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Sonia Mall, Jasleen Kaur Jolly, Kanmin Xue, Chetan K Patel, Robert E MacLaren, Funded by the Oxford University NHS Hospitals NIHR Biomedical Research Centre; Refractive outcomes with toric intraocular lens implants.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4195.
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Refractive astigmatism is a combination of corneal and lenticular components. Cataract surgery removes lenticular astigmatism but with standard intraocular lens (IOL) implants, corneal astigmatism remains uncorrected unless combined with additional surface incisional procedures, which are of limited value with cylinders above 2.0 dioptres (D). Toric IOLs may therefore confer benefits for patients with higher degrees of corneal astigmatism. The purpose of this study was therefore to establish postoperative refractive outcomes in patients implanted with the new AMO Technis toric IOL (USA) and specifically to establish changes in astigmatism and unaided visual acuity (VA) following surgery.
We conducted a retrospective analysis of patients operated over a ten month consecutive period up to October 2013. These patients all had a toric lens implant inserted to correct corneal astigmatism by senior surgeons at a single UK teaching hospital. Data were collected on pre and post-operative cylindrical corrections, predicted post-operative refractions & K values on the biometry calculation performed on the Zeiss IOL master. In total, 21 eyes of 21 patients were analysed. The predicted spherical equivalent of the lens was compared with the post-operative refraction in 17 patients.
In total, 15 patients had an improvement in unaided visual acuity, 5 patients had no change in unaided VA and 1 patient had a reduction in VA. 8 pts were within 0.5D of predicted spherical equivalent, 3 were within 1.5 D, 5 were within 1 D and 1 within 2 D. The median residual cylinder was 0.75D, interquartile range (IQR) 0.5 - 1.5D. The median of the post-operative sphere was 0D, and IQR was -0.50 to +0.50D. 14 of patients had a reduction in post-op cylinder, 4 had no change and 3 patients showed an increase in cylindrical correction. In one case the IOL rotated out of position twice in a patient who had had a previous vitrectomy and zonular weakness was suspected. This was the only case in which the lens was exchanged for a non-toric IOL combined with a surface procedure.
The use of toric intraocular IOLs improved cylindrical correction and unaided VA in the majority of patients. This suggests that with careful planned cataract surgery patients are able to attain a good level of vision. Patients need to be consented about the possible need to correct post-operative IOL rotation. Strategies for improving outcomes will be discussed.
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