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Objective reduction of cylinder during toric IOL implantation guided by intraoperative wavefront aberrometry

Session Details

Session Title: Intraoperative Biometry and Correction of Astigmatism

Session Date/Time: Monday 07/10/2013 | 08:00-10:00

Paper Time: 08:35

Venue: Main Lecture Hall (Ground Floor)

First Author: : W.Wiley USA

Co Author(s): :    S. Bafna              

Abstract Details


To evaluate the objective reduction of cylinder in eyes implanted with toric IOLs guided by intraoperative aberrometry and to compare these intraoperative results with postoperative manifest refraction in the same eyes.


Private clinical practice – Cleveland Eye Clinic


A series of 300 consecutive toric IOL cases was retrospectively analyzed. In each case, preoperative keratometry was compared to aphakic cylinder power and axis measured with intraoperative aberrometry (ORA System, WaveTec Vision). The aphakic intraoperative measurements were used to determine the expected residual spherical equivalent for the selected IOL power in order to confirm or guide the selection of a different IOL. After implantation of the IOL on the axis identified by the intraoperative aberrometry system, a pseudophakic measurement was performed to confirm accurate positioning of the IOL or to guide repositioning, if needed. A final pseudophakic refraction with the system confirmed the lens placement and actual cylinder. This was compared to manifest refraction at 3 months postoperative.


Postoperative results are available for 194 eyes so far; results for all eyes will be presented. Keratometry showed a mean preoperative corneal cylinder of 1.92 D. Intraoperative aberrometry assessments showed a mean aphakic cylinder of 1.74 ± 0.78 D for the). The final mean pseudophakic intraoperative cylinder was 0.50 ± 0.42 D. Mean postoperative manifest cylinder was 0.45 D. The greatest differences between the preoperative Ks and the ORA aphakic cylinder measurements were in high-cylinder cases. The mean final pseudophakic cylinder was comparable across all cases (low, moderate, and high cylinder) and toric IOLs. The magnitude of posterior corneal cylinder not identified by preoperative keratometry was similar to the magnitude of anterior corneal cylinder.


Intraoperative aberrometry-guided toric IOL selection, placement, and positioning reduces the intraoperative cylinder based on objective measurements during cataract surgery. The residual cylinder predicted by the final pseudophakic aberrometry measurements correlates closely with postoperative manifest cylinder. These data also demonstrate the significant contribution of posterior corneal cylinder and the value of planning toric lens surgery utilizing the information that can be obtained from intraoperative measurements.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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