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Correction of astigmatism with toric IOL

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Correction of astigmatism with toric IOL

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									  CORRECTION OF                                                     GLASSES
 ASTIGMATISM WITH                                                   CONTACT LENSES
     TORIC IOL                                                      LRI
                                                                    OCCI
                                                                    LASIK
            V. Jašinskas, R. Žemaitienė, D. Jarušaitienė
           National Center of Ophthalmology, Lithuania              TORIC IOL

                22nd Congress of the DGII in Heidelberg, 2008




PURPOSE.
• TO EVALUATE STABILITY OF TORIC
  IOL MODEL TSN 60 T3-T4-T5 (ALCON)
  AFTER CATARACT SURGERY WITH
  ENDOCAPSULAR IOL IMPLANTATION




                            TO CORRECT                          PREOPERATIVE PATIENT
                            PREOPERATIVE                        EXAMINATION/PREPARATION
                            CORNEAL
                            ASTIGMATISM
                            WITH VERY GOOD                      INTRAOPERATIVE MANIPULATIONS
                            VISUAL
                            OUTCOMES                            POSTOPERATIVE EVALUATION
PREOPERATIVE PATIENT                                                                                        REFRACTOMETRY
EXAMINATION/PREPARATION                                                                                     KERATOMETRY
                                                                                                            (STEEP & FLAT MERIDIAN)
INTRAOPERATIVE MANIPULATIONS                                                                                SPHERICAL IOL POWER
                                                                                                            TORIC IOL CALCULATIONS
POSTOPERATIVE EVALUATION
                                                                                                            MARKING 3,6,9,12 O’CLOCK POSIONS




                                                                                                                                Please review the pre-op information and press continue.
                                                                                                                Surgeon Name              Jasinskas

                                                                                                                Patient Name
                  Please correct the errors noted in below and press continue.                                                            Ginkus Arunas

                       Steep Axis and Flat Axis must differ by 90 ° ± 5 °.                                      Additional Patient
    Surgeon Name               Jasinskas                                                                        Information                                         T
    Patient Name                                                                                                (I.D., Case, etc.)                                  e
                               Ginkus Aru                                                                                                                                                  N
                                                                                                                                                                    m
                                                                                                                                                                                           a
    Additional Patient                                                                                                                          OD (Right)          p
                                                                    T                                           Eye Selection                                                              s
    Information                                                                                                                                                     o
                                                                    e                                                                           OS (Left)                                  a
    (I.D., Case, etc.)                                                                                  N                                                           r
                                                                    m                                                                                                                      l
                                                                                                        a                                                           a
                                                                    p
                                                                                                        s                                       Diopter             l
                                OD (Right)             OS           o                                           K Notation
    Eye Selection                                                                                       a
                             (Left)                                 r                                                                           Millimeter
                                                                                                        l
                                                                    a                                                                                   35.00D
    K Notation                                                      l                                           Flat K                    44,88         ~
                                    Diopter       Millimeter
                                                 35.00D ~                                                                                               50.00D
    Flat K                     44,88                                                                                                                                    Steep Axis
                                                 50.00D                                                                                                 0° ~
                                                                                                                @ Flat Axis               8                             Flat Axis
    @ Flat Axis                8                 0° ~ 180°                                                                                              180°
                                                                                                                                                                        Incision
                                                                            Steep Axis
                                                 35.00D ~                   Flat Axis                                                                     35.00D
    Steep K                    49,63
                                                                            Incision                            Steep K                   49,63           ~
                                                 50.00D
                                                                                                                                                          50.00D
    @ Steep Axis               98                0° ~ 180°
                                                                                                                                                          0° ~
                                                                                                                @ Steep Axis              98
                                                                                                                                                          180°
    IOL Spherical              17.5 D
                                                 6.0 D ~ 30.0
    Power (P-IOL)                                D
                                                                                                                IOL Spherical             17.5 D          6.0 D ~
    Surgically Induced                                                                                          Power (P-IOL)                             30.0 D
                               0,25              0.00D ~
    Astigmatism (SIA)
                                                 2.00D
    Incision Location                                                                                           Surgically Induced        0,25
                                                                                                                                                          0.00D
                               180               0° ~ 360°                                                      Astigmatism (SIA)                         ~
    (IL)
                                                                                                                                                          2.00D
                               Continue
                                                                                                                Incision Location         180
                                                                                                                                                          0° ~
                                                                                                                (IL)                                      360°
                                              V: 3.0.1
                                                                                                                                     Continue
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                                                                                                                                              V: 3.0.1
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       Alcon does not receive or retain any patient data. Please print a copy of the final output for
        your records. Contact your Alcon representative for available AcrySof® Toric IOL models.
                                  Lens Recommendation
      Surgeon & Patient Information
       Surgeon Name                 Jasinskas
                                    Ginkus
       Patient Name
                                    Arunas
       Additional Patient
       Information
                                                                      OD (Right)
       (I.D., Case, etc.)

