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      Refractive and visual outcomes of plate-haptic toric intraocular lens implantation for astigmatic correction after uncomplicated microincision cataract surgery


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          Objective: To evaluate visual and refractive outcomes with plate-haptic toric intraocular lens implantation (ph-toric) after uncomplicated microincision cataract surgery (MICS) to correct moderate-to-severe astigmatism.

          Design: Prospective cross-sectional study.

          Methods: The study was conducted at a tertiary eye care center in New Delhi, India, on patients with visually-significant cataract and moderate-to-severe astigmatism (>1.00 diopters [D]). Preoperative parameters like visual-acuity, keratometry and astigmatism values and lens power calculation were noted. After MICS via 1.8 mm incision, a ph-toric IOL was implanted. The outcome measures noted were uncorrected and corrected distant visual-acuity (UDVA, CDVA), decrease in astigmatism and rotational stability. Follow-up was done on day 1, day 7, 1-month and 3-months postoperative.

          Results: This study involved 30 eyes of 30 patients. 27 patients (90%) gained UDVA of 6/ 9 or better. Out of these, 27 patients (90%) achieved CDVA of 6/ 6. Mean CDVA changed from 0.967 ± 0.101 postoperative to 0.176 ± 0.82 preoperatively (p<0.001). The mean preoperative astigmatism was 2.08 ± 0.59 D and the mean postoperative astigmatism was 0.35 ± 0.39 D. The mean correction achieved was 1.28 ± 0.32 D. Statistically significant (p<0.001) correction of astigmatism was observed by use of ph-toric IOL. The mean reduction in astigmatism was 84.16 ± 10.61 with excellent reduction in 43.3%. IOL rotation was <10 degrees in all the eyes. No complications were observed. Patients had satisfaction with the procedure and visual outcomes.

          Conclusion: Implantation of a plate-haptic toric IOL after uncomplicated MICS via 1.8 mm incision is a feasible and safe option in cataract cases with astigmatism to provide good visual and refractive outcomes. No major drawbacks were observed attributable to ph-toric IOL.

          Abbreviations: SIA - surgically induced astigmatism, D - diopters, MICS - microincision cataract surgery, ph-toric IOL - plate-haptic toric IOL, IOL - intraocular lens, UDVA - uncorrected distant visual acuity, CDVA - corrected distant visual acuity

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          Most cited references16

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          Biometry of 7,500 cataractous eyes.

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            Astigmatism and toric intraocular lenses.

            C Novis (2000)
            The article reviews some of the basic optics of astigmatism and the correction of astigmatism with cylindric lenses. A simple model of the conoid of Sturm is demonstrated, and an ideal position for the conoid is postulated. The orientation of the conoid shows that leaving patients with some simple myopic "against-the-rule" astigmatism is beneficial to near work, whereas "with-the-rule" astigmatism is beneficial for distant viewing. Surgeons should be less aggressive with patients with with-the-rule and against-the-rule astigmatism and more aggressive with oblique astigmatism. The toric intraocular lens (IOL) should be positioned on axis or, if slightly off axis, err on the side away from the vertical or horizontal meridian so that the resultant cylinder is more vertical or horizontal. Clinically significant rotation of the toric IOL occurs in a few cases, but these can be easily rerotated. Rerotation should be done between the first and second weeks after primary implantation.
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              Outcomes of microincision cataract surgery versus coaxial phacoemulsification.

              To compare outcomes of microincision cataract surgery (MICS) with coaxial phacoemulsification. Prospective randomized consecutive case series. One hundred eyes of 50 patients with nuclear or corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification System III. One hundred eyes (50 patients) were randomly operated through clear corneal incisions using 2 techniques: coaxial phacoemulsification (50 eyes) and microincision cataract surgery (50 eyes). Mean phacoemulsification time, total phacoemulsification percent, effective phacoemulsification time (EPT) (calculated by multiplying total phacoemulsification time in seconds by the average power percent used), intraoperative total balanced salt solution (BSS) volume, visual outcome, vectorial astigmatic changes, corneal thickness, endothelial cell count, and anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3 months. Statistically significant differences were found between MICS and coaxial phacoemulsification regarding mean incision size, mean total phacoemulsification percent, and EPT. There were no significant differences between the techniques regarding the mean percent of endothelial cell loss, anterior chamber cell count and flare, mean phacoemulsification time, pachymetric measures or total BSS volume utilized, or visual outcome. The vectorial astigmatic changes in the MICS group showed a change of 1 D were not observed. In the coaxial phacoemulsification group, vectorial astigmatic changes of 1.0 D. Mean vectorial astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the coaxial phacoemulsification group (P<0.001). Microincision cataract surgery significantly lowered mean phacoemulsification time, mean total phacoemulsification percent, mean EPT, and surgically induced astigmatism when compared with coaxial phacoemulsification.

                Author and article information

                Rom J Ophthalmol
                Rom J Ophthalmol
                Romanian Journal of Ophthalmology
                Romanian Society of Ophthalmology (Romania )
                Oct-Dec 2022
                : 66
                : 4
                : 310-316
                [* ]Department of Ophthalmology, Command Hospital, Pune, India
                [** ]Department of Ophthalmology, Sir Ganga Ram Hospital, New Delhi, India
                Author notes
                Correspondence to: Dr. (Maj) Mohini Agrawal, MS, DNB, Department of Ophthalmology, Command Hospital, Pune, Pune Cantonment, Pune, Maharashtra, Code: 411001, India, Phone: 7015 088 150, E-mail: mohiniafmc.15@gmail.com
                #x00A9; The Authors.Romanian Society of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 18 November 2022
                General Articles

                plate-haptic toric,microincision,astigmatism,cataract surgery


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