Intelliaxis-L capsular marks provided excellent alignment of toric IOLs, with a surgical misalignment of only 0.74° ± 0.58° in 77 eyes. After 3 months, misalignment increased slightly to 3.00° ± 3.99°, around half the errors reported in literature. Capsular marks were more reproducible, sharper, and closer to the IOL plane than corneal marks, improving precision of toric IOL alignment. Capsular marks were still visible in only 21% of eyes after 3 months.

1. Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder, iOptics, LensAR, Medicem,
Novartis, Oculentis, Oertli, Revision Optics, Santen, Staar Surgical,
Sifi Medtech, Thea, Topcon, Visufarma, Ziemer
Alignment of Toric IOL via automated Femtosecond Laser-
Assisted Capsular Marks
Karsten Klabe, D.R.H. Breyer, H. Kaymak, P. R. Hagen, T. Ax, F.T.A. Kretz, G.U. Auffarth
Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, Alkahest, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron,
Gesundheitsamt Rhein-Neuss-Kreis, Geuder, Glaukos, Hangzhou Classon Tec, HOYA, iOptics,
KangHong Biotec., LensAR, Medicem, Novartis, Oculentis, Oertli, OMNITM, Optos, PharmaStulln,
PhysIOL, Revision Optics, Santen, Staar Surgical, Sifi Medtech, Teleon Surgical Optics, Thea, Topcon,
Visufarma, Ziemer

2. Background: Since 6 Months LENSAR: Capsular Marks via IntelliAxis-L™
• Cassini LED Videokeratography with
simultaneous Iridography
• Data transferred to the LENSAR
• Cyclotorsion is detected by iris matching
and automatically compensated
• Pair of small opposing tabs on the
capsular rim at implantation axis as part of
laser capsulorhexis

3. Material & Methods: Advantages of Capsulotomy Marks
Corneal Marks
Capsulotomy
Marks
Caspulotomy marks are
more reproducible,
Sharper,
radially closer to IOL-marks, and
closer to IOL-plane
( smaller tilt-effect)
than corneal marks.
Precision in toric
IOL alignment
should be
increased

4. Material & Methods: Disadvantages of Caspulotomy Marks are Very Rare
Capsulotomy marks can be shifted
in case of ovalization of initially
circular capsulotomy
 Only impacts axis alignment if
implantation axis is off from
elliptic deformation axes
 Rare
(in our data: 1 in 77 eyes)

5. Materials and Methods - Surgeon: Breyer - Reading center: Hagen
Implanted toric IOLs:
• Oculentis: Comfort LS-313 MF15, LS-313
• Zeiss: AT LISA tri 939, AT Torbi 709M
• Alcon: SN6AT2, PanOptix
Patient-& IOL data:
• Eyes = 77
• M : F = 48% : 52%
• Plate haptic : c-loop = 90% : 10%
• Age = (60 ± 11)years
• Preop. corn. cylinder = (-1,6 ± 1,0)D
Compare
• LENSAR protocol data,
• OP microscope foto directly after surgery,
and
• slitlamp foto in mydriasis 3 months after
surgery
in order to determine surgical misalignment and
postoperative IOL rotation.

6. Capsulotomy marks easy to recognize Capsulotomy marks no longer recognizable
Case1 Case 2
??
Results: 3 Months after Surgery
Capsulotomy marks 3 months after surgery
recognizable only in 16 of 77 (21%) eyes

7. Results: Angular Differences
0%
10%
20%
30%
40%
50%
[0, 0.5] (0.5, 1] (1, 2] (2, 4] (4, 8] (8, 16] (16, oo)
PercentageofEyes[%]
Angle [°]
Angular difference MV ± SD
Cyclotorsion(OP) 4.74° ± 3.47°
TM(OP) – IA 0.74° ± 0.58°
TM(3M) – IA 3.00° ± 3.99°
TM(3M) – CM(3M)
1.71° ± 1.25°
(n=16)
TM = toric IOL marks
IA = implantation axis
CM = capsulotomy marks

8. Summary: Excellent Alignment of Toric IOL with Intelliaxis-L
 First n=77 Eyes:
 Comparison with literature
(1 year after surgery):
 Alignment errors approx. reduced by half
Alignment error due to surgery:
0.74° ± 0.58°
Misalignment after 3 months:
3.00° ± 3.99°