Custom-designed toric phakic intraocular lenses to correct high corneal astigmatism

PURPOSE: To analyze the results of a custom-designed posterior chamber toric phakic intraocular lens (PIOL). METHODS: A 40-year-old woman with high astigmatism and thin corneas underwent bilateral PIOL implantation with the toric Implantable Collamer Lens (ICL) custom-designed and manufactured by STAAR Surgical. The appropriate toric ICL power was calculated to be -8.00 +8.00 x 96 degrees for the right eye and -8.50 +7.50 x 86 degrees for the left eye. Optical zone was 5.5 mm and 6.875 mm at the corneal plane. RESULTS: At 3 and 6 months postoperatively, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA) of both eyes had improved to 20/20 and 20/16, respectively. At 19 months, UCVA was 20/20 and 20/16 in the right and left eyes, respectively, and BSCVA had improved to 20/16 and 20/10, respectively. The subjective refraction was stable, with a change of -0.37 +/- 0.17 D from preoperative to 19 months postoperatively. Throughout the postoperative period, iridotomies remained patent and the corneas were clear. CONCLUSIONS: Bilateral implantation of the custom-designed toric ICL successfully corrected the patient's high astigmatism. Preoperative subjective refractive cylinder of -5.25 x 6 degrees in the right eye and -5 x 176 degrees in the left eye changed to -0.5 x 77 degrees and -0.5 x 115 degrees, respectively, after toric IOL implantation. There was almost no change in corneal astigmatism. This customized approach led to UCVA of 20/20 in the right eye and 20/16 in the left eye, and BSCVA of 20/16 in the right eye and 20/10 in the left eye. This is the first report of a toric PIOL being specifically manufactured to meet the refractive cylinder requirements of a specific patient.     

Implantation of an ARTISANtrade mark toric phakic intraocular lens to correct high astigmatism after penetrating keratoplasty

BACKGROUND: Visual outcome after penetrating keratoplasty is often Iimited by residual astigmatism. Sometimes conservative treatment modalities like glasses or contact lenses fail to correct the keratoplasty-associated astigmatism. Refractive options are arcuate keratotomy, photorefractive keratectomy or laser in situ keratomileusis. The implantation of an ARTISAN toric intraocular lens presents an additive option to correct corneal astigmatism in phakic eyes. This toric intraocular lens (IOL) has an optical zone of 5.0 mm with a sphericaI front and a toric back. The torus of the IOL is available up to 7 D in half dioper steps. CASE REPORT: A 27-year old female presented with a bestcorrected visual acuity of 20/32. Penetrating keratoplasty was performed in 1997 because of a decompensated keratoconus. Despite a clear allgraft visual acuity was limited because of a keratoplasty-related high astigmatism of 7.6 D/124 degrees, which could not be sucessfully treated with glasses or contact lenses. An ARTISAN toric intraocular lens with - 3 D spherical and 7.0 D/0 degrees cylindrical power (individually manufactured) was implanted via a sclerocorneal tunnel incision into the anterior chamber. Postoperatively an optimal graft clarity with a well-centered and stable-positioned IOL was found. After 3 months uncorrected visual acuity was 20/25. Six months after implantation the IOL was still well-centered and uncorrected visual acuity was 20/20. CONCLUSION: Implantation of an ARTISAN toric intraocular lens in phakic eyes is an alternative and new option to correct higher astigmatism. In contrast to the keratorefractive option minor manipulation on the allograft can be expected. For a final conclusion of the endothelial cell loss longer follow-up is necessary.     

Implantation of a toric poly(methyl methacrylate) intraocular lens to correct high astigmatism

A 57-year-old man experienced a decrease in visual function because of cataract formation. Corneal astigmatism was 13.4 diopters (D) because he had had a penetrating keratoplasty 27 years before. Cataract surgery was planned, and biometric data for toric intraocular lens (IOL) implantation were collected for the manufacture of a custom IOL. After phacoemulsification, a toric poly(methyl methacrylate) (PMMA) IOL of +19.0 D spherical and +12.0 D cylindrical power was implanted via a sclerocorneal tunnel incision. Three months postoperatively, corneal astigmatism was 14.3 D and best corrected visual acuity (BCVA), 20/25. Postoperative refraction (+1.5 -3.0 x 90) and BCVA remained stable for 7 months. No significant IOL rotation was observed. Implantation of a toric PMMA IOL corrected high corneal astigmatism. Toric IOL technology with high cylindrical power allows enhancement of IOL surgery.     

