Eyeworld

Supported by unrestricted educational grants from Abbott Medical Optics, Alcon Laboratories, and Bausch + Lomb by Bonnie An Henderson, MD Intraoperative toric IOL alignment: Technologies and techniques for optimal outcomes Bonnie An Henderson, MD Device manufacturers continue to strive for seamless integration of systems M ost cataract surgeons rely on manual marking techniques when implanting to- ric intraocular lenses (IOLs), but technologic advances are streamlining this process by linking automated systems. Learn more about the array of available options to determine The Verion Reference Unit (Alcon, Fort Worth, Texas) measures keratometry, pupillom- etry, and other parameters in the surgeon's office and produces a high-resolution image of the eye (Figure 1). This information is imported into the planning High-tech systems Image-guided systems increas- ingly link devices seamlessly to reduce the risk of manual data entry errors, while eliminating the need for manual marking. Wirelessly or with a USB stick, these tools capture data in a clinical area and transfer it to the intraoperative area, potentially decreasing the risk of error. 5 " Device manufacturers are linking systems with preoperative, intraoperative, and postoperative data collection to decrease human error and improve overall outcomes. " the best ways to improve accuracy and your surgical outcomes. Manual marking With manual marking tech- niques, it is critical to avoid the effects of cyclorotation. In a LASIK study, Swami et al. reported that the average torsional misalignment was ap- proximately 4 degrees, but more than 8% rotated more than 10 degrees. 1 To avoid the effects of cy- clorotation, surgeons must make preoperative reference marks on the cornea while the patient is upright. Subsequently, when the patient is supine, surgeons can use marking instruments that are held with one hand by dialing in the steep axis on a marker, then marking the cornea and align- ing the preoperative reference marks to determine the incision location. Another approach is to use marking instruments with a bimanual approach and mark the steep axis with the other hand. continued on page 6 Figure 1. Preoperative measurements performed with Verion Image Guided System Figure 2. Zeiss Cataract Suite graphical overlays are displayed on the monitor as well as the eyepiece through the Integrated Data Injection System.

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