dr. khaled ezzat kotb ali md.phd.frcs egypt air hospital cairo – egypt
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DESCRIPTIONToric IOL Versus Adjustable Incision for Treatment of Mild to Moderate Astigmatism in Phacoemulsification. Dr. Khaled Ezzat Kotb Ali MD.PhD.FRCS Egypt Air Hospital Cairo Egypt The author does not have any financial interest with any of these products. Purpose:. - PowerPoint PPT Presentation
Toric IOL Versus Adjustable Incision for Treatment of Mild to Moderate Astigmatism in Phacoemulsification
Dr. Khaled Ezzat Kotb AliMD.PhD.FRCSEgypt Air HospitalCairo EgyptThe author does not have any financial interest with any of these products
Purpose:To compare the efficacy of implantation of toric IOL(AcrySof Toric lens T3,T4,T5) with adjustable incision in treatment of mild to moderate astigmatism in phacoemulsification, in subjects with mild to moderate astigmatism in a 12 months study.
AcrySof Toric is a single piece acrylic lens with modified "L" shaped haptics, posterior toricity and marks indicating the toric axis Its total length is 13.0 mm and the optic diameter is 6.0 mm. Three models uesd:
SN60T3, SN60T4 and SN60T5 in a spheric dioptric range from 6.0 to 30.0. The cylindrical correcting power in the lens plane is 1.50 D for the T3 model. 2.25 D for the T4 model. 3.00 D for the T5, modelto these parameters we used T3 model for astigmatisms 0.75 to 1.25 D T4 model for astigmatisms 1.5 to 2.0 D. T5 in astigmatisms greater than 2.25 D.
Methods:Study population: 114 eyes of 71 patients with cataract and preoperative mild to moderate astigmatism (-0.75 D to -3.0 D) were classified into two groups: (1) group A, toric IOL were implanted after phacoemulsification (57 eyes) (2) group B, adjustable incision were done (57 eyes) intraoperative with implantation of one piece acrylic IOL of the same type. Both groups matched for preoperative astigmatism, visual acuity (uncorrected, UCVA; best spectacle-corrected, BSCVA), and keratometry (K) values (flat, steep, average). Main outcome included: postoperative astigmatism, visual acuity, refractive errors, K values.
Patient selection:1-patients with cataracts 2-pre existing mild to moderate (-0.75 D to -3.0 D) Considering the prevalence of astigmatism in the general population, approximately 35% of the patients undergoing cataract.3-corneal regular astigmatism Surgical Technique for group AToric online IOL calculator .Upper temporal clear cornea wonud 2 mm.perfect capsulorhexis .Divide and conger (my preferred technique for phaco)correct lens implantation within the capsular bag.My usual post operative cylinder is 0.5.
Axis Markingmarking the eye before surgery and during surgery. The marking of the eye should be extremely careful; the reference marks are placed in the limbus in two points 180 apart (3 and 9 o'clock meridians) and should be performed before entering the operation theater on a sitting patient to prevent cyclo torsion of the eyeball. The slit lamp is set to project a fine horizontal light beam across the undilated pupil in order to ensure a perfect location of the marks in the 0 - 180 meridian.The purpose of the marks of the axis is to identify the steepest meridian of the cornea where the marks of the IOL toric axis should be aligned.
After implanting the lens within the capsular bag, the lens is rotated clockwise until reaching 30 from the desired location. The viscoelastic is removed taking care that the lens is not further rotated and the aligning of the lens is carefully completed by clockwise rotation. Over rotation should be avoided; if over rotation occurs the lens should be completely rotated clockwise until reaching the final position. Meticulous orientation of the IOL is essential for an optimal visual outcome and as much time as needed should be taken to perform it correctly.
Surgical Technique for group B.Adjustable clear corneal wound in steep axis 2.8 mm for cylinder from 0.75 to 1.25 D
Limbal relaxing incision ( LRI): For cylinder from 1.25 to 3.00 I used the NAPA NOMOGRAM for with the rule astigmatism ( steep Axis 45 to 135 degree)
Paired Incision in Degree of Arc
Results:There were more improvements as regard preoperative astigmatic error ,UCVA, in patient with moderate astigmatism (-1.50 D up to -3.0 D) in group A with toric IOL, than in the group B with adjustable incision, and more improvement as regard preoperative astigmatic error, UCVA, in mild astigmatism (-0.75 D up to -1.25 D) in group B with adjustable incision than in group A with toric IOL.
Group A with tonic IOL Group B with Adjustable insicion
Conclusion:Toric IOL is a good option for treatment of moderate preoperative astigmatism (1.25 to 3.00 ) than adjustable incision but in mild astigmatism (-0.75 D up to -1.5 D) adjustable incision is more effective.