Evaluation of a toric intraocular lens with a Z-haptic

PURPOSE: To evaluate the efficacy and rotational stability of the MicroSil 6116TU foldable 3-piece silicone toric intraocular lens (IOL) (HumanOptics). SETTING: Department of Ophthalmology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom. METHODS: This prospective observational study included 21 eyes of 14 consecutive patients with more than 1.50 diopters (D) of preexisting corneal astigmatism having cataract surgery. Phacoemulsification was performed, and a MicroSil 6116TU toric IOL was inserted through a 3.4 mm temporal corneal incision. LogMAR uncorrected visual acuity (UCVA), best corrected visual acuity, refraction, keratometry, and cylinder axis of the toric IOL were measured. RESULTS: The mean preoperative refractive and keratometric astigmatism was 3.52 D +/- 1.11 (SD) and 3.08 +/- 0.76 D, respectively. Six months postoperatively, the logMAR UCVA in eyes without ocular comorbidity (n = 14) was 0.20 +/- 0.15 (Snellen 20/32). Seventy-nine percent (11 eyes) had a visual acuity of 0.24 (Snellen 20/35) or better. The mean refractive astigmatism at 6 months was 1.23 +/- 0.90 D. Vector analysis using the Holladay-Cravy-Koch method showed a mean reduction in refractive astigmatism of 2.16 +/- 2.33 D. The mean difference between intended and achieved cylinder axis at 6 months was 5.2 degrees (range 0 to 15 degrees). No IOL rotated more than 5 degrees during the follow-up period. CONCLUSIONS: The MicroSil 6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence. The IOL was stable in the capsular bag, showing no significant rotation up to 6 months postoperatively.     

Acrysof toric人工晶状体的临床应用研究

目的 评价白内障术中植入一片式散光型人工晶状体(IOL)矫正术前角膜散光的疗效和旋转稳定性.方法 白内障超声乳化吸除联合Acrysof toric IOL植入31只眼,其中T3(柱镜为1.50D)19只眼,T4(柱镜为2.25D)7只眼,T5(柱镜为3.00 D)5只眼.另外,对照组30只眼,手术方式相同,术中植入SA60AT型IOL.白内障超声乳化吸除联合IOL植入手术通过颞侧角膜切口进行.观察术后早期(1周)和远期(3月)术眼散光和角膜散光,晶状体的旋转度数,裸眼视力(UCVA),球镜矫正视力(SCVA)和最佳矫正视力(BCVA).结果 在最后随访时,观察组全部患眼的UCVA均LogMAR 0.3(20/40)以上,而对照组有86.7%的患眼达到LogMAR0.3(20/40)以上.平均眼散光观察组为(0.44±0.24)D,对照组为(1.44±0.34)D.观察组有21只眼(77%)的IOL轴旋转小于3°,所有患眼IOL旋转不超过9°.结论 术后早期和远期观察表明Acrysof toric IOL,植入可以有效和稳定地矫正白内障患者术前即存在的散光.     

Treatment of keratoconus by toric foldable intraocular lenses

PURPOSE: To report on the correction of marked regular corneal astigmatism due to keratoconus by toric intraocular lenses (IOL). SETTING: University eye hospital. METHODS: A 66-year-old woman presented with cataract and unilateral keratoconus (keratometric readings: 50.2/41.3 diopters [D]). She underwent routine cataract surgery with implantation of a foldable posterior chamber toric IOL (refractive power: +10.0 D sphere/+12.0 D cylinder). A 68-year-old surgically aphakic woman presented with peripheral accentuated keratoconus with regular and stable corneal astigmatism (keratometric readings: 39.75/61.5 D). She underwent secondary implantation of a foldable toric IOL (refractive power: -9.0 D sphere/+30.0 D cylinder) into the ciliary sulcus. RESULTS: After a follow-up period of 4 months, visual acuity increased to 0.70 with a correction of +0.75 sphere -2.5 cylinder/84 degrees in Patient 1; after a follow-up period of 6 months, visual acuity increased to 0.60 with a correction of +1.0 -2.0/90 degrees in Patient 2. CONCLUSIONS: Foldable toric silicone IOL may be a surgical option in the management of regular marked corneal astigmatism caused by keratoconus.     

