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First Author: A.Grixti UK
Co Author(s): A. Tey S. Comely M. Batterbury S. Kaye
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To evaluate the visual and refractive outcomes of patients with pre-existing corneal astigmatism who underwent cataract surgery with the implantation of a Tecnis toric intraocular lens (IOL) (Abbott Medical Optics).
St Pauls Eye Unit, Royal Liverpool University Hospital, United Kingdom.
Retrospective, noncomparative, case series of 12 eyes from 9 consecutive patients with at least 1.5 dioptres (D) of pre-operative corneal astigmatism on keratometry who underwent phacoemulsification with the insertion of a toric IOL (AMO Tecnis) between March and December 2012. Patients were examined 6 weeks postoperatively. The pre-operative and post-operative uncorrected logMAR distance visual acuity (UDVA); corrected logMAR distance visual acuity (CDVA); manifest refraction and keratometry using the IOLMaster partial coherence interferometry (PCI) device (Carl Zeiss Meditec AG) were measured. The intended (target) refraction and post-operative rotational stability of the toric IOL were also recorded. The refractive surgical effect (RSE) or the change between pre-operative and post-operative refraction as well as the difference between the intended and post-operative refraction were then calculated using Longs matrix formalism for decentration problems. The keratometric surgical effect or surgically induced change in keratometry (KSE) was also determined using the same formula. Any perioperative adverse events or post-operative complications were documented.
Mean patient age was 67 years (range 47 to 81). The mean uncorrected logMAR distance visual acuity (UDVA) improved significantly from 0.9 (range 0.3 to 1.7) pre-operatively to 0.1 (range -0.2 to 0.5) post-operatively (p < 0.01, paired sample t-test). The mean refraction improved from -4.87/0.99 X 150.15 [Lower 95% CI -16.87/4.13 X 41.43; Upper 95% CI 3.14/5.82 X 137.37] pre-operatively to -0.33/0.22 X 17.71 [Lower 95% CI -0.58/-1.83 X 146.71; Upper 95% CI 0.16/1.79 X 153.52] post-operatively. The mean intended refraction measured -0.22/0.09 X 160.26 [Lower 95% CI -1.01/0.34 X 43.42; Upper 95% CI 0.25/0.47 X 142.15]. The difference between the mean intended and post-operative refraction was equivalent to -0.14/0.21 X 29.43 [Lower 95% CI -0.22/-1.98 X 146.56; Upper 95% CI 0.25/1.77 X 152.11]. The mean keratometry only changed marginally from 44.19/0.64 X 126.5 [Lower 95% CI 43.04/-3.11 X 147.73; Upper 95% CI 45.46/4.14 X 141.73] pre-operatively to 44.46/0.15 X 149.02 [Lower 95% CI 43.21/-3.47 X 144.09; Upper 95% CI 45.71/3.77 X 144.48] post-operatively. This was equivalent to a mean KSE of -0.24/0.54 X 30.74 [Lower 95% CI -1.69/1.81 X 34.62; Upper 95% CI 1.22/-0.75 X 40.22]. No eye had IOL rotation >5Ḟ. No intra- or postoperative complications occurred.
The AMO Tecnis pseudophakic toric IOLs are a safe, predictable and effective method for providing good unaided vision in eyes with corneal astigmatism and cataract.