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First Author: Ahmed AbdelwahabSaad UK
Co Author(s): Saeid Kenawy Taha Sarhan Waleed Nada
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As we have moved from large- to small-incision cataract surgery, we have become obsessed with the concept of astigmatically neutral surgery. In real life, the vast majority of corneas have some degree of astigmatism, and the modern refractive cataract surgeon must take this into account and plan surgery accordingly. The aim of this work is to compare between the outcomes of the AcrySof Toric intraocular lens and peripheral corneal relaxing incisions in the management of patients with both cataract and astigmatism.
: Zagazig University Hospitals,Egypt Alpha vision Eye centre,Zagazig, Egypt.
Before initiating this study, the protocol, the informed consent form and any other written information to be given to patients was reviewed and approved by the Ethics Committee of the Zagazig University Hospital. The study sample was 60 eyes (60 patients).Cataract patients with 1.0 to 4.0 D of corneal astigmatism were included. Patients with previous corneal surgery , irregular astigmatism, concurrent posterior segment disease or corneal opacities were excluded .Also we excluded any patient with occurrence of intraoperative complications e.g. vitreous loss. • (Preoperative assessment) o Complete medical assessment. o Complete ophthalmic examination Uncorrected visual acuity Autorefractometer readings,Retinoscopy was done if cataract prevents autorefractometer reading Best spectacle-corrected visual acuity Corneal topography Keratometry Slit lamp and retinal evaluation, tonometry and pachymetry. The patients were divided into 2 equal groups. Group 1 (Toric IOL) Group 2 (Limbal relaxing incisions) All patients were subjected to the following: (postoperative assessment) at 1 week and 3 months postoperatively o Uncorrected visual acuity o Autorefractometer readings. o Best spectacle-corrected visual acuity o Corneal topography o Keratometry Data were monitored all through the 3 months follow and the results were statistically analyzed for each group and compared.
The toric subgroup included 30 eyes of 30 patients. 12 of which were males and 18 were females. Mean age of 64.8. The LRI subgroup included 30 eyes of 30 patients, 16 were males and 14 were females with mean age of 66.2. The mean preoperative BCVA was 0.1 ± 0.15 in toric subgroup, 0.15 ± 0.15 in LRI subgroup. The mean postoperative UCVA at one week was 0.72 ± 0.12, 0.61 ± 0.09, in each part respectively. The mean postoperative UCVA at 1 month was 0.89 ± 0.14, 0.58 ± 0.1.In the 3 months follow up visit the mean for the postoperative UCVA was 0.9±0.13 and 0.59±0.16 for each subgroup respectively. There was a highly significant statistical difference between the result of UCVA preoperative and the results of UCVA at the early and last postoperative follow up. The mean preoperative refractive astigmatism was -1.24± 0.25 in toric subgroup and -1.62 ± 0.50 in LRI subgroup at 3 months. There was a significant statistical difference between the result of mean preoperative refractive astigmatism and mean postoperative refractive astigmatism at 1 week, 1 month and 3 months in the two groups.
There are several approaches for reducing preexisting astigmatism during cataract surgery. One of these is LRIs which is easy to learn and to perform. The incisions can be applied without great danger along the limbus and are almost invisible a few days after surgery. It works well for asymmetric corneal astigmatism. From our results, it is evident that LRIs are safe, effective, and predictable method for correcting pre-existing astigmatism in cataract surgery. However, one disadvantage for the LRLs is the regression that may occur after surger.Toric IOL implantation has recently become available as a means of correcting preexisting astigmatism. Implantation of toric IOL through 3 mm clear corneal incision is astigmatically neutral and not affecting the cornea. Careful attention to correct axis positioning of the IOL & meticulous removal of residual viscoelastic material will help reduce the rate of postoperative rotation. With introduction of new toric IOLs with higher cylindrical correcting powers may be very useful for higher amounts of astigmatism in which the LRIs become very unpredictable. Toric IOL implantation with cataract surgery is very effective, predictable, stable, and safe procedure in correction of preexisting astigmatism with cataract surgery. FINANCIAL INTEREST: NONE