Early experience of phacoemulsification    cataract surgery with Toric IOLS                   Hany EL-Defrawy             ...
Magnitude of the problem The  prevalence of astigmatism increases  with age Approximately 50% of the population older  t...
What are the treatment options? Peroperative Postoperative
Surgical options Astigmatic keratotomy Limbal relaxing incisions PRK LASIK Toric IOLs
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  patie...
•    Inclusion criteria1.   Visually significant cataract2.   Regular corneal astigmatism 3D or more3.   Pharmacologic myd...
Preoperative assessment1.   Complete ophthalmic examination2.   Logmar UCVA and BCVA3.   Manifest Refraction4.   Slitlamp ...
Postoperative follow up Allpatients were evaluated at one day to  assess the lens position A refraction was done at one ...
Toric IOL1.   Reversible and adjustable2.   Predictable and effective
Surgical tips Preoperative   reference marking ? Intraoperative reference marking Incision location Meticulous removal...
Results            Preoperative Preoperative               Post            Postoperative            spherical    cylinder ...
Paired T testP =0.141>0.05
Paired T testP<0.001
Refraction(pre-Operation)Spherical                                                      0            -15   -13   -11   -9 ...
Refraction(post-Operation)Spherical                                    0            -1.5   -1           -0.5              ...
Refraction(pre & post-Operation)Spherical                                                                                 ...
Paired T testP<0.001
Drawbacks of this study Small  sample size and not powered Non comparative We did not assess the IOL position after 1  ...
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Early phacoemulsification experience with toric iol

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  • THE DRAWBACKS OF LRI INCLUDE LACK OF PERCISION, Varied healing response, limited cylindrical correction, undercorrection , overcorrection, perforation, wound gap, loss of BSCVA, regression, neurotrophic effect with corneal erosion. Disadvantages of PRK and LASIK include regression, haze, dry eye, DLK, under or over correction
  • Early phacoemulsification experience with toric iol

    1. 1. Early experience of phacoemulsification cataract surgery with Toric IOLS Hany EL-Defrawy Tariq Ayoub Hadi Zambarakji
    2. 2. 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)
    3. 3. What are the treatment options? Peroperative Postoperative
    4. 4. Surgical options Astigmatic keratotomy Limbal relaxing incisions PRK LASIK Toric IOLs
    5. 5. What are the Disadvantages of othermodalities? LRI Astigmatic keratotomy PRK LASIK
    6. 6.  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
    7. 7. • 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
    8. 8. 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.
    9. 9. 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
    10. 10. Toric IOL1. Reversible and adjustable2. Predictable and effective
    11. 11. Surgical tips Preoperative reference marking ? Intraoperative reference marking Incision location Meticulous removal of OVD with attention to avoid rotation of the IOL Lens alignment
    12. 12. 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
    13. 13. Paired T testP =0.141>0.05
    14. 14. Paired T testP<0.001
    15. 15. Refraction(pre-Operation)Spherical 0 -15 -13 -11 -9 -7 -5 -3 -1 1 3 5 -1 -2 -3 -4 -5 -6 Cylindrical
    16. 16. Refraction(post-Operation)Spherical 0 -1.5 -1 -0.5 0 0.5 1 -0.5 -1 -1.5 -2 -2.5 Cylindrical
    17. 17. Refraction(pre & post-Operation)Spherical 0 -15 -13 -11 -9 -7 -5 -3 -1 1 3 5 -1 -2 -3 -4 -5 -6 Cylindrical Spherical(pre) Cylindrical(pre) Spherical(post) Cylindrical(post)
    18. 18. Paired T testP<0.001
    19. 19. 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)

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