Artisan toric phakic intraocular lens for the correction of high astigmatism

PURPOSE: To evaluate efficacy, predictability, and safety of Artisan toric phakic intraocular lens (Ophtec, Groningen, The Netherlands) implantation for the correction of astigmatism higher than 2 diopters. DESIGN: Interventional case series. METHODS: This prospective study included 27 eyes of 16 patients with a mean preoperative spherical equivalent of -11.78 +/- 6.24 diopters and a mean preoperative astigmatism of -3.43 +/- 0.81. The Artisan phakic intraocular lens was inserted in the anterior chamber through a posterior corneal incision; the technique is similar to the implantation of the classical Artisan lens, but in these cases it is particularly important to secure the lens accurately in the correct axis. The main parameters evaluated in this study were uncorrected visual acuity, best-corrected visual acuity, refraction, and endothelial cell count. RESULTS: Twelve months after the implantation of the Artisan toric phakic intraocular lens, 62.90% of the eyes were within +/-0.50 diopters. of emmetropia and 96.20% within +/-1.0 diopters. Seventy percent of the eyes gained 1 or more Snellen lines from their preoperative best-corrected visual acuity, and 11.11% lost 1 Snellen line. Mean endothelial cell count increased 2.9%. Mean of the parallel and orthogonal components of cylinder correction were 1.97 diopters and 0.10 diopters, respectively, of the intended cylinder change. The mean of axis alignment error was 10.53 degrees. No serious complications were observed. CONCLUSION: Artisan toric phakic intraocular lens implantation appears to be a safe and predictable method for the correction of high levels of astigmatism.     

Implantation of Artisan toric phakic intraocular lens following Intacs in a patient with keratoconus

We report a 24-year-old man with bilateral keratoconus in whom Intacs (Addition Technology, Inc.) were implanted in both eyes. The procedure was followed by Artisan toric phakic intraocular lens (Ophtec) implantation to correct the residual myopic and astigmatic refractive error.     

Long-term outcome of custom toric intraocular lens for treating high astigmatism in case of cataract associated with pellucid marginal corneal degeneration

Pellucid marginal corneal degeneration (PMCD) is a progressive corneal ectasia that ultimately results in high regular astigmatism and correction of this astigmatism is always challenging. However, when a PMCD patient develops a cataract, it provides a golden opportunity to treat this coexisting astigmatism with toric intraocular lens (IOL) implantation. Regular toric IOLs would correct astigmatism only up to 6 diopters in the IOL plane but higher astigmatism would require customization of such IOLs. Our case report describes the long term outcomes of customized toric IOL to tackle this high astigmatism during cataract surgery in PMCD cases.     

Artisan toric phakic intraocular lens for correction of astigmatism

PURPOSE: To assess the safety and efficacy of implanting Artisan toric phakic intraocular lenses (PIOLs) (Ophtec BV, Groningen, The Netherlands) in eyes with high degrees of compound myopic, hyperopic, and mixed astigmatism. METHODS: Twenty-five eyes (20 patients) presenting with high astigmatism were implanted with Artisan toric PIOLs and followed for 1 year. Group 1 included 8 eyes (myopic astigmatism), group 2 included 9 eyes (hyperopic astigmatism), and group 3 included 8 eyes (mixed astigmatism). RESULTS: In the myopic astigmatism group, 8 (100%) of 8 eyes had preoperative uncorrected visual acuity (UCVA) of < or = 20/50, and at 6-month follow-up, 5 (62.5%) of 8 eyes had UCVA of > or = 20/40 (P = .005). In this group, 75% of eyes were within +/- 1.00 diopter (D) of the intended correction. In the hyperopic astigmatism group, 8 (88.9%) of 9 eyes had preoperative UCVA of < or = 20/40, and at 6-month follow-up, 6 (66.6%) of 9 eyes had UCVA of > or = 20/32 (P = .199). Approximately 77.8% of eyes were within +/- 1.00 D of the intended correction. In the mixed astigmatism group, 8 (100%) of 8 eyes had preoperative UCVA of < or = 20/50, and at 6-month follow-up, 6 (87.5%) of 8 eyes had UCVA of > or = 20/40 (P = .007). In this group, 87.5% of eyes were within +/- 1.00 D of the intended correction. The safety index of the procedure was 1.6, 1.3, and 1.3 in the myopic, hyperopic, and mixed astigmatism groups, respectively. The efficacy index of the procedure was 1.2, 1.0, and 1.0 in the myopic, hyperopic, and mixed astigmatism groups, respectively. CONCLUSIONS: Artisan toric PIOLs are safe for the correction of high degrees of astigmatism associated with myopic or hyperopic spherical refractive defect.     

