Eyeworld

MAY 2019 | EYEWORLD | 17 Contact information Siatkowski: RMichael-Siatkowski@dmei.org toric IOLs or CAIs depending on the degree of astigmatism, and the same method for astig- matic correction (IOL vs. CAI) was used in each of the patient's eyes. Each patient had one eye randomly assigned to each surgical group. Multiple measurements were recorded preop- eratively including uncorrected visual acuity, best corrected visual acuity, manifest refraction, and keratometry. The same measurements were recorded postoperatively with the addition of toric lens rotation, which was determined by a single examiner at the slit lamp. Eventually 38 eyes were treated with toric IOLs, and 40 eyes were treated with CAIs. The authors found a statistically significant difference in the mean residual cylinder when comparing toric IOLs to CAIs, with toric IOLs having nearly 0.25 D less residual cylinder on average than CAIs. Interestingly, the study found no statistically significant difference in residual astigmatism by surgical group. Addi- tionally, there was no statistically significant difference in mean spherical equivalent refrac- tion, uncorrected visual acuity or best correct- ed visual acuity by treatment (toric IOL vs. CAI). When analyzing postoperative toric IOL rotation, they found that 11% (four eyes) were greater than 10 degrees away from intended axis. These four eyes were distributed evenly between the two surgical groups, with two in the standard group and two in the image guided system/intraoperative aberrometry group. Also, all four of the rotated lenses were T3 (low cyl- inder) torics. Finally, while comparing VERION keratometry to LENSTAR, they found the mag- nitude of the astigmatism measured to be equal, but the mean keratometric value was 0.16 D higher in the VERION system. The finding of this study is that femto- second laser-assisted cataract surgery utilizing and femtosecond incisions, capsulotomy, and lens fragmentation versus manual planning and surgery. Solomon et al. primarily wanted to see if laser-assisted phacoemulsification utilizing image guided surgical planning and intraop- erative aberrometry yielded any improvement in outcomes when compared to the surgeon's standard of care in the absence of these tech- nologies. Thirty-nine patients (78 eyes) under- went bilateral cataract surgery with astigmatism correction. They randomized the patient's initial eye into either Group A or Group B, with the second eye defaulting to the other group. Eyes in Group A were treated with the surgeon's standard of care, which included the Barrett Universal II formula for sphere power selection, IOLMaster (Carl Zeiss Meditec) and LEN- STAR (Haag-Streit) for biometry, LENSTAR for keratometry, the Barrett Toric Calculator for toric IOL selection, and the Johnson & Johnson Vision LRI calculator for LRI planning. Blue ink marks were used for toric IOL axis guidance and LRIs were made manually. The cataract surgery was done manually as well. Group B eyes underwent laser-assisted phacoemulsifica- tion, preoperative planning with the VERION Image Guided System and the VERION plan- ner (Alcon), which determined spherical power selection (using optimized Holladay 2), toric IOL power selection and CAI planning. The LENSTAR was used to determine axial length and AC depth. VERION digital markers were used for axis placement and ORA intraoperative aberrometry (Alcon) was used to evaluate need for spherical or toric IOL power/orientation modification. The cataract was removed using femtosecond laser-assisted phacoemulsifica- tion (primary incision, capsulorhexis, and lens fragmentation), and the femtosecond laser was used to create CAIs as well. In each group patient astigmatism was corrected with either the time of cataract surgery: intraocular lenses and corneal image guidance system and manual planning and surgery" continued on page 18

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