Foldable toric intraocular lens for astigmatism correction in cataract patients

PURPOSE: To evaluate the results of AcrySof toric intraocular lens (IOL) (Alcon) implantation to correct preexisting astigmatism in patients having cataract surgery. SETTING: Ophthalmology Service, Donostia Hospital, San Sebastián, Spain. METHODS: This prospective observational study included 30 eyes of 15 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having cataract surgery. Bilateral implantation of the AcrySof toric IOL was performed after phacoemulsification. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere, residual keratometric and refractive cylinders, and toric IOL axis were measured. RESULTS: The UCVA was 20/40 or better in 93.3% of eyes and 20/25 or better in 66.6%. All eyes achieved 20/25 or better BCVA. The mean refractive cylinder decreased significantly after surgery from -2.34 D +/- 1.28 (SD) to -0.72 +/- 0.43 D (P<.01). Vector analysis of attempted versus achieved correction showed that 100% of eyes were within +/-1.00 D and 80% and 93.9% were within +/-0.50 D for J(0) and J(45), respectively. The mean toric IOL axis rotation was 3.63 +/- 3.11 degrees, with rotation less than 10 degrees in 96.7% of eyes. CONCLUSIONS: The results indicate that phacoemulsification and posterior chamber AcrySof toric IOL implantation is an effective option to correct preexisting astigmatism in cataract surgery. The AcrySof toric IOL showed good rotational stability.     

Toric intraocular lens for correction of high corneal astigmatism in cataract patients

AIM: To evaluate the efficacy of Bi-Flex toric intraocular lens (T-IOL; Medicontur, Medical Engineering, Ltd., Inc.) implantation to correct preexisting astigmatism in patients having cataract surgery. METHODS: This retrospective consecutive study included 22 eyes of 16 patients with more than 2.50 diopters (D) of corneal preexisting astigmatism having cataract. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction and keratometric and topographic cylinder were measured. Postoperative the toric IOL axis was evaluated using vector analysis. RESULTS: Postoperatively, subjective refractive cylinder was reduced significant (P<0.05) from 4.05±1.53 D to 1.35±0.86 D. The component J0 reduced in magnitude from -0.81±2.02 D to -0.12±0.62 D (P<0.05). Both, UCVA and BCVA improved significantly at 1mo after surgery (P<0.05 in both cases). After the surgery, the UCVA and BCVA were 0.24±0.19 and 0.06±0.08, respectively. The mean toric IOL axis rotation was 2.95±5.25 degree, with rotation less than 10 degrees in 86.36% of eyes. No differences in mean keratometric values obtained before and after surgery were found (P>0.05 for J0 and J45). CONCLUSION: Implantation of the Bi-Flex toric IOL is a safe and effective method to correct the preexisting regular astigmatism (greater than 2.50D).     

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with low degrees of corneal astigmatism. METHODS: Twenty six eyes of 22 patients who underwent implantation a trifocal toric IOL (FineVision PODFT, PhysIOL s.a., Liege, Belgium) were enrolled. Phacoemulsification with femtosecond laser, capsular tension ring insertion and intraoperative aberrometry were performed in all cases. All IOLs used showed a cylinder power of 1.00 D. Main outcome measures were refractive error and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) values. Eyes were evaluated at 4mo post-surgery. RESULTS: Totally 50% of eyes showed a spherical equivalent (SE) within ±0.13 D and all of them within ±0.50 D. The mean SE and refractive cylinder were -0.02±0.23 and -0.16±0.22 D, respectively. Vector analysis revealed that 100% of eyes were within ±0.50 D for the SE and cylindrical components (J0 and J45). Refractive changes were not correlated with keratometric changes (P>0.05) showing that the reduction in astigmatism comes from the trifocal toric IOL. Of 81% and 96% of eyes showed UDVA and CDVA of 20/20, respectively. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02 (about 20/20), respectively. CONCLUSIONS: The present study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.     

Long-Term Efficacy and Rotational Stability of AcrySof Toric Intraocular Lens Implantation in Cataract Surgery

Purpose

To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients.

Methods

This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3±5.0 months) follow-up were evaluated.

Results

At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28±0.38 diopter (D) from -1.28±0.48 D. The mean rotation of the toric IOL was 3.45±3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees.

Conclusions

Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients.     

