Eyeworld

54 | EYEWORLD | DECEMBER 2023 R EFRACTIVE Reference 1. Singh A, et al. Rotational stability of toric intraocular lenses. Med J Armed Forces India. 2022;78:68–73. Relevant disclosures Baartman: None Hardten: astigmatismfix.com Lee: None Zhu: None Contact Baartman: brandon.baartman@ vancethompsonvision.com Hardten: drhardten@mneye.com Lee: bryan@bryanlee.pro Zhu: dagny.zhu@gmail.com "This has been shown to reduce re-rota- tion. There are different calculators to help determine the ideal axis of the toric IOL based on the IOL power, position, and postoperative refraction," he said. "Assuming the IOL power is OK and that it doesn't need to be exchanged, we will usually be able to rotate the IOL using balanced salt solution on a cannula, trying to open the capsule as little as possible." Dr. Zhu said patients with true IOL rotation often had 20/20 vision on their first day postop, but it dropped in the subsequent week or two. She said she's honest with these patients, telling them that while it looks like the lens moved, the good news is it can be fixed. Dr. Zhu is able to perform office-based surgery, so she can take the patient back and rotate the IOL on the same day it's identified. She also noted that if the cornea is healthy enough and if the patient doesn't want to go back inside their eye, she'll offer LASIK or PRK. "Laser vision correction is also a good op- tion when you have a patient in whom residual refractive error is not completely explained by IOL rotation, where the calculations might be off or the wound is affecting the final astigma- tism," she said. Sometimes the issue isn't IOL alignment but changes in corneal curvature postop. This can occur from wound contraction and scarring or relaxation, Dr. Hardten said. While most IOL calculators take into consideration posterior corneal astigmatism, it's also a possible source of residual refractive error because it's a difficult area to measure, he said. continued from page 53 Removing viscoelastic behind the IOL may help reduce the risk of toric rotation. Source: Bryan Lee, MD, JD Dr. Baartman: I think early identification and intervention of postoperative problems is always a worthwhile pursuit, particularly if dealing with a refractive cataract patient with unexpected outcomes. They have usually paid out of pocket for their outcome, and they're going to want to know you're invested in their success. It's nice when you have staff check in on patients as they go through the healing process, especially if they'd traveled a distance for surgery and may be doing their postoperative care elsewhere. Dr. Hardten: One of the main lessons I've learned over time for astigmatism cor- rection is to utilize toric IOLs for regular astigmatism. There have been some reports of using torics for keratoconus, post-RK, or post-PRK/LASIK, but these are very difficult cases, and it's likely that leaving the astig- matism alone, or considering astigmatic keratotomy in non-ectatic eyes and later PRK, is more useful. Dr. Lee: Although toric IOLs can rotate, the rate is very low, and the success rate for repositioning is very high. Correcting astigmatism is so advantageous for patients that I don't think rotation is something to fear. LESSONS LEARNED

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