Toric Intraocular Lenses One way or patients decision? Moschou Konstantinos M.D. Diathlasis Day Care Unit
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1 Toric Intraocular Lenses One way or patients decision? Moschou Konstantinos M.D. Diathlasis Day Care Unit Scienti'ic Workshop of Diathlasis Day Care Unit November, 2016 The Met Hotel Thessaloniki, Greece
2 FINANCIAL DISCLOSURE MAYROGENIS BAUSCH+LOMB
3 Cataract surgery Ø Modern cataract surgery is more of refractive surgery Ø Myopia & hypermetropia can be corrected using appropriate spherical powers of IOL s Ø However approximately 20% of patients who undergo cataract surgery have 1.25D of corneal astigmatism or more Ø It can be corrected with Toric IOL s
4 Cataract surgery Ø Other options for correction of co- existent cataract and astigmatism Ø LRI during cataract surgery (unpredictable results) Ø Laser procedures postoperatively (are associated with new set of complications)
5 Available Toric IOLs
6 EnVista toric (Model MX60T)
7 EnVista toric specixications
8 EnVista toric specixications
9
10 Patient selection Ø Regular corneal astigmatism > 1.0 D Ø Patient wants spectacle independence
11 Toric IOL power calculation Ø Precise keratometry Ø Surgically induced astigmatism (SIA)
12 Keratometry Ø Can be done with Ø Manual keratometer Ø Automated keratometer with steps of 0.12 only Ø Corneal topography Ø Optical biometry Ø K readings from all the three show high repeatability and are comparable Ø Manual keratometer should be calibrated regularly
13 Keratometry Ø Corneal topography is required in case of unusual reading & poor quality mires Ø Precautions Ø Reading must be quick to avoid drying of cornea Ø Don t rub on the cornea Ø Centration must be proper
14 Interferometers for Axial Length Measurement & Keratometry IOL Master 700 LenStar Diathlasis Day Care Unit, Thessaloniki, Greece
15 Bausch and Lomb envista toric calculator
16 Diathlasis Day Care Unit, Thessaloniki, Greece
17
18 Marking of eye
19 Digital markers VERION (ALCON) CALLISTO (ZEISS)
20 ORA
21 STEPS Ø Reference marking Ø Done prior to surgery with patient upright Ø Two reference markers placed at limbus 180 degree apart Ø Used to align marking instruments for placement of axis marks Ø Axis marking: Using reference marks as a guide the patient eye is marked accurately at two positions 180 degree apart
22 TIPS Ø Dry the conjunctiva with a swab Ø Enhance marking at 3-9 o clock Ø Apply mark with twisting action Ø It lasts throughout surgery
23 Surgery Ø Standard phacoemulsi'ication Ø Incision size mm Ø Well centered rhexis with diameter mm with 360 degrees overlap of IOL margin Ø Marks on IOL indicate 'lat meridian or plus cylinder axis of toric IOL Ø Cohesive viscoelastics are preferred
24 IOL alignment Gross alignment OVD removal Final alignment If overshoots Tap ( nudge ) IOL down into capsular bag to seat lens onto the posterior capsule.
25 IOL alignment
26 IOL alignment Ø If any compromise of zonular integrity or capsule occurs please switch to standard non toric IOL Postoperative axis alignment : Ø Slit Lamp with dilated pupil Ø Wavefront aberrometry in undilated pupil Ø Realignment should be done in < 2 weeks
27 COMPLICATIONS Ø Rotational stability is critical to effectiveness of toric IOLs Ø 1 rotation results in 3.3 % IOL power loss Ø 30 rotation negates cylindrical correction of toric IOL Ø Further rotation induces more astigmatism 27
28 Conclusion Ø After a cataract surgery using toric intraocular lens, the patient will not need to wear distance or reading glasses. Ø Toric IOL offers better quality of vision even in conventional cataract surgery.
29 Thank you for your attention!
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