Effect of Toric Intraocular Lens Implantation on Visual Acuity and Astigmatism Status in Eyes Treated With Microhook Ab Interno Trabeculotomy

Abstract

Précis: Use of toric intraocular lenses is a reasonable option for better visual outcomes when a combined minimally invasive glaucoma surgery (MIGS) and cataract surgery is performed in eyes with corneal astigmatism. Purpose: To assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and MIGS, visual and refractive outcomes were compared between eyes implanted with nontoric and toric IOLs during microhook ab interno trabeculotomy triple procedures. Methods: Glaucomatous eyes with preexisting corneal astigmatism exceeding −1.5 D implanted with nontoric (n=10) or toric (n=10) IOLs were evaluated retrospectively. The uncorrected visual acuity (UCVA) and refractive astigmatism preoperatively and 3 months postoperatively were compared. Results: Preoperatively, the groups had similar logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism. Postoperatively, the logMAR UCVA (toric, 0.07±0.07; nontoric, 0.33±0.30; P=0.0020) was significantly better and the refractive astigmatism (toric, −0.63±0.56 D; nontoric, −1.53±0.74 D; P=0.0110) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (−0.58, P=0.0039) and refractive astigmatism (+1.45 D, P=0.0195). Vector analyses showed the postoperative centroid magnitude of refractive astigmatism was less in the toric group (0.23 D at 83 degrees) than the nontoric group (1.03 D at 178 degrees). Postoperatively, 70% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 10% in the nontoric group. Surgically induced astigmatism (nontoric group, 0.62 D at 10 degrees; toric group, 0.50 D at 113 degrees) and intraocular pressure reduction (22% in both groups) did not differ between groups. Conclusions: Better visual outcomes may be achieved with toric IOLs when a combined MIGS/cataract surgery is performed in eyes with corneal astigmatism.

Roles of Toric intraocular Lens implantation on visual acuity and astigmatism in glaucomatous eyes treated with iStent and cataract surgery

“…[16] Previously, reasons for SIA after LEC were reported to be a gap around the scleral flap [1], sinking of the limbus because of the tissue loss under the scleral flap [17], tissue contraction due to extensive scleral cautery [18], subconjunctival scarring [19,20], corneal steepening due to the compression of a bleb by eyelid [18], and postoperative hypotony. [4] Absence of these possible mechanisms explains the small SIA by iStent [9] and other goniotomy-related MIGSs procedures [7,8].…”

“…The study design and methods for statistical analyses were followed our previous works that tested the the roles of toric IOLs during TMH [ 7 , 8 ].…”

“…Good predictability and small amount of SIA prompted us to use toric intraocular lens (IOL) during the combined cataract extraction and ab interno MIGS procedures including TMH and iStent for correction of corneal astigmatism. Other than cataract surgery alone, toric IOLs have been used during combined cataract surgery and small-gauge vitrectomy [5,6]; we have reported the roles of toric IOLs during TMH [7,8], however only a recent study reported the use of toric IOLs during iStent [9]. In this study, we compared the visual acuity and refractive status between glaucomatous eyes that implanted with non-toric and toric IOLs during combined iStent.…”

Premium Intraocular Lenses in Glaucoma—A Systematic Review

“…Bissen-Miyajima et al [41] showed that the post-operative visual outcomes (distance-corrected visual acuity, contrast sensitivity) of glaucoma patients following EDOF IOL implantation was almost comparable to those of normal eyes with the same IOLs implanted and were within normal ranges. Ichioka et al (2021) [46] investigated the effect of toric IOL implantation on visual acuity and astigmatism in 20 POAG eyes with a pre-existing corneal astigmatism of −1.5 D, following combined cataract surgery with micro-hook ab interno trabeculotomy. Post-operatively, the logMAR UCVA was significantly better in the toric group (toric, 0.07 ± 0.07; non-toric, 0.33 ± 0.30; p = 0.0020).…”

Refractive Status in Eyes Implanted with Toric and Nontoric Intraocular Lenses during Combined Cataract Surgery and Microhook Ab Interno Trabeculotomy

“…Accordingly, minimal induction of astigmatism and less astigmatism-related decreases in the BCVA would be expected with the μ LOT procedure. Recently, toric IOLs have been implanted increasingly in patients with corneal astigmatism during both cataract surgery alone and combined microincision vitrectomy surgery and cataract surgery to achieve postoperative spectacle-free distance vision [ 7 , 8 ]; however, the use of toric IOL during MIGS is limited and far between in the literature [ 9 ], and the correcting astigmatism effect of toric IOL during combined MIGS is unclear.…”