Dr Vidushi Sharma
MD (AIIMS), FRCS (UK)
SuVi Eye Institute & Lasik Laser Centre C-13, TALWANDI, KOTA, RAJASTHAN, INDIA Phone +91 9351412449, +91 744 2406744, 2433575 Website: www.suvieye.com EmailEmail- suvieye@gmail.com Visiting Assistant Professor, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Sydney Eye Hospital, University of Sydney, Australia
ACRYSOF TORIC RTM at Raipur, Chhatisgarh, Chhatisgarh, India August 28, 2011
Dr Suresh K Pandey Speaking at AcrySof TORIC Round Table Meeting at Raipur, Chhatisgarh, India, August 28, 2011
Dr Suresh K Pandey Speaking at AcrySof TORIC Round Table Meeting at Raipur, Chhatisgarh, India, August 28, 2011
After spherical errors, astigmatism remains the major cause of reduced UCVA
n = 3538 Average K astig >/= 1 D >/= 2 D >/= 3 D 0.916 D 39% 8.6% 2.4%
Management of Astigmatism
Measures to deal with astigmatism include tailoring the wound construction and other modalities (LRI/PRK etc) Most of the procedures do not have a predictable result over a long period of time
Toric IOLs
Astigmatism
Excimer Laser
Astigmatic Keratotomy/LRI
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN
Toric IOL
We found that the patients were more satisfied than even the routine monofocal probably because:
They had never worn glasses before and hence had never realized the potential of that eye They could not be completely corrected for their astigmatism, and hence once corrected had vision like never before
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN
TORIC IOL
Correcting astigmatism with Toric IOLs does not demand extra skill from the surgeon If at all only accurate biometry and axis markings as already discussed.
Alcon AcrySof Toric IOL (Most preferred as it provide best rotational stability)
PURPOSE
To evaluate visual outcome and astigmatic correction following implantation of the first 52 AcrySof Toric IOLs at our centre during 2008 to 2010
EXCLUSION CRITERIA
Corneal surface abnormalities Irregular astigmatism Extensive retinal pathology Previous ocular surgery/trauma causing astigmatism
CASE SELECTION
Counseling Keratometry (Auto/Manual) A Scan Biometry Complete ophthalmic examination Preoperative informed consent
Dimensions
Overall length: 13.0 mm Optic diameter: 6.0 mm
Delivery
Monarch II Injector C and D Cartridge
CORNEAL MARKING
The preoperative Reference markings were made with the patients sitting upright to negate any possible cyclotorsion in the supine position An intraoperative toric axis marker was used for determination of actual axis placement.
SURGICAL PROCEDURE
After injection, all IOLs were rotated 15-25 degrees from intended axis and the viscoelastic was then removed from posterior to the lens. The IOLs were then rotated to their final position to coincide with corneal axis markings.
VISUAL OUTCOME
Visual acuity and Refraction checked at 1st postop day, 2 weeks and 6 weeks Final correction at 6 weeks IOL rotation also checked at 6 weeks correlating with incision placed at steep axis
RESULTS
No. of AcrySof toric IOLs used since 2008 to 2010 52 (47 patients) 42 cases were unilateral; 5 had bilateral toric IOL Gender distribution
35
2 5
5
o b
o b
<
2
<
o 2
<
<
First Case
65 year old male One Eyed Other Eye NVG following CRVO IOL model 21.50 D T3 Preop Visual acuity 6/60 Corneal Astigmatism 1.50 D Postop VA 6/6 unaided
Youngest Case
4 years old boy with zonular cataract Preop Cylinder 1.50 diopter IOL power used 21.0 Diopter T3 Preop VA FC at 2 meters Postop VA 6/9
PiggyBack IOL
DISCUSSION
In our series, 65% patients achieved 0.5D astigmatism and 95% patients achieved postoperative astigmatism within 0.75D 95% patients achieved an unaided visual acuity of 6/12 or better markedly decreasing their spectacle dependence for distance vision
DISCUSSION
One patient had postoperative best corrected visual acuity of 6/12 and had macular edema One 8 year old child had surgery for developmental cataract and achieved postoperative BCVA of 6/12 (amblyopia) Only 1 patient had IOL rotation > 5 (postoperative cylinder - 0.75D)
DISCUSSION
Our series compared favorably with most published series possibly due to case selection Most patients reported seeing much better unaided than they had ever seen
CONCLUSION
AcrySof toric IOL shows excellent rotational stability, if placed accurately during surgery due to its sticky surface Accurate keratometry, biometry is crucial and should be rechecked Calculate surgeons induced astigmatism (SIA)
CONCLUSION
Preoperative counseling extremely important to select the most appropriate cases medically, financially and psychologically!! Results with AcrySof toric IOL are very gratifying to most patients with a difference they can truly appreciate
POINTS TO REMEMBER
IOL placed and marks aligned precisely with the steep axis of the post-incisional cornea For every 1 of rotation, 3.3% of the lens cylinder power is lost For 30 of rotation there is a complete loss of astigmatic correction
Dr. Vidushi Sharma, MBBS (AIIMS, New Delhi), MD (Ophthalmology, AIIMS, New Delhi), FRCS (UK) EmailEmail- suvieye@gmail.com Phone +91 9351412449, 0744 2433575 www.suvieye.com