      Lens Details
                                              SN60T5
        AcrySof® Toric IOL                                     T
        IOL Spherical Equivalent              17.5 D           e
                                                                                                        N
        (SE)                                                   m
                                                                                                        a
        Axis of Placement                     98°              p
                                                                                                        s
        Cylinder Power                        3.00 D           o
        (IOL Plane)                                                                                     a
                                                               r
        Cylinder Power                        2.06 D                                                    l
                                                               a
        (Corneal Plane)
                                                               l
      Calculation Details
                                              4.75 D X
        Pre-Op Corneal Astigmatism:
                                              98°
        Surgically Induced                    0.00 D X
        Astigmatism:                          90°
        Crossed-Cylinder Result               4.75 D X
        (corneal plane):                      98°
        Anticipated Residual                  2.69 D X
        Astigmatism:                          98°
                                              Pre-Op Information
      Patient Data
       Flat K                                 44.88 D
       @ Flat Axis                            8°
       Steep K                                49.63 D
       @ Steep Axis                           98°              T
       IOL Spherical                                           e
       Power (P-IOL)
                                              17.5 D                                                    N
                                                               m
       Surgically Induced                                                                               a
                                              0.25 D           p
       Astigmatism (SIA)                                                                                s
                                                               o
       Incision Location (IL)                 180°                                                      a
                                                               r
                                                                                                        l
                                                               a
                                                               l




                                                                        Steep Axis

                                                                        Flat Axis

                                                                        Incision
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PREOPERATIVE PATIENT
EXAMINATION/PREPARATION

INTRAOPERATIVE
MANIPULATIONS

POSTOPERATIVE EVALUATION




INTRA-
INTRA-OP TORIC AXIS MARKING




CATARACT SURGERY AND IOL
      IMPLANTATION
    GROSS IOL ALIGNMENT
    REMOVAL OF OVD
    FINAL IOL ALIGNMENT




PREOPERATIVE PATIENT
                               ROTATION STABILITY
EXAMINATION/PREPARATION
                               REFRACTOMETRY
INTRAOPERATIVE MANIPULATIONS
                               CUMMULATIVE RESIDUAL
POSTOPERATIVE    EVALUATION    REFRACTIVE EYE
                               MISALIGNMENT
                         IOL RELATED
                         • IOL rotation

                         SURGERY RELATED
                         • Preop. Marking
                         • Patient in horizontal position
                         • Wide eyelids
                         • Incision location


                         EXAMINATION RELATED
                         • One (two) investigators
                         • Same conditions for examination
                         • Manual machine




                          K 1- K 2              IOL MODELS

23 EYES WERE OPERATED.   3.61 ± 1.27       → SA 60 T5 (n16)
AGE OF PATIENTS WAS
                         1.64 ± 0.32        → SA 60 T4 (n 4)
FROM 35 TO 74 YEARS.
                         1.33 ± 0.16        → SA 60 T3 (n 3)
                                                           IOL AXIS ROTATION
                                                            (IN DEGREES):
• UCVA BEFORE SURGERY 0,12 ± 0,08
                                                           • 1 day after surgery 1,73 ± 1,21
• BCVA BEFORE SURGERY 0,22 ± 0,19                            (max 4°) (<0,001)
                                                           • 1 month after surgery 1,79 ± 1,55
                                                               (max 4°) (<0,001)




    RESIDUAL REFRACTION
                                                                     Dynamics of VA
     IOL       1 day after surgery 1 month after surgery
    MODELS                                                         Before        1 day after   1 month after
  SA 60 T5     1.14 ± 0.58         0.92 ± 0.64                     surgery       surgery       surgery
                                                           UCVA    0.12 ± 0.08   0.88 ± 0.23   0.85 ± 0.1
  SA 60 T4     0.56± 0.43          0.42 ± 0.42

  SA 60 T3     0.50 ± 0.25         0.25 ± 0.50             BCVA    0.22 ± 0.19   0.90 ± 0.22   0.92 ± 0.06

  Total        0.94 ± 0.57         0.90 ± 0.65




             DYNAMICS OF VA
                                                                      CONCLUSION
                     1 day after         1 month after
     IOL               surgery              surgery
    models
                        UCVA                  UCVA         •Is safe & predictable tool in
                        BCVA                  BCVA
   SA 60T5           0.83 ± 0.14           0.83 ± 0.15     refractive cataract surgery
                     0.85 ± 0.12           0.87 ± 0.11     •Rotation stability
   SA 60T4           0.98 ± 0.05           0.97 ± 0.06     •Alcon toric IOL seems a good option
                     0.98 ± 0.05           0.97 ± 0.06
                                                           for moderate Ast correction
   SA 60T3           0.97± 0.06                1,0
                     0.97 ± 0.06               1,0
THANK YOU FOR ATTENTION

								
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