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Rafael Castaneda Diez, Maria Luisa Zavala Aznar, Carolina Prado Larrea, Sandra Karina Silva Romano, María Jose Iriarte Barbosa, Jesus Jimenez-Roman; Three months follow up of toric IOL in phacoemulsiphication and trabeculectomy, preliminary results. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4191.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluate VA and refraction, in patients with more than 1 D of astigmatism, operated of phaco-trabeculectomy (PhacoTBC) using toric IOL.
Prospective study included 7 eyes of 7 patients who underwent AcrySof aspheric, IQ toric IOL implantation for astigmatism over 1 corneal D, associated with PhacoTBC without MMC, by the same surgeon, from March 2013 till November 2013. Toric IOL power was considered with the Alcon IOL calculator. The usual Phaco TBC technique was made, using phemtosecond laser. Follow up was made on day 1, 3,7,15,21,30, 60 and 90.
Mean age was 71.7,(7.65 SD) (range 58 to 80). 4 patients were women (57%), and all Hispanic. Preoperative VA 0.87 and 0.25 VC logMAR, improved to 0.31 on VA and 0.11 of VC logMAR. The IOL had a movement range of 4 grades (g) but 1 patient IOL was displaced downwards 8g. 2 patients VF results were reported. One improved 2.8 dB in MD, and the other probably worsened 2.22 dB, but need a second VF to confirm. IOP improved from 18.7 to 14 mmHg, without hypotensive medication in 6 patients, and 1 with Latanoprost. Mean preop-refractive astigmatism was -1.93 D, at 85.71g (-0.25D to -4.25D), 85.7% against the rule (ATR), and 14.3% with the rule (WTR). Mean postop-refractive astigmatism was -1.11D at 57.14g (0 to -2.25D). 42.9% were WTR, 14.3% ATR, and 42.9% oblique. There was a difference of 0.82D and 28.57g compared with the preoperative values. Mean preop-corneal astigmatism was of -1.61 D at 92.86g, (-3.25D to -1D), 57.1% WTR, 42.9% ATR. Postop-mean corneal astigmatism was of -1.64D at 92.86g, 28.6% WTR, 42.9% ATR, and 28.6% oblique. The difference was of 0.03D and 48.57g. Vectorial analysis shows 2.16D at 97.43g. These values range from -3.32D to -0.25D, with 14.3% WTR, 57.1% ATR, and 28.6% oblique.
We find IOP reduction and improvement on VA in all patients. There is a tendency to shift the astigmatism axis ATR after surgery. Toric IOL reduced refractive astigmatism in 0.82D. IOL tends to stay stable, with 4g of rotation in 85% of cases. Induced corneal astigmatism proved a refractive stability after surgery, changing 0.46D. Nevertheless, we find a change of 48g in the corneal axis, when individual cases are analyzed. Due to variability of 0.75-1D induced by this procedure, maybe the use of toric IOL in higher keratometric astigmatisms is more corrective than in lowers. A larger cohort of patients is suggested.
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