Abstract
Purpose: :
Toric intra-ocular lenses are a recent technology developed to treat astigmatism in cataract patients. These lenses are deployed in a similar manner as monofocal IOL's, but may require additional operating time to appropriately position them in the lenticular capsule. This is due to the need to align the optic with the axis of astigmatism, which often involves additional surgical maneuvers as compared to monofocal lenses. Resident surgeons learning to employ them may need additional time allotments in the operative suite to accomplish this if a significant time difference exists. In addition to the potential intraocular complications associated with longer operative times, patients may also be exposed to the dangers of anesthesia longer if these lenses take longer to place. This study seeks to determine if resident surgeons require a significantly longer period of time to place a toric IOL's as compared to a monofocal IOL's.
Methods: :
A retrospective analysis was performed on 48 uncomplicated resident cases involving placement of Alcon's SN6AT-series of toric IOL's over a one year period. The operative time of each case was compared to the last uncomplicated cataract case of the day performed by the same resident, involving placement of an Alcon's SN60WF lens, considered to be the standard monofocal IOL in the facility. This was to eliminate differences between surgeons, to examine the standard lens case when the surgeon would presumably be most efficient on a given day, and to exclude complicated cases involving longer operative times. The time differences were then averaged. The study involved 6 resident surgeons at various stages of their learning of the placement of toric and multifocal IOL's.
Results: :
The operative times for the 48 SN6AT-series toric IOL's were between 13 and 67 minutes, averaging 33.4 minutes. The monofocal IOL operative times were between 12 and 60 minutes, averaging 31.1 minutes. The average time difference in the 48 cases was an additional 2.42 minutes being required for toric IOL's.
Conclusions: :
Although some toric cases may have been perceived as taking significantly longer than their standard-lens counterparts, on a daily basis, the two styles of IOL's take similar periods of time for resident surgeons to place properly in the lenticular capsule. This data may encourage facilities to include more toric IOL's in their resident training, as an additional two to three minutes is less likely to cause adverse effects on scheduling in operative facilities. Residents should remain mindful of the potential intraocular complications and risks of anesthesia when longer operating times are anticipated.
Keywords: cataract • astigmatism