Toric intraocular lens implantation: 100 consecutive cases

PURPOSE: To evaluate the first 100 consecutive cases of toric posterior chamber silicone intraocular lens (IOL) implantation by 2 community-based ophthalmologists. SETTING: Two private practices in western Virginia, USA. METHODS: Data on the first 100 consecutive toric IOL implantations in 81 patients were collected in a prospective manner. Cataract surgery was performed using topical anesthesia and phaco-chop, phaco-flip, or divide-and-conquer phacoemulsification. A Staar AA4203TF or AA4203TL IOL with a 2.00 diopter (D) or 3.50 D toric power was implanted using a lens injector. After the viscoelastic material was removed, the IOL was rotated to the desired orientation. The IOL orientation was assessed postoperatively at 1 day, 1 to 2 weeks, and the last visit. The mean follow-up was 23 weeks +/- 17 (SD). RESULTS: The IOLs performed in a predicable fashion. The mean astigmatism correction with IOLs within 15 degrees of the intended axis was 1.62 D with the 2.00 D IOL and 2.86 D with the 3.50 D IOL. Eleven patients had IOLs that were rotated more than 15 degrees away from the intended axes; in 3, the astigmatism was worse than preoperatively. The mean preoperative refractive and keratometric astigmatism was 2.48 D and 2.11 D, respectively. The mean postoperative astigmatism was 0.87 D and 2.05 D, respectively. At the last follow-up, half the patients had residual refractive astigmatism of 0.50 D or less and 45% had an uncorrected visual acuity of 20/30 or better. Of postoperative patients with a 20/30 visual acuity with or without correction, 52% could see this well no correction. CONCLUSIONS: The results show that toric IOL implantation can help an estimated 20% of patients with astigmatism achieve good vision and a reduced need for distance spectacles. If IOL rotation occurs, it is usually during the first week and can be remedied by repositioning the IOL at 1 week.     

Toric人工晶状体在合并高度角膜散光白内障中的应用

目的：评估Bi-Flex toric人工晶状体在合并散光的白内障中的应用。

方法：回顾性研究包括16例22眼合并2.50D以上散光的白内障患者。测量了术前与术后的裸眼视力、最佳矫正视力、客观及主观验光、角膜散光仪和角膜地形图测量的散光值。术后人工晶状体屈光轴位置使用向量进行分析。

结果：术后,主观验光散光值从4.05D±1.53D显著降低至1.35D±0.86D,(P<0.05)。屈光轴位置指标J₀,从术前的-0.81±2.02D降至 -0.12±0.62D(P<0.05)。裸眼视力和最佳矫正视力术后1mo时均显著改善(P<0.05),分别为0.24±0.19和0.06±0.08。人工晶状体屈光轴旋转程度平均为2.95±5.25度,86.36%的患眼旋转程度小于10度。术前、术后角膜散光计测量值未见显著差异(J₀ 和J₄₅均有P>0.05)。

结论：对于合并大于2.50D散光的白内障患者,Bi-Flex toric人工晶状体植入是安全有效的治疗方法。     

Compensation of corneal astigmatism with toric intraocular lens: results of a multicentre study

This clinical trial was conducted to evaluate visual acuity, refraction and rotation after implantation of the foldable toric intraocular lens (IOL) MicroSil Toric. PATIENTS AND METHODS: 68 eyes of 48 patients from four different surgical departments were examined over a follow-up of three months after cataract surgery. RESULTS: An individually produced IOL with cylindrical correction between 2.0 and 12.0 D was implanted in all eyes. Postoperatively, 68 % of the eyes achieved an uncorrected visual acuity (VA) of 0.5 or better, 12 % achieved 1.0 or better. A corrected VA of 0.5 or better was achieved by 85 %, 31 % achieved a corrected VA of 1.0 or better. Corrected VA improved by 3 (+/- 2) lines. The uncorrected VA improved by 6.0 lines in the mean. The increases in uncorrected and corrected VA were statistically significant (p < 0.001). The efficacy index amounted to 1.1 in the median and 1.3 (+/- 1.5) in the mean. Residual refraction (spherical equivalent) was 0.89 D (+/- 0.7 D) in the mean and was reduced by 5.14 D (+/- 4.78 D) in the mean. The total astigmatic error was reduced both in a statistically as well as in a clinically significant manner from 4.6 D (+/- 2.3 D) to 1.12 D (+/- 0.9 D) in the mean. 75 % of eyes needed a postoperative cylindrical correction of less than 1.5 D, 95 % less than 2.25 D. Corneal astigmatism was not changed significantly (p = 0,435). The surgically induced astigmatism (Naeser) amounted to 0.7 D in the median. In 85 % of the cases IOL rotation was less than 5 degrees. 15 % of the IOLs rotated more than 5 degrees, one IOL more than 10 degrees (max. 28 degrees). Patients ranked their surgical outcome on a scale from 1 (very good) to 6 (poor) which resulted in a mean score of 1.9 (+/- 1.0; min. 1.0; max. 5.0). No clinically relevant correlations of clinical parameters and satisfaction were detected. CONCLUSION: Implantation of the foldable, toric IOL with Z-haptics decreased the refractive error and improved postoperative visual outcome. This IOL was suitable for low as well as for high astigmatism. IOL rotation was low during the follow-up of three months resulting in sufficient correction of the pre-existing astigmatism.     

