ASCRS Boston 2010 Residual astigmatism after multifocal IOL implantation: prediction and possible management Authors: Eva Vyplasilova, MD Katerina Buusova Smeckova, MD, MBAAs. proff. Zdenek Smecka, MD, CSc. Klinika ocni a esteticke chirurgie in Zlin Czech Republic None of the authors has a financial interest on the presented data.
Aim Methods • evaluation the satisfaction with unilateral and bilateral UCVA in patients after implantation of AcrySof ReSTOR +3 IOL. • prediction of the final refraction (mainly Dcyl) and overall patient satisfaction. • determination the amount of dioptries when patients usually request a laser enhancement • findning recommendations about suitable procedures to be chosen. • Dissatisfaction with optical phenomenons like halo, glare, speed of focusing, eye dryness and surgery or speed of recovery were not taken into account. • Preoperative BCVA, autorefractometry values and corneal astigmatism values from the IOL Master were measured. Lens clearness and pathologies were evaluated. • Standard cataract / RLE surgery was performed-Infinity phaco, incision 2,2mm, one surgeon, in the case of the higher astigmatism incision in the K max, no relaxation incisions. • Postoperatively was evaluated mono- and binocular UCVA, autorefractometry values, requests for glasses prescription, patient subjective satisfaction and laser enhancement rate- how many were requested and performed. ASCRS Boston 2010
Setting / Venue ASCRS Boston 2010
Results: Refraction: • 0,33 Dsf +/- 0,48 [-1,5; +2,50] • 0,50 Dcyl +/- 0,79 [-5; 0] • SE: 0,7 +/- 0,56 [-2,5; +2,6] • UCVA: 0,83 [0,2; 1,5] Subjectivesatisfaction: • satisfied: 390 eyes 77 % • parctiallysatisfied: 95 eyes 19% ofeyes • unsatisfied: 23 eyes 4% In 77%ofcaseswastheastigmatismdecreased,unchangedorincreased by no more than 0,1Dcyl. ASCRS Boston 2010
Results- prediction of astigmatism Group 0-0,5 Dcyl Residual astigmatism Preoperative on the average: O,33Dcyl 0,39Dcyl [0; 1,25] Postperative on the average: 55% orunchanged x 45% (max. by 0,75Dcyl) ASCRS Boston 2010
Results- prediction of astigmatism Group 0,5- 1,0 Dcyl Residual astigmatism Preoperative on theaverage: O,74Dcyl 0,54Dcyl[0; 1,75] Postperative on the average: 82%orunchanged x 18% ASCRS Boston 2010
Results- prediction of astigmatism Group 1,0– 1,5 Dcyl Residual astigmatism Preoperative on theaverage: 1,20Dcyl 0,71 Dcyl Postperative on the average: 92% orunchanged x 8% ASCRS Boston 2010
Results- prediction of astigmatism Group 1,5 Dcyl and more Residual astigmatism Preoperative on theaverage: 2,50Dcyl 1,9 Dcyl Postperative on the average: 86% orunchanged x 14% ASCRS Boston 2010
Comparison with other means of correcting astigmatism ASCRS Boston 2010
Conclusion • 80% of patients had post-operative astigmatism equal or better, so it is quite predictable. • We recommend to tailor the solution upon the pre-operative corneal astigmatism. • When pre-operative corneal astigmatism is higher than 1,0Dcyl, enhancement is highly possible. • When more than 1,5Dcyl is measured, enhancement or other correction means (toric IOL) should be planned. • Toric multifocal IOLs are technically very complex and according to our experience there might be a problem with their prediction and sometimes the dispersion in sphere or cylinder may be as high as 1,5D, • When the result with toric MIOL is not perfect, enhancement is necessary and this modality increases costs for the clinic and patients are often distempered. • That's why we prefer the alternative of MIOL followed by laser enhancement. The main disadvantage are 2 surgeries, but the result is precise.