Jagdish Dukre
refractive surgery.
Myopia & hypermetropia can be corrected
results)
Laser procedures postoperatively (are
from PMMA.
It had oval optic with loop haptics ,available
AVAILABLE
TORIC
IOLs
Cylinder power at
IOL plane(D)
Cylinder Power at
corneal plane(D)
SN60AT3
1.50
1.03
SN60AT4
2.25
1.55
SN60AT5
3.00
2.06
SN60AT6
3.75
2.57
SN60AT7
4.50
3.08
SN60AT8
5.25
3.60
SN60AT9
6.00
4.11
Patient selection
Regular corneal astigmatism > 1.5 D
Vision compromising cataract
Patient wants spectacle
independence
Facts
20% of patients with cataract have
astigmatism >1.25 D
Every incision on cornea induces additonal
astigmatism (SIA).
Implantation of monofocal lens will require
distance and near correction both in these
cases.
B/L Toric IOLs give high level of spectacle
independence(97%).
Requirement of near correction can be
overcome by multifocal toric IOL(AcriLisa
multifocal toric IOL)
Keratometry
Can be done with
Manual keratometer
Automated keratometer with steps of 0.12 only
Corneal topography
K readings from all the three show high
regularly.
cornea.
Dont rub on the cornea.
Centration must be proper.
Surgically Induced
Every incision changes
Astigmatism
the cornea.
Closer to the centre & larger the incision more
patient.
Overall effect can be summed up with vector
analysis.
SIA Calculation
Obtain SIA calculator
Fill it for 20-30 cases minimum
Be precise about axis and incision
Calculator auto calculates SIA
Output screen
Recommended IOL
model and spherical
equivalent power
Optimal axis
placement
Magnitude and axis
of anticipated
residual astigmatism
16
Marking of Eye
Instruments
Bubble marker
Gravity marker
STEPS
A) Reference marking
Done prior to surgery with patient upright
Two reference markers placed at limbus 180
degree apart
Used to align marking instuments for placement
of axis marks
B) Axis marking : Using reference marks as a guide
the patient eye is marked accurately at two
positions 180 degree apart
TIPS:- Dry the conjunctiva with a swab
- Enhance marking at 3-9 o clock
- Apply mark with twisting action
Surgery
Standard phacoemulsification
Incision size 1.5 3.4 mm
Well centered rhexis with diameter 5- 5.5 mm
IOL alignment
Gross
alignment
OVD removal
Final alignment
If overshoots
Complications
Rotational stability is critical
22
Conclusion
Bilateral toric IOL implantation shows