Pre-operative biometry, toric intraocular lens (IOL) implantation techniques, and rotational stability of the IOL are all important for great visual results. Targeting post-operative astigmatism less than 0.5 diopter (D) instead of looking for pre-operative anterior corneal astigmatism that is more than 0.75 D can lead to better refractive results.

1. Strategies for better toric
IOL outcomes
俞函杰
板橋大學眼科
Han-Chieh Yu, MD
Universal Eye Center
Banqiao, New Taipei
Taiwan
俞函杰 Han-Chieh Yu, MD, 2017
Annual Meeting of the Ophthalmological Society of Taiwan 2017

2. Accuracy Precision Bullseye
Rotational stability
Measurement
Implantation
俞函杰 Han-Chieh Yu, MD, 2017

3. Tabernero, Biomed Opt Express, 2015
Astigmatism
↑Astigmatism à ↓Contrast
俞函杰 Han-Chieh Yu, MD, 2017

4. Posterior corneal astigmatism
Abulafia, CRSTEurope
Koch, ESCRS, 2016俞函杰 Han-Chieh Yu, MD, 2017

5. Which Kcyl to look at?
+
=
Anterior Kcyl
Posterior Kcyl
Total Kcyl
俞函杰 Han-Chieh Yu, MD, 2017

6. Target final cyl < 0.50 D
0
0.2
0.4
0.6
0.8
1
1.2 0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
150
160
170
AL 23
AL 25
AL 27
Anterior Kcyl
Steep axis
When is toric IOL required?
俞函杰 Han-Chieh Yu, MD, 2017

7. Which K?
Keratometry
Biometry
Topography
Tomography
Verion
Intraoperative aberrometry
The most consistent one
Repeat
俞函杰 Han-Chieh Yu, MD, 2017

8. IOL formula
Haigis
SRK-T
Holladay 1
Hoffer Q
+
Wang-Koch AL
adjustment
Hill-RBF
Barrett Universal II
Olsen
俞函杰 Han-Chieh Yu, MD, 2017

9. SIA
Koch, Wang, JRS, 2015; 31 (8): 565-566
2.4-mm, temporal, 25 eyes
俞函杰 Han-Chieh Yu, MD, 2017

10. Toric calculator
PhysIOL Toric Calculator
with Abulafia-Koch regression formula (JCRS 2016)
Barrett Toric Calculator
Posterior corneal astigmatism✓
↓IOL power
↑ELP
(↑AL ↑K)
→ ↑Required IOL toricity
Holladay, OSN, 2011
✓
俞函杰 Han-Chieh Yu, MD, 2017

11. PhysIOL Ankoris
Cyl 1.5, 2.25, 3.0, 3.75, 4.5,
5.25, 6.0
Abbe number 58
Double C-loop
Monofocal
toric IOL
ANKORIS
Technical specifications
Commercial name Ankoris
Material 26% hydrophilic acrylic
Overall diameter 11.40 mm
Optic diameter 6.00 mm
Optic Biconvex aspheric aberration-correcting (-0.11μ SA)
Filtration UV & blue light
Refractive index 1.46
俞函杰 Han-Chieh Yu, MD, 2017

12. Excellent rotational stability
Torio, Philipp J Ophthamol. 2014;39:67-72
Post-op cylinder -0.40 ± 0.28 D
Magnitude of error 0.1 D
Rotation 2.16 ± 1.95 deg
Chassain, J Fr Ophthalmol. 2014;37(7):507-13
俞函杰 Han-Chieh Yu, MD, 2017

13. Vandekerckhove, ASCRS 2016
俞函杰 Han-Chieh Yu, MD, 2017

14. Marking
Slitlamp ≈ pendular marker > bubble marker > tonometer marker
Popp, JCRS, 2012; 38:2094–2099
Verion Manual
Misalignment 1.7 ± 1.5 3.1 ± 2.1*
Residual cyl -0.36 ± 0.32 -0.47 ± 0.28
UDVA 0.03 ± 0.10 0.04 ± 0.09
* P < .05 Webers, JCRS, 2017, 43(6):781-788
俞函杰 Han-Chieh Yu, MD, 2017

15. Intra-op tips
CCC good covering of optic
Remove all OVD
No overfill
Water tight wound
Check orientation one last time
俞函杰 Han-Chieh Yu, MD, 2017

16. Post-op misalignment
Large capsular bag
Long Eye
WTR astigmatism
Miyake, JCRS, 2014;40(10):1654-60
IOL cyl Misalign → cyl >
0.75 D
1.00 33
1.50 22
2.25 14
3.00 11
3.75 9
4.50 7
5.25 6
6.00 5
俞函杰 Han-Chieh Yu, MD, 2017

17. IOL reorientation
Astigmatismfix.com Barrett Rx Formula
Within 2 weeks 俞函杰 Han-Chieh Yu, MD, 2017

18. My initial experience
4 males, 8 females
17 eyes
Age 63.3 ± 11.5 (range 39 to 81)
Pre-op refractive astigmatism
-1.62 ± 1.06 D (-0.25 to -3.75 D)
俞函杰 Han-Chieh Yu, MD, 2017

19. Cumulative Visual Acuity
83%
99% 100%
0%
20%
40%
60%
80%
100%
20/20 20/25 20/32
Cumulative % of Eyes
Cumulative Snellen Visual Acuity (20/x or better)
17 eyes, 1 month post-op
俞函杰 Han-Chieh Yu, MD, 2017

20. Refractive Astigmatism
6% 6%
12%
18%
6%
24%
6%
12%
35%
41%
24%
0% 0% 0% 0% 0%
0%
10%
20%
30%
40%
50%
% of Eyes
Refractive Astigmatism (D)
17 eyes
1 month post-op
Pre-op
Post-op
< 0.50 D: 76%
< 0.75 D: 100%
俞函杰 Han-Chieh Yu, MD, 2017