Eyeworld

16 | EYEWORLD | WINTER 2024 ASCRS NEWS EYEWORLD JOURNAL CLUB by Eli Pratte, MD,* John Wilson, MD,* Maggie Xing, MD,* Washington University Department of Ophthalmology and Visual Sciences residents, Arsham Sheybani, MD, Residency Program Director *All authors contributed equally to this work. and regular corneal astigmatism of greater than or equal to 1.50 D of cylinder and less than 5.00 D of cylinder, as measured on the IOLMaster 700 biometer's (Carl Zeiss Meditec) anterior keratometry function and confirmed by Scheimpflug tomography (Oculus). Participants were free of other vision-impairing comorbidi- ties. All participants received aspheric RayOne single-piece, hydrophilic acrylic TIOL RAO610T (Rayner) initially sized per the Raytrace online premium IOL calculator (Rayner) without in- clusion of PCA data. In the initial study, partic- ipants were randomly assigned into a control group that received a TIOL calculated to achieve full correction of astigmatism or an intervention group that utilized a 2.00 D cylinder (DC) or 4.00 DC TIOL with residual corneal astigmatism corrected by an opposite clear cornea incision. In the post-hoc analysis, 6-month postop subjec- tive refractive positive cylinder was compared with baseline biometric steep axis to analyze the number of cases of axis-flip (defined as a change in cylinder axis of 90±22.5 degrees) from the baseline corneal astigmatism. Quality of life scores CATPROM-5 and EuroQoL EQ-5D- 3L were used as proxies of patient tolerance of any residual postoperative cylinder. Addition- ally, PCA inclusion in TIOL calculation was ret- rospectively analyzed to identify cases in which axis-flip may not have occurred with inclusion of this coefficient in original lens calculations. Results The original study enrolled 102 patients, 92 of whom underwent cataract surgery and received a TIOL. Of those, 91 followed up at 4 weeks and 84 at 6 months. Demographic data was similar between the flipped cases (FC) and the unflipped cases (UF) in terms of age, sex, preoperative measures including UDVA, CDVA, biometric K1-K2, Pentacam K1-K2, axial length, CATPROM-5, EQ-5D-3L value and raw scores, and intervention group-to-control group ratio. There were fewer eyes with against-the-rule (ATR) and oblique (OB) astigmatism in the flipped group. At 6 months postoperatively, about 1/3 (29/84, 34.5%) of patients had axis-flip. The mean UDVA (logMAR) was similar (0.13 for both groups), as was CDVA (0.01 [flipped] vs. EyeWorld Journal Club review Review of "The effects of axis-flip of the refractive cylinder on vision and patient-reported outcome measures following toric intraocular lens implantation" T oric intraocular lens (TIOL) implan- tation aims for correction of pre-ex- isting corneal astigmatism during cataract surgery and has been shown to improve uncorrected distance visual acuity (UDVA) and increase spectacle independence. 1 While traditional teaching cautions against flipping the axis of astigma- tism (i.e., overcorrection of the astigmatism) during TIOL placement, recent publications reported no intolerance in patients with astig- matic overcorrection as well as possible benefit from axis-flip to with-the-rule astigmatism. 2,3,4 In this study, Naderi et al. performed a post hoc analysis to investigate the effects of axis-flip after TIOL placement on visual performance and patient-reported outcomes. The authors also re- calculated TIOL power with inclusion of poste- rior corneal astigmatism (PCA), which was not utilized in the initial study, to further identify any effects on axis-flip in this cohort of patients. Methods This was a post-hoc analysis of data from patients who received a TIOL for intraopera- tive astigmatism correction from a prospective randomized case-control study conducted at Guy's and St. Thomas' Hospital, NHS Founda- tion Trust between October 2019 and March 2022. Participants had symptomatic cataracts Arsham Sheybani, MD Ophthalmology Residency Program Director Washington University School of Medicine in St. Louis St. Louis, Missouri This study certainly provides important evidence that axis-flip, even WTR to ATR, may not impact final VA or affect patient satisfaction.

• Blank Page
• Blank Page (1)