Treatment of astigmatism during phacoemulsification

Abstract

Purpose: To compare the effectiveness of limbal relaxing incisions (LRI) with that of toric intraocular lens (IOL) implantation for the treatment of astigmatism during phacoemulsification using nonvectorial (predictability, safety, and efficacy) and vectorial analyses. Methods: This longitudinal observational case series assessed 62 eyes of 31 consecutive cataract patients with preoperative corneal astigmatism of 0.75-2.50 diopters (D) in both eyes. Patients were randomly assigned to 2 groups: a toric IOL group, which received toric IOLs in both eyes, and an LRI group, which received spherical IOLs associated with LRI placement in both eyes. All patients were evaluated at 1, 3, and 6 months after surgery, when refractive astigmatism analysis was performed using both nonvectorial and Alpins vectorial methods. Outcomes were assessed within each group and compared between groups. Results: The proportion of eyes within ±0.50 D of the intended correction at 3 and 6 months after surgery was 75% and 71.88%, respectively, in the LRI group and 40% and 66.67%, respectively, in the toric IOL group. In the remaining period, the proportion was greater in the toric IOL group. The safety index showed no difference at any time point. The efficacy index at 1 and 3 months after surgery was significantly higher in the toric IOL group (0.43 and 0.44, respectively) than in the LRI group (0.31 and 0.36, respectively). At 6 months after surgery, the status of eyes in the LRI group was as follows: 53.13% were undercorrected, 43.74% achieved the intended correction, and 3.13% were overcorrected. In the toric IOL group, 16.76% eyes were undercorrected, 76.67% achieved the intended correction, and 6.67% were overcorrected. The success rates for astigmatic surgery, astigmatism reduction at the intended axis, and astigmatism corrected were 43%, 62%, and 64%, respectively, in the LRI group and 57%, 81%, and 94%, respectively, in the toric IOL group. Conclusions: Our results suggest that the use of toric IOLs may be advantageous over the use of LRIs for the treatment of astigmatism during phacoemulsification. Although such advantages seem subtle in nonvectorial analyses, they are highlighted in vectorial analyses.

Prevalence of Astigmatism in Patients Undergoing Cataract Surgery at a Tertiary Care Center in North India

“…The choice of the procedure to be performed depends upon the amount of pre-operative corneal astigmatism. 23 The present study utilized the LensStar LS9000, which is based on the principle of optical low coherence reflectometry, which is a non invasive, non contact optical biometer.…”

Toric Intraocular Lenses in the Correction of Astigmatism During Cataract Surgery

“…The prevalence of postoperative complications was reported by 6 studies. 21,24,26,27,29,30 A summary of all complications encountered is shown in Table 2. A total of 23 of the 554 patients randomized to toric IOL implantation (4.2%) experienced a postoperative complication versus 11 of 478 patients randomized to non-toric IOL implantation (2.3%).…”

Successful Premium Multifocal IOL Surgery: Key Issues and Pearls

“…For less than 1.0D astigmatism, the incision at steep axis is the better approach. When preoperative astigmatism is up to1.5 diopter, the limbal relaxing incisions (LRIs) can be considerable [65]. At higher levels of astigmatism than 1.5D, the best solution is toric multifocal IOLs [66].…”