ESCRS - P059 - TOPICAL TIMOLOL 0.25% TO ENHANCE PREOPERATIVE REFERENCE VESSELS IMAGE IN DIGITALLY ASSISTED INTRAOPERATIVE AXIS ALIGNMENT FOR TORIC IOL

TOPICAL TIMOLOL 0.25% TO ENHANCE PREOPERATIVE REFERENCE VESSELS IMAGE IN DIGITALLY ASSISTED INTRAOPERATIVE AXIS ALIGNMENT FOR TORIC IOL

Published 2022 - 26th ESCRS Winter Meeting

Reference: P059 | Type: Abstracts | DOI: 10.82333/skn5-zr92

Authors: Eduardo Roditi* 1 , Elad Ziv-on 1 , Adi Abulafia 1

1Ophthalmology,Shaare Zedek Medical Center,Jerusalem,Israel

Purpose

When performing biometry with the Zeiss IOL Master 700®, a scleral image (using green monochromatic light, a red-free type image) for clear identification of limbal vessels is captured as a reference for the intraoperative augmented reality axis alignment assistant in the Zeiss Callisto ® microscope. Rarely, an error message appears as "not enough vessels near the limbus have been found", without any proposed solution from the manufacturer instructions manual, even recommending manual marking for toric alignment. 

We herein report the use of topical timolol 0.25% drops as an effective method to enhance preoperative limbal vessels reference image and solve effectively the “unsolvable” error message.

Setting

Premium IOL Cataract Clinic at the department of ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

Methods

Case presentation after review of preoperative, intraoperative and postoperative data.

Results

A 71-year-old female patient performed preoperative assessment for programmed left eye cataract surgery with a toric intraocular lens implantation due to regular mild astigmatism, with topography values of K1: 45.25 at 178° K2: 46.09 at 88° ΔK: +0.84 at 88° in the left eye.  A T2 toric lens with intraoperative digitally assisted alignment was intended but the error message "not enough vessels near the limbus have been found" kept appearing and no scleral image was captured.


Topical timolol 0.25% drops were instilled in the eye and 20 minutes later biometry was repeated, this time with successful and quality scleral image acquisition.

The day of the surgery topical 0.25% timolol drops were instilled as well and she underwent uneventful phacoemulsification with toric IOL implantation at 88°. On the postoperative one, seven and 30 days follow up visit her UCVA was 20/20 without any disaligment of the IOL. 

Conclusion

Timolol 0.25% is a common and available drop preparation at ophthalmic clinics. It is regularly used as an ocular hypotensor medication. Although the mechanism of action by which it induces dilation of conunctival vessels is poorly understood, it has been proven by several studies. Although further studies are warranted, cataract surgeons using the intraoperative alignment technology should be aware of this potential solution to a previously “unsolvable” error from a modern biometry machine.