Clear The Axis With A Smile: Toric Marker For Lenticule Based Refractive Surgery
Published 2023 - 41st Congress of the ESCRS
Reference: PO1025 | DOI: 10.82333/bpj9-wc50
Authors: Kumar Jayesh Doctor* 1 , Shivani Pattnaik 1
1Anterior Segment ,Doctor Eye Institute,Mumbai,India
Traditional toric markers can help identify the 0o, 90o and 180o axis to facilitate marking the axis required in cases with high astigmatism slated for refractive surgery. But these markers are not visible beyond the applanated area when the femto laser is applied. To eliminate the residual cylindrical refractive error with accurate toric marking of the cornea prior to lenticule based refractive surgery, a modification of the toric marker was innovated, guided by an image guided marking device. The purpose of this poster is to introduce an easier and more accurate manner of marking the cylindrical axis in astigmatic cases prior to lenticule based refractive surgery.
50 patients were chosen with myopic refractive error and astigmatism of -0.75dc and above, the upper limit being -5.00dc. Marking was done using the modified toric marker and under guidance of imaged guided marking system. The results were computed and visual outcomes were deduced based on visual acuity, the pachymetry and the cap thickness pre and post operatively.
100 eyes of 50 patients were included in this study. Small incision lenticule based refractive surgery was done using the Ziemer Z8 femto laser platform, which was called CLEAR (corneal lenticule extraction for advanced refractive correction). All surgeries were performed by a single surgeon under similar clinical conditions. Toric marking was done using the modified marker and image guided system, and enhanced witha drop of methylene blue dye which was washed off. The markings left, were prominent enough for auto axis alignment by the femto laser machine. Ablation was successfuly completed, wash and massage of cap and stroma was done. All surgeries were uneventful.
All 50 patients showed excellent post operative outcome. By post operative day 7 , all patients had achieved 6/6 vision for distance in both eyes. Postoperative pachymetry and wavefront readings showed a well centered ablation. Residual cylinder was less than -0.25dc in all cases.
A well planned preoperative marking for cylindrical axis helps to achieve excellent post operative outcomes.