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

Abstract

Purpose. To compare the refractive status between eyes implanted with toric and nontoric intraocular lenses (IOLs) during combined cataract surgery and microhook ab interno trabeculotomy (μLOT), a minimally invasive glaucoma surgery (MIGS). Methods. Twenty eyes of 20 patients who had open-angle glaucoma, cataract, and preexisting regular corneal astigmatism exceeding 1.5 diopters (D) and underwent combined μLOT and phacoemulsification were recruited retrospectively. Ten eyes were implanted with a toric IOL and 10 eyes with a nontoric IOL. The primary outcomes were the uncorrected visual acuity (UCVA) and refractive cylinder at 3 months postoperatively. Results. The mean UCVA of the toric IOL group (logarithm of the minimum angle of resolution (logMAR), 0.23 ± 0.25) was significantly better than that of the nontoric IOL group (logMAR, 0.45 ± 0.26) at 3 months postoperatively ( p < 0.05 ). The mean absolute residual refractive cylinder of the nontoric IOL group (2.25 ± 0.62 D) was significantly greater than that of the toric IOL group (1.30 ± 0.68 D) ( p < 0.05 ). Postoperatively, 60% of eyes in the toric IOL group and 10% in the nontoric IOL group had an absolute refractive astigmatism level of 1.5 D or less. Surgically induced astigmatism (0.77 ± 0.43 D for toric group and 0.60 ± 0.32 D for nontoric group) and IOP reduction (33.9 ± 15.6% for toric group and 29.4 ± 11.7% for nontoric group) were not different between groups. Conclusions. Use of toric IOL during combined cataract surgery and μLOT is possible and better than not, but physician should prevent their patient of persisting residual astigmatism. The study was registered at https://www.umin.ac.jp/, and the clinical trial accession number is https://clinicaltrials.gov/ct2/show/UMIN000043141.

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“…Full-text assessment was performed on the remaining 13 records; 2 were not retrieved, and 1 additional study was included from citation searching ( Figure 1 ). Twelve studies [ 22 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] fulfilled the inclusion criteria.…”

“…Five studies [42,[44][45][46][47] reported astigmatism outcomes. Ichioka et al 2021) [46] included 20 POAG eyes (20 patients) with pre-existing corneal astigmatism exceeding −1.5 D implanted with either non-toric (n = 10) or toric IOLs (n = 10).…”

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.…”