Eyeworld

EW CATARACT 41 September 2015 Best in cataract astigmatism (SIA), axis misalign- ment and method of prediction to unexpected outcomes after toric IOL implantation. Methods: The refraction, keratom- etry and axis of the implanted lens were measured postoperatively in a series of 54 patients who had cataract surgery performed with a toric intraocular lens. Using vector calculations the error in predicted residual astigmatism was compared in a serial fashion by eliminating errors in assumed SIA and axis alignment. The relative contribution of these factors was estimated using different toric calculators and meth- ods of calculation. Results: With the Alcon calcula- tor the percentage of cases with a predicted error in residual astigma- tism of 0.75 D or less improved by 10% when errors in both SIA and axis alignment were eliminated. Using the Barrett toric calculator improved the percentage of cases within 0.75 D of predicted error in residual astigmatism by an addition- al 30%. Eliminating errors due to SIA and axis alignment, 70.4% of cases had an error in predicted residual astigmatism within 0.5 D with the Barrett calculator vs. 50% using the Holladay calculator modified with the Baylor nomogram or direct measurements of the posterior cornea obtained with a Pentacam Scheimpflug camera. Conclusion: Assumed values for SIA and errors in alignment of the toric IOL axis played a smaller role than the method of calculation in this series. Dr. Tipperman: I chose this paper because I believe it has the potential to help improve the clinical outcomes of anyone implanting toric IOLs. In recent years, ophthalmologists have become aware of the contribution of posterior corneal astigmatism to the total vector effect of the final refractive astigmatism from cataract surgery. Different meth- ods, including the Baylor nomogram, have been developed to help surgeons account for the influence of posterior corneal astigmatism in their toric IOL calculations. This paper compares the Barrett toric calculator to several other commonly used formulas including the Alcon calculator, Holladay calculator, Baylor nomogram, and the Pentacam and demonstrates that the Barrett calculator would leave the greatest percentage of patients within +/–0.5 D of the intended target. The Barrett toric calculator is available for use on the ASCRS website. Small-incision 4-point scleral suture fixation of foldable hydrophilic acrylic IOL in absence of capsule support Daniel C. Terveen, BS, Nicole R. Fram, MD, Brandon D. Ayres, MD, John P. Berdahl, MD Purpose: To determine visual outcomes and complications of a novel small incision technique for 4-point fixation of a hydrophilic, acrylic posterior chamber IOL in the absence of capsule support. Methods: Retrospective chart review of 37 eyes from 35 patients who underwent secondary IOL place- ment from 2011 to 2014. Cases were performed by 3 surgeons at 3 independent sites. Indications for surgery, clinical results and compli- cations were analyzed. Primary out- comes included postoperative best corrected visual acuity and surgical complications. Results: Mean age at surgery was 56 years and the mean follow-up was 6 months (range 3–24 months). Clin- ical indications included dislocated IOL (35%), ocular trauma (19%), crystalline lens subluxation (19%), UGH syndrome (8%), post com- plicated cataract (8%), congenital cataract (8%), and decompensated cornea (3%). Mean BCVA improved from 20/80 preoperatively to 20/40 postoperatively (P<0.01). Thirty-six eyes (97%) had an improved or unchanged BCVA and 1 (3%) had a reduced BCVA (due to worsening glaucoma). Postoperative complica- tions included ocular hypertension (24%), iritis (5%), wound leakage (3%), transient corneal edema (3%), glaucoma requiring tube shunt (3%), and IOL dislocation (3%). Conclusion: Small incision 4-point scleral fixation of the Akreos AO60 hydrophilic, acrylic IOL in the ab- sence of capsular support appears to be a safe and effective technique for secondary IOL placement. Dr. Tipperman: I chose this paper because I always enjoy learning a new technique or approach at a meeting— especially if it's something that I find clinically relevant and useful. An often true aphorism in medicine is that "if there are many ways to do something then usually none of them is ideal." One could argue that this is certainly the case with the surgical management of aphakia. This paper adds anoth- er technique to the anterior segment surgeon's repertoire of maneuvers. Using the unique geometry of the Bausch + Lomb Akreos lens the authors describe a straightforward technique allowing for 4-point scleral fixation, which could be applicable in many clinical situa- tions. EW Editors' note: Dr. Tipperman is attending surgeon at Wills Eye Hospital, Philadelphia. He has no financial interests related to this article. Contact information Tipperman: rtipperman@mindspring.com View Dr. Tipperman's presentation at Clinical.EWrePlay.org.

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