Combined 23-gauge microincisonal vitrectomy surgery and phacoemulsification with AcrySof toric intraocular lens implantation: a comparative study

Abstract

Aim To compare AcrySof toric intraocular lens (IOL) and non-toric IOL in patients who had combined 23-gauge microincisional vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with pre-existing corneal astigmatism. Methods This is a prospective comparative study comprised of 30 patients (30 eyes) who had combined 23-gauge MIVS and phacoemulsification for vitreoretinal diseases and cataract with pre-existing regular corneal astigmatism greater than 1 diopters (D). In all, 15 eyes had AcrySof toric IOL (Alcon Laboratories) and 15 eyes had non-toric IOL (Akreos AO MI60; Bausch & Lomb) implantation. Main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, surgically induced astigmatism (SIA), and IOL misalignment during 6 months. Results The mean UCVA of the toric IOL group was better than the non-toric IOL group at postoperative months 1, 3, and 6 (Po0.001, respectively). The mean absolute residual refractive cylinder of the toric IOL group at postoperative week 1, and months 1, 3, and 6 was less than the non-toric IOL group (P ¼ 0.008, o0.001, o0.001, and o0.001, respectively). There was no difference in the mean SIA between the two groups (P40.05, respectively). The mean toric IOL axis rotation was 3.52±2.751, which was within 51 in 66.7% of the toric IOL group and within 101 in 100%.Conclusions Combined 23-gauge MIVS and phacoemulsification with AcrySof toric IOL implantation is an effective method of correcting vitreoretinal diseases and cataract and pre-existing corneal astigmatism, and the toric IOL showed good rotational stability, even in vitrectomized eyes for 6 months.

Two-year results of AcrySof toric intraocular lens implantation in patients with combined microincision vitrectomy surgery and phacoemulsification

“…Holland et al 3 investigated favourable rotational stability of AcrySof toric IOL at 1 year postoperatively and the mean axis rotation was 3.8°. Previously, the authors reported that toric IOL showed favourable results for correcting pre-existing cornea astigmatism and good rotational stability, even in vitrectomised eyes for 6 months 9. However, the follow-up period was not sufficient to evaluate the long-term effect and rotational stability of the toric IOL in vitrectomised eyes.…”

Correction of irregular and induced regular corneal astigmatism with toric IOL after posterior segment surgery: a case series

“…Furthermore it has been proved that the vitrectomized status of eyes does not provoke mispositioning of toric IOL [2]. The similar incidence of rotation to the non-vitrectomized eyes may be derived from the special haptic design and adhesive properties of the AcrySof toric IOL [1, 2, 9]. Our keratoconus patient had cataract, which was induced by a previous vitrectomy.…”

“…All of these treatments have limitations including the degree of treatable astigmatism and long-term instability [1]. In the present paper, we report the successful management of two cases with cataract and high astigmatism after posterior segment surgeries, due to scleral buckling or keratoconus.…”

“…Cataract surgery with implantation of toric IOL in stable keratoconus is a safe and effective procedure regarding keratometry stability, visual and refractive results [5]. The first result with toric IOL implantation after vitrectomy was reported in 2011, and showed that combined phacovitrectomy with toric IOL implantation is an effective method for correcting vitreoretinal diseases, cataract and pre-existing regular corneal astigmatism [1]. In vitrectomized eyes, the postoperative IOL axis stability for one year is similar to cataract surgery alone.…”

“…With the improvement of biometry procedures, including corneal topography and tomography, toric intraocular lens (IOL) implantation has become more and more predictable in correcting astigmatism [1–3]. …”