Evaluation of axis alignment and refractive results of toric phakic IOL using image-guided system

AIM: To evaluate accuracy of axis alignment and refractive results of toric phakic intraocular lens(IOL) implantation using a digital imaging system. METHODS: This retrospective study investigated toric implantable collamer lens(ICL) implantation in 30 eyes of 21 patients with myopic astigmatism more than 2.0 D guided with digital imaging system. Data were collected during the first week after phakic IOL implantation.RESULTS: Thirty eyes of 21 patients were included in our study. Patients includes 9 males and 12 females. The mean age of the patients was 26.5±7.1(range 21-44)y. The mean preoperative manifest astigmatism was 3.2±1.7(range from 2.25 to 4.75) D. The mean postoperative uncorrected distance visual acuity(UCDVA) were 0.07±0.07(range from 0.1 to 0.0) log MAR. The mean postoperative residual refractive cylinder was 0.25±0.29(range 0-0.75) D. Eyes with postoperative residual refractive cylinder of 0.5 D or less represented 80%(24 eyes). The mean postoperative toric IOL misalignment measured by the OPD scan III was 1.9°±1.45°(range from 0 to 5°). CONCLUSION: Image guided system allows accurate alignment of toric ICL. This is associated with good postoperative visual acuity and low residual refractive astigmatism which correlates with the precision of toric phakic IOL alignment.     

Toric人工晶状体植入矫正角膜散光的疗效观察

目的：观察Toric人工晶状体(intraocular lens, IOL)植入用于治疗合并角膜散光的白内障患者的临床治疗效果。

方法：对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及IOL植入术治疗,进行回顾性分析。其中22眼植入Toric IOL,25眼植入Acrysof IQ IOL。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种IOL的疗效。观察Toric IOL植入后的稳定性。

结果： 术后随访观察6mo,植入Toric IOL的试验组,术后裸眼视力平均0.73±0.37,明显优于植入Acrysof IQ IOL的对照组(平均0.47±0.18),结果有显著性差异。试验组术后裸眼视力0.5以上者占81.8%,优于对照组32.0%。试验组患者术后残余散光0.53±0.40D,明显低于对照组(2.13±0.76D),差异有统计学意义。植入Toric IOL组,随访6mo,术后平均旋转4.22±1.46度。

结论：对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric IOL植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Correction of low corneal astigmatism in cataract surgery

AIM: To evaluate and compare aspheric toric intraocular lens (IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions (LRI) to manage low corneal astigmatism (1.0-2.0 D) in cataract surgery.METHODS:A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes (102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were:visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III (Nidek Co, Japan). Follow-up lasted 6mo.RESULTS: The mean uncorrected distance visual acuity (UCVA) and the best corrected visual acuity (BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group (P<0.01). No difference was observed in the postoperative endothelial cell count between the two groups.CONCLUSION: The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.     

