Visual and refractive outcomes of monofocal toric intraocular lens implantation in amblyopic eyes

Abstract

Purpose To evaluate the visual and refractive outcomes of monofocal toric intraocular lens (IOL) implantation after cataract surgery in amblyopic eyes Methods Our center’s database was used to identify patients who had undergone bilateral cataract surgery between 2016 and 2020 with the implantation of a toric IOL in their amblyopic eye. Exclusion criteria were the presence of strabismus, ocular pathologies other than cataract or intra-surgical complications. The outcomes analysed were uncorrected distance visual acuity (UDVA), subjective refraction and corrected distance visual acuity (CDVA) one month after surgery. Results Ninety patients were included, with a mean age of 68.96 ± 7.81years. CDVA was lower for the amblyopic eye, both before and after surgery. There was a mean improvement in CDVA of 0.23 ± 0.21 LogMAR for the dominant eye and of 0.39 ± 0.33 for the amblyopic eye, p < 0.001 in both cases. Postoperative subjective refractive cylinder was higher in the amblyopic eye (-0.24 ± 0.39 D versus −0.10 ± 0.25 D, p < 0.01), as well as mean cylinder prediction error (-0.30 ± 0.47 D versus 0.02 ± 0.42 D, p < 0.01), compared to the dominant eye. There was a statistically significant correlation between preoperative and postoperative CDVA in amblyopic eyes (Spearmańs Rho = 260, p = 0.013). Mean postoperative UCVA was 0.15 ± 0.25 for amblyopic and 0.03 ± 0.12 for dominant eyes. Only one patient required distance spectacle correction due to residual astigmatism. Conclusions Cataract surgery with toric IOL implantation in amblyopic eyes leads to an improvement in visual acuity and to spectacle independence in almost all cases, even in the presence of a higher cylinder prediction error.

Medium-term visual and refractive outcomes in patients with pseudoexfoliation implanted with a toric or multifocal intraocular lens

“…Toric IOLs are recommended in patients with ≥0.8 diopters (D) of for-the-rule astigmatism or ≥0.6 D against-the-rule astigmatism in corneal topography or biometric evaluation. 10 Candidates to toric IOL implantation are also explored with the Verion Image Guidance System (Alcon, Fort Worth, USA). This system is also used during surgery to correctly align toric IOLs.…”

“…In our centre, the IOL is chosen using the Barrett Universal II formula. 10 In our centre, patients are seen at least on the day following surgery, one week and one month after second eye surgery. At the one-month visit patients undergo subjective refraction for distance and near vision.…”

“…At the one-month visit patients undergo subjective refraction for distance and near vision. 10 Due to the increased risk that the presence of PXF poses for the development of glaucoma, even after cataract surgery, periodic check-ups are recommended for these patients, so that patients are usually seen at least once a year. At each follow-up visit, uncorrected visual acuity and subjective refraction is performed.…”

“…As we have previously described, 10 candidates for cataract surgery in our centre, a private practice ophthalmology clinic, undergo an extensive preoperative examination, including corrected distance visual acuity, slit-lamp examination, corneal topography and biometric evaluation with an IOLmaster 500 or 700 (Zeiss, Jena, Germany), tonometry, fundus evaluation under pharmacological mydriasis and optical coherence exploration of the macula and optic nerve. Toric IOLs are recommended in patients with ≥0.8 diopters (D) of for-the-rule astigmatism or ≥0.6 D against-the-rule astigmatism in corneal topography or biometric evaluation.…”