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Early experience of phacoemulsification cataract surgery with Toric IOLS Hany EL-Defrawy Tariq Ayoub Hadi Zambarakji
Magnitude of the problem The prevalence of astigmatism increases with age Approximately 50% of the population older than 60 years has more than 1D of astigmatism 22% of cataract surgery candidates have pre-existing astigmatism exceeding 1.5 D (Hoffer KJ,1980), (Ferrer-Blasco et al 2009)
What are the treatment options? Peroperative Postoperative
What are the Disadvantages of othermodalities? LRI Astigmatic keratotomy PRK LASIK
Purpose: To evaluate toric IOL efficacy in treating corneal astigmatism Method: Retrospective pilot study of 7 patients (11 eyes) who underwent phacoemulsification and Toric IOL at WX
• Inclusion criteria1. Visually significant cataract2. Regular corneal astigmatism 3D or more3. Pharmacologic mydriasis of at least 6 mm to allow intraoperative and postoperative visualisation of axis marks4. Intact capsular bag for in the bag implantation at the end of surgery• Exclusion criteria1. Corneal scarring2. Advanced glaucoma3. Significant macular disease4. Irregular astigmatism
Preoperative assessment1. Complete ophthalmic examination2. Logmar UCVA and BCVA3. Manifest Refraction4. Slitlamp examination5. Keratometry and Biometry using IOLMaster6. Toric cylindrer power and axis placement was provided by manufacturer.
Postoperative follow up Allpatients were evaluated at one day to assess the lens position A refraction was done at one day and one month One patient required reposition of the IOL
Toric IOL1. Reversible and adjustable2. Predictable and effective
Surgical tips Preoperative reference marking ? Intraoperative reference marking Incision location Meticulous removal of OVD with attention to avoid rotation of the IOL Lens alignment
Results Preoperative Preoperative Post Postoperative spherical cylinder operative cylinder error spherical errorMean -2.55 -3.20 Mean -0.069 -0.91Standard 5.28 0.93 Standard 0.63 0.56deviation deviation Range -1.25 to 0.75 -2.25 to -0.25Range -14 to 4.25 -5 to 1.5
Drawbacks of this study Small sample size and not powered Non comparative We did not assess the IOL position after 1 month A recent study showed the toric IOL misalignment from the intended axis occurs mostly during the first month (Mingo Botin etal J Cataract and refractive surgery 2010)