高度角膜散光白内障患者植入Toric IOL的临床观察

目的:评估高度角膜散光患者植入高度数环曲面人工晶状体（AcrySof Toric intraocular lens,Toric IOL）术后的视力和屈光结果。 方法:对21例24眼高度角膜散光的白内障患者行回顾性系列研究,术前角膜散光≥2.5D,植入AcrySof Toric IOL(T6,T7,T8或者T9)。研究数据包括术前和术后3mo的裸眼远视力（uncorrected distance visual acuities,UCDVA）、最佳矫正远视力（best-corrected distance visual acuities,BCDVA）、术前角膜散光、术后残留散光和散光轴向的偏离情况。 结果:术后3mo的UCDVA中75%（18/24）患眼视力＞05,显著高于术前BCDVA,两组差异有统计学意义（χ2=50.12,P<0.05）。术前角膜散光是3.45±0.63D。术后3mo残留的散光是0.72±0.23D。两者差异具有统计学意义（t=0.128,P＜0.01）。术后67%（16/24）的眼残留散光＜0.75D,83%（20/24）的眼＜1.00D。术前预计矫正散光312±0.54D,术后实际矫正散光3.05±0.66D,两者差异无统计学意义（t=1.659,P＞0.05）。人工晶状体术后3mo和1wk之间的旋转度数是3.2°±2.1°。 结论:植入高度数Toric IOL是一种安全的、有效的和可预测的治疗白内障合并高度角膜散光的方法。     

Significant postoperative refractive errors in vivo with the Mentor Memorylens intraocular lens

PURPOSE: To determine the difference between the predicted and postoperative refraction in eyes after implantation of the Mentor MemoryLens intraocular lens (IOL) and compare these results with those of 2 other types of foldable IOLs implanted by the same surgeons. SETTING: Community-based group practice ophthalmology clinic. METHODS: All operated eyes (341) of all patients who had routine phacoemulsification with implantation of a MemoryLens IOL performed by 1 of 2 surgeons were evaluated retrospectively. The predicted refractive error and actual postoperative refractive error were compared in each eye in the MemoryLens group and in 2 smaller control groups with an AcrySof acrylic (Alcon) or SI-40 silicone (Allergan Medical Optics) IOL implanted by the same surgeons using identical technique and IOL calculation parameters. Patients in whom the difference between the predicted and actual postoperative refraction fell significantly outside expected parameters were rechecked with repeat axial length and keratometric readings, and these measurements were used to back-calculate the effective in vivo IOL power. RESULTS: The MemoryLens group had significantly greater variability in postoperative refractive results from those predicted by the Hoffer program than the 2 control groups. The postoperative refractive error in the MemoryLens group differed from +1.50 to -5.50 diopters (D) from that predicted by the IOL calculation formulas. When the outlier groups (ie, greater than +0.50 D or less than -1.00 D from predicted refractive error) were evaluated and compared to the rest of the MemoryLens group and the 2 control groups, no significant difference in axial length, keratometric measurements, operative surgeon, surgical technique, or patient age was found. Repeat axial length and keratometric measurements in the outlier group were not significantly different from those in the same eyes preoperatively. Back-calculation using postoperative axial length and keratometric measurements in the highly myopic outlier group showed that the mean difference between the labeled IOL power and actual in vivo IOL power in the outlier group was -3.08 D (range -1.98 to -7.54 D). The best corrected visual acuity was not affected in patients in the outlier groups despite the refractive variability. CONCLUSION: The variation in postoperative refractive results in the MemoryLens group was significantly greater than in the 2 other foldable IOL groups.     

Toric人工晶状体矫正角膜散光的效果评价

目的评价Toric人工晶状体（IOL）矫正角膜散光的效果及在囊袋内的稳定性。方法收集确诊为年龄相关性白内障并伴有角膜规则散光的患者32例（35眼）,采用白内障超声乳化法植入ToricIOL。观察术前、术后裸眼视力（UCVA）及最佳矫正视力（BCVA）、术前角膜散光、预计残余散光、术后残余散光、IOL旋转度,并进行分析。结果术后3个月92%患眼UCVA≥0.5,78%患眼UCVA≥0.8,BCVA≥0.8者达96%。术前角膜散光平均为（1.500±0.405）D,术后3个月残余散光为（0.200±0.179）D。3个月时与术后第1d轴位相比较,IOL旋转平均为（2.132±1.853）°。结论ToricIOL可使患者获得更好的裸眼远视力,减少了患者的残余散光,预测性强,具有良好的旋转稳定性,是一种有效的矫正角膜规则散光的治疗方法。     

Combined toric intraocular lens implantation and relaxing incisions to reduce high preexisting astigmatism

PURPOSE: To evaluate whether combining toric intraocular lens (IOL) implantation with astigmatic keratotomy (AK) can correct higher levels of astigmatism while minimizing undue effects on the optical qualities of the cornea. SETTING: St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida, USA. METHODS: Thirteen eyes with corneal astigmatism greater than 2.50 diopters (D) (mean 5.54 D) had implantation of a Staar toric IOL combined with AK. RESULTS: All eyes had less than 1.00 D of refractive astigmatism postoperatively. Sixty-nine percent achieved an uncorrected visual acuity of 20/40 or better, and no patient lost best corrected visual acuity. CONCLUSIONS: Implanting a toric IOL in patients with high astigmatism reduced the amount of incisional surgery required. Combining techniques can correct all or most of even very high astigmatism (>5.00 D) while avoiding induced corneal irregularities.     

