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Comparative evaluation of toric intraocular lens alignment and visual quality with image-guided surgery and conventional three-step manual marking

Authors Titiyal JS, Kaur M, Jose CP, Falera R, Kinkar A, Bageshwar LMS

Received 31 January 2018

Accepted for publication 10 March 2018

Published 24 April 2018 Volume 2018:12 Pages 747—753

DOI https://doi.org/10.2147/OPTH.S164175

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Jeewan S Titiyal, Manpreet Kaur, Cijin P Jose, Ruchita Falera, Ashutosh Kinkar, Lalit MS Bageshwar

Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Purpose: To compare toric intraocular lens (IOL) alignment assisted by image-guided surgery or manual marking methods and its impact on visual quality.
Patients and methods: This prospective comparative study enrolled 80 eyes with cataract and astigmatism ≥1.5 D to undergo phacoemulsification with toric IOL alignment by manual marking method using bubble marker (group I, n=40) or Callisto eye and Z align (group II, n=40). Postoperatively, accuracy of alignment and visual quality was assessed with a ray tracing aberrometer. Primary outcome measure was deviation from the target axis of implantation. Secondary outcome measures were visual quality and acuity. Follow-up was performed on postoperative days (PODs) 1 and 30.
Results: Deviation from the target axis of implantation was significantly less in group II on PODs 1 and 30 (group I: 5.5°±3.3°, group II: 3.6°±2.6°; p=0.005). Postoperative refractive cylinder was -0.89±0.35 D in group I and -0.64±0.36 D in group II (p=0.003). Visual acuity was comparable between both the groups. Visual quality measured in terms of Strehl ratio (p<0.05) and modulation transfer function (MTF) (p<0.05) was significantly better in the image-guided surgery group. Significant negative correlation was observed between deviation from target axis and visual quality parameters (Strehl ratio and MTF) (p<0.05).
Conclusion: Image-guided surgery allows precise alignment of toric IOL without need for reference marking. It is associated with superior visual quality which correlates with the precision of IOL alignment.

Keywords: toric IOL alignment, image-guided surgery, manual marking toric IOL, Callisto eye and Z align toric IOL, visual quality toric IOL, visual quality image-guided surgery

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