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10 - 12 February 2017, MECC Maastricht,The Netherlands.

This Meeting has been awarded 15 CME credits.

Unexpected residual astigmatism occurrence and management after toric intraocular lens (IOL) implantation: a 3 years cohort study

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Session Details

Session Title: Cataract
Session Date/Time: Saturday 11/02/2017 | 08:30-11:00
Paper Time: 09:12
Venue: Auditorium 1

First Author: V.Webers THE NETHERLANDS
Co Author(s): N. Visser  N. Bauer  I. Saelens  H. Beckers  C. Webers  R. Nuijts  

Abstract Details


To describe the incidence and management of unexpected high residual refractive astigmatism in a 3-year period at the University Eye Clinic Maastricht, Netherlands.


All secondary treatments after toric IOL implantation performed at our institution (University Eye Clinic Maastricht) between June 2013 and June 2016 were included.


A total of 310 eyes, undergoing toric IOL implantation, were retrospectively analyzed. In the majority of cases (>90%) an Acrysof SN6ATT tIOL-model (SN6AT3-SN6AT9) was implanted with the assistance of the VERION Image Guided System. K-readings obtained with the IOLMaster were transferred into a web-based first generation toric calculator (Acrysof Toric Calculator). Astigmatism axis orientation was with-the-rule (WTR) in 61% and against-the-rule (ATR) in 25% of cases. Vector analyses by Alpins was performed to measure the amount of unexpected residual refractive astigmatism. The Berdahl & Hardten Astigmatism Fix Calculator was used to determine if repositioning of the toric IOL was indicated.


Overcorrection of >1.00D compared to predicted residual refractive astigmatism was seen in 21 cases (11%) in the WTR-group compared to 2 cases (3%) in the ATR-group. Six out of 23 eyes (26%) with residual refractive astigmatism >1.0D desired secondary treatment. IOL-exchange and laser touch-up was required in respectively 4 (1% of total population) and 2 (1% of total population) cases. Misalignment of >10? was present in 15 cases (5%) and 7/15 cases (47%) underwent repositioning (2% of total population). After secondary treatment, all 13 eyes had residual refractive astigmatism of <0.5D and all patients were satisfied with their visual outcome.


This study showed that toric IOLs are a safe and effective treatment option to correct pre-existent corneal astigmatism in patients undergoing cataract surgery. A general overcorrection was seen in WTR patients, which might be explained by the use of a first generation toric calculator neglecting the posterior corneal astigmatism. Up to a quarter of patients having overcorrection of >1.00D required secondary treatments. Misalignment of >10? was in nearly 50% of cases a reason for repositioning. After secondary treatment, all patients were satisfied with their visual outcome.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a competing company

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