Sutured piggyback toric intraocular lenses to correct high astigmatism

A 74-year-old woman presented for bilateral cataract surgery, which was performed 3 days apart. Corneal astigmatism was 4.25 diopters (D) in the right eye and 4.87 D in the left. After cataract extraction through 6.0 mm scleral incisions, 2 toric, plate-haptic, silicone intraocular lenses (IOLs), each with a 3.50 D cylinder add power (2.30 D at spectacle plane), were sutured together and implanted in the bag. Both eyes had limbal relaxing incisions postoperatively. Four months postoperatively, corneal astigmatism was 4.50 D in the right eye and 4.00 D in the left. Refractive astigmatism was 0.50 D with an uncorrected visual acuity of 20/40 in both eyes. No IOL rotation was observed. Suturing toric lenses together allows greater correction of astigmatism without concern about counter rotation of the lenses.     

Use of a T-flex toric intraocular lens to correct clinically significant astigmatism

PurposeTo investigate the stability and effectiveness of T-flex toric intraocular lenses (IOLs) for the correction of regular corneal astigmatism during cataract surgery.MethodsFrom October 2009 to January 2014 we enrolled patients receiving phacoemulsification and T-flex toric IOL implantation in the capsular bag at the Far Eastern Memorial Hospital. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal astigmatism, refractive astigmatism, and the degree to which the IOL axis deviated from the demanded axis were recorded both before the operation and 6 months postoperatively.ResultsWe enrolled 24 eyes of 24 consecutive patients in this study. The mean spherical power of the implanted toric IOLs was 17.13 ± 4.21 D (range 6.0–24.0 D) and the mean cylindrical power of the IOLs was 3.0 ± 0.86 D (range 2.0–5.0 D). At the 6-month follow up examination, the refractive astigmatism had improved from 3.21 ± 1.50 D to 0.77 ± 0.47 D (p < 0.001) and the spherical equivalence had improved from 4.47 ± 5.43 D to 0.63 ± 0.49 D (p = 0.007). The CDVA improved from 0.81 ± 0.45 logMAR to 0.09 ± 0.11 logMAR (p < 0.001). The mean improvement from the preoperative CDVA to the postoperative UDVA was 5.3 lines on the Snellen chart. Ninety-two percent of our patients achieved a postoperative UDVA ≥20/40 and 67% achieved a postoperative UDVA ≥20/25.ConclusionThe T-flex toric IOL can effectively reduce visually significant corneal astigmatism and improve uncorrected distance visual acuity during cataract surgery.     

有晶状体眼前房型环曲面人工晶状体植入矫正散光

散光的矫治一直是屈光手术的焦点,有晶状体眼前房型环曲面人工晶状体（Artisan toric phakic intraocular lens,TPIOL）矫正散光,以其矫治范围大、安全、有效,逐渐受到临床关注。本文就Artisan TPIOL的物理特征、手术患者的筛选、术前准备、手术方法,以及对其术后安全性、有效性、准确性、稳定性、最小损害等评价作一综述。     

Correcting high astigmatism with piggyback toric intraocular lens implantation

An 86-year-old man presented for cataract surgery with corneal astigmatism of 5.12 diopters (D). After cataract extraction with small-incision techniques, 2 toric plate-haptic silicone intraocular lenses (IOLs) were implanted in the capsular bag, each with a 3.50 D cylinder add (2.30 D at the spectacle plane). Six weeks postoperatively, corneal astigmatism was 3.38 D at 70 degrees and refractive astigmatism was 1.00 D at 20 degrees. Uncorrected visual acuity was 20/40. No IOL rotation was observed. Implantation of piggybacked toric lenses may be a viable option for correcting moderate to high astigmatism.     

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism

AIM: To investigate and compare the quality of life, satisfaction, contrast sensitivity, glare, depth perception, and intraocular lens (IOL) rotation in patients who underwent trifocal toric and bifocal toric IOLs. METHODS: A total of 80 eyes of 40 patients were included in this prospective study. Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL, respectively. Preoperative and postoperative 6-month measurements were recorded for both patient groups. Comprehensive anterior and posterior segment examinations, distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations. Patient satisfaction, contrast sensitivity, glare, intermediate-near and distance stereopsis and IOL rotation were also evaluated. RESULTS: No significant difference was found between the groups in terms of distance and near visual acuities (P=0.269, P=0.451). Intermediate visual acuity was significantly increased in the trifocal toric group (P<0.001). The visual function scale results were increased after surgery in both groups (P=0.001 and P<0.001), with no difference determined between them (P=0.158 and P=0.691). The number of patients wearing glasses was low in both groups and there was no significant difference between the groups (P>0.05). The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group (P=0.03). The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions (1.80±0.24 logU, 1.74±0.20 logU). Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group (P=0.02, 0.048, 0.003, respectively). Although there was no significant difference for 3 meters stereopsis, the trifocal toric group had higher depth perception (P=0.577). Mean rotation was 5.76°±3.93° in the trifocal toric group and 12°±7.1° in the bifocal toric group. CONCLUSION: Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery. Moreover, the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.     

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。