Eyeworld

67 EW INTERNATIONAL April 2015 Contact information Kaweri: info@narayananethralaya.com Nicholson: maneck.nicholson@gmail.com Rajat: rajat.kgmu@gmail.com (preoperative corneal astigmatism), 0.5 D (induced astigmatism), 4.01 D at 86 degrees (crossed-cylinder result, corneal plane), –0.05 D at 86 degrees (anticipated residual astig- matism), T6.0 (toric IOL), 16.5 (IOL spherical equivalent), 86 degrees (axis of placement), 6.00 D (cylinder power, IOL plane), 4.05 D (cylinder power, corneal plane), 90 degrees (incision location), and uneventful phacoemulsification with toric IOL implantation. "Anterior and posterior segment examination were within normal limits, but surprisingly unaided visual acuity of the operated eye was 1/60, BCVA 5/60," Dr. Rajat report- ed. "All parameters were repeated in the IOL mode and were the same. The autorefractor reading was +4.0 Dsph/–9.0 Dcyl at 89 degrees [the astigmatism was exactly double]. Postoperative rotation of the toric IOL was ruled out after confirming the axis marking of IOL in a dilated pupil." Hence, before performing the IOL explantation, Dr. Rajat said the researchers considered that the IOL might be defective. "The toric IOL was rotated by 90 degrees," Dr. Rajat said. "Now the unaided best corrected visual acuity of the patient was 6/9." Based on their research, Dr. Rajat made a series of recommenda- tions. "To ensure that the toric IOL has defective markings, each step should be repeated in a meticulous manner," Dr. Rajat reported. "All steps of preoperative and intraoper- ative events were checked twice for any mistakes, but none were found. A possibility of exchange of IOL in the theatre with the other patient was [investigated] by matching the box and patient's IOL card. Ocular and fundus examination were found normal. So the only possibility remaining was the manufacturing defect. After pinhole, radioscopy and autorefraction, we found out there was an astigmatic error double of the preoperative value. This gave a hint to attempt a rotation before explanting the IOL." All told, Dr. Rajesh said a man- ufacturing defect was confirmed in the marking of the toric IOL. "Now we have one more thing to keep in mind before attempting the radical measures like explanting the defective IOL," Dr. Rajat said. "Attempt a rotation accordingly as the residual astigmatism suggests." EW Editors' note: The sources have no financial interests related to their comments. Register Now! Be part of the excitement in Guadalajara, Mexico: • Hundreds of scientific sessions led by internationally-renowned experts on topics like retina, glaucoma, cornea and refractive surgery, pediatric ophthalmology, and oculoplastics. • Network with more than 7,000 ophthalmologists from over 120 countries. • More than 100 exhibiting companies displaying the very latest cutting-edge products and services in ophthalmology. Abstract Submission Deadline: June 1 /attendwoc /attendwoc Reserve your place today: woc2016.org World Ophthalmology Congress ® of the International Council of Ophthalmology Host: Mexican Society of Ophthalmology Co-host: Pan-American Association of Ophthalmology

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