0.5). Conclusions: The implantation of plate-haptic toric IOLs in the combined phacovitrectomy group resulted in refraction and IOL positioning outcomes comparable to those in the phacoemulsification-only group. Full article

Purpose: To analyse the correspondence between refractive astigmatism and corneal astigmatism in pseudophakic eyes with non-toric intraocular lenses. Setting: Yeouido St. Mary hospital, Seoul, Republic of Korea. Design: Evaluation of a diagnostic test instrument. Methods: This retrospective study included 95 eyes of 95 patients. Corneal astigmatism was measured with an automated keratometer (RK-5, Canon) and Scheimpflug tomography (Pentacam HR, Oculus). Refractive astigmatism was compared to keratometric astigmatism (based on anterior corneal measurements only), equivalent K-reading, and total corneal astigmatism (both based on anterior and posterior corneal measurements). Vector analysis was carried out by Næser’s polar value method. The accuracy was defined as the average magnitude of the vectorial difference in astigmatism (DA). Each corneal measurement was optimized in retrospect by a multiple linear regression equation between refractive and corneal astigmatism. Results: Keratometric astigmatism overestimated with-the-rule (WTR) refractive astigmatism and underestimated against-the-rule (ATR) refractive astigmatism. Several measurements based on both corneal surfaces’ values did not show any statistically significant difference with respect to refractive astigmatism. The mean corneal astigmatism by total corneal refractive power (TCRP) at 4.0 mm (zone/pupil) produced the lowest mean arithmetic DA and the highest percentage of eyes with a DA ≤ 0.50 dioptre. After optimization, the accuracies of automated KA and TCRP 4.0 mm (zone/pupil) were similar. Conclusions: Total corneal astigmatism measured by Scheimpflug tomography at a 4.0 mm zone centered on the pupil accurately reflects the refractive astigmatism in pseudophakic eyes. However, the accuracy of total corneal astigmatism is not different from automated KA after optimization. Full article

The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments. Full article

(1) Background: To compare the results of a new intraoperative contactless device (INTEGRA Optomed, Poland) with the result of a manual method for determining the axis for toric intraocular lens implantation. (2) Material and Methods: This retrospective observational study included 60 eyes of 40 patients (17 men, 23 women) who had toric intraocular lenses implanted. A video recording of each surgery that used the INTEGRA system was made for the analysis. Two researchers then independently assessed the location of the implant axes determined with both digital and manual slit-lamp methods, and compared the results between methods. (3) Results: The implantation axes suggested through the manual and INTEGRA methods were similar. The median axis disparities were 0.0 degrees for both groups. The standard deviation was 0.63 and 0.75 for researcher 1 and 2, respectively. The dominant value was 0.0 in both groups. The INTEGRA axis designation was statistically significantly different from the manual method for researcher 1 (p < 0.05), but it was statistically insignificant for researcher 2 (p = 0.79). (4) Conclusions: The INTEGRA system is a digital ink-free device for image tracking scleral vessels. It was helpful for determining the implantation axis in a precise manner, and the measurements were comparable with those obtained through a manual technique. Full article

Background: To perform a systematic review and meta-analysis of the refractive outcomes of non-toric and toric intraocular lenses (IOLs) in keratoconus (KC) using different IOL power calculation formulas. Methods: A systematic search was conducted to identify studies that report on refractive outcomes of different IOL power calculation formulas in KC patients undergoing cataract surgery. Inclusion criteria were primary posterior chamber non-toric and toric monofocal intraocular lens implantation, data on the degree of KC, explicit mention of the formula used for each stage of KC, and the number of eyes in each category. We calculated and compared the absolute and mean prediction errors, percentage of eyes within 0.5 D and 1 D from target, and the weighted absolute prediction errors of IOL formulas, all were given for KC degrees I–III. Results: The bibliographic search yielded 582 studies published between 1996 and 2020, 14 of which (in total 456 eyes) met the criteria: three studies on non-toric IOL (98 eyes), eight studies on toric IOLs (98 eyes) and three studies of unknown separation between non-toric and toric IOLs (260 eyes). The lowest absolute prediction error (APE) for mild, moderate, and advanced KC was seen with Kane’s IOL power formula with keratoconus adjustment. The APE for the top five IOL power formulas ranged 0.49–0.73 diopters (D) for mild (83–94%) of eyes within 1 D from the target), 1.08–1.21 D for moderate (51–57% within 1 D), and 1.44–2.86 D for advanced KC (12–48% within 1 D). Conclusions: Cataract surgery in eyes with mild-to-moderate KC generally achieves satisfactory postoperative refractive results. In patients with advanced KC, a minority of the eyes achieved spherical equivalent refraction within 1 D from the target. The Kane’s formula with keratoconus adjustment showed the best results in all KC stages. Full article

Smartphone apps are becoming increasingly popular in ophthalmology, one specific area of their application being toric intraocular lens (IOL) surgery for astigmatism correction. Our objective was to identify, review and objectively score smartphone apps applicable to toric IOL calculation and/or axis alignment. This review was divided into three phases. A review was conducted on four major app databases (phase I): National Health Service (NHS) Apps Library, Google Play Store, Apple App Store and Amazon Appstore. A systematic literature review (phase II) was conducted to identify studies for included apps in phase I of our study. Keywords used in both searches included: “toric lens”, “toric IOL”, “refraction”, “astigmatism”, “ophthalmology”, “eye calculator”, “ophthalmology calculator” and “refractive calculator”. Included apps were objectively scored (phase III) by three independent reviewers using the mobile app rating scale (MARS), a validated tool that ranks the quality of mobile health apps using a calculated mean app quality (MAQ) score. Phase I of our study screened 2428 smartphone apps, of which six apps for toric IOL calculation and four apps for axis marking were eligible and were selected for quantitative analysis. Phase II of our study screened 477 studies from PubMed, Medline and Google Scholar. Three studies validating two apps (toriCAM, iToric Patwardhan) in a clinical setting as adjunct tools for preoperative axis marking were identified. Phase III ranked Toric Calculator for iPhone (Apple iOS, MAQ 4.13; average MAQ 3.34 ± 0.54) as the highest-scoring toric IOL calculator, and iToric Patwardhan (Android OS, MAQ 4.13; average MAQ 3.41 ± 0.44) was the highest-scoring axis marker in our study. Our review identified and objectively scored ten smartphone apps available for toric IOL surgery adjuncts. Toric Calculator for iPhone and iToric Patwardhan were the highest-scoring toric IOL calculator and axis marker, respectively. Current literature, though limited, suggests that axis marking smartphone apps can achieve similar levels of misalignment reduction when compared to digital systems. Full article

Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2–3° tilt and a 0.2–0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients’ satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt. Full article