Toric人工晶状体植入矫正特殊角膜散光的疗效观察

目的：回顾分析Toric(环曲面)人工晶状体植入治疗合并特殊角膜散光的白内障患者的临床治疗效果。

方法：对10例12眼合并特殊角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中4眼为翼状胬肉切除术后,3眼为外伤后角膜散光,5眼为角膜云翳或斑翳患者。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入后的疗效,旋转稳定性。

结果：术后随访观察6mo,术后裸眼视力平均0.62±0.31,最佳矫正视力0.70±0.35。裸眼视力≥0.8者2眼,占17%。裸眼视力≥0.5者9眼,占75%。术后残余散光0.51±0.36D。术后角膜源性散光未见明显改变,全眼总合散光得到明显改善,差异有统计学意义。术后全眼总合散光与术前预计残余散光值接近,无显著性差异。术后6mo旋转度为(3.80±1.46)°。末次随访时间点,植入Toric人工晶状体的12眼中,旋转度小于5°的11眼,占92%。仅1例术后旋转度为6°。

结论：对于某些特殊原因导致角膜散光的白内障患者,经过严格的手术前筛选,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Toric intraocular lenses for correcting astigmatism in 130 eyes

OBJECTIVE: This study evaluated the results after implantation of toric intraocular lenses (IOLs) to correct preexisting corneal astigmatism in patients undergoing either cataract or clear lens extraction surgery. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred thirty eyes of 99 patients who underwent phacoemulsification and posterior chamber toric IOL implantation from January 1997 through February 1998 were included in the study. INTERVENTION: Implantation of a toric IOL was performed after cataract surgery (122 eyes) or clear lens extraction surgery (eight eyes). Both preoperative corneal cylinder and refractive cylinder powers were more than 1.50 diopters (D) for all the eyes included in this study. To provide a comparison, we also studied 51 eyes of 45 patients meeting the same preoperative criteria for degree of corneal and refractive cylinder who underwent implantation of a spherical (nontoric) IOL combined with limbal relaxing incisions. The data for both study and comparison groups were analyzed retrospectively. The selection for the two groups was arbitrary. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), mean spherical equivalent, residual refractive cylinder, and toric IOL axis. RESULTS: In the toric IOL group, 84% of eyes achieved 20/40 or better UCVA. In the spherical IOL group, 76% achieved 20/40 or better UCVA. The mean postoperative refractive cylinder was -1.03 +/- 0.79 D in the toric IOL group and -1.49 +/- 0.75 D in the spherical IOL group. CONCLUSIONS: Our results indicate that phacoemulsification and posterior chamber toric IOL implantation is a largely predictable new surgical option to correct preexisting corneal astigmatism in cataract or clear lens extraction surgery.     

Phacoemulsification and customized toric intraocular lens implantation in eyes with cataract and high astigmatism after penetrating keratoplasty

Phacoemulsification and implantation of a hydrophilic acrylic toric intraocular lens (IOL) (T-flex 623T) with customized cylindrical power was performed in 1 eye in 3 consecutive patients with cataract and high postkeratoplasty astigmatism (range 6.75 to 8.75 diopters [D]). Twelve months postoperatively, the uncorrected distance visual acuity improved from 20/200 to 20/30 in Case 1, from 20/400 to 20/40 in Case 2, and from 20/200 to 20/25 in Case 3 and the corrected distance visual acuity was 20/25 or better in all 3 eyes. The spheroequivalent was within ± 0.50 D of the intended value and the refractive astigmatism was less than 1.00 D. The corneal grafts were transparent, and the endothelial cell loss range was 6% to 12%. Rotation of the toric IOL was less than 5 degrees. The toric IOL with customized cylindrical power provided good postoperative rotational stability and very satisfactory postoperative visual recovery. This type of toric IOL is appropriate to correct high postkeratoplasty astigmatism in eyes operated on for cataract. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.