Eyeworld

105 EW REFRACTIVE September 2017 Contact information Garg: gargs@uci.edu 20/60 and J2 at near, still waxy, and the IOL was oriented at 198 degrees, which was off by about 40 degrees. "There are multiple factors at play here: error in the astigmatic or sphere power calculation and IOL selection, an axis alignment error, IOL decentration or optic tilt, in- duced astigmatism related to wound healing, or surface irregularity. At this point the question is whether to rotate or not," Dr. Garg said. "I consider IOL rotation if the patient is unhappy with the IOL off-axis, if there is no significant spherical error (from target), if the ocular surface is optimized, if the refraction is stable, and if the posterior capsule is intact. If the axis is off from intend- ed, using astigmatismfix.com you can calculate the optimal refractive result using vector analysis. I used it in this case, and put all the informa- tion into the website and it showed a prospective residual error of –0.75 with very little residual cylinder. I saw the steep axis was off on retroil- lumination from where I put the IOL, so I rotated the lens." Dr. Garg said that when rotat- ing the IOL, it is important to mark where the IOL was because it serves as a good reference, and then mark the eye again at the position where the IOL should be. Alternatively, one could use image guidance systems. He said using a capsular tension ring (CTR) is a good way to stabilize the bag and hold down the peripheral haptics. Longer, myopic eyes tend to rotate more than shorter eyes, and using a CTR to provide stability can be very helpful, even sometimes when used preemptively. He tries not to get too much OVD behind the lens when rotating the IOL and makes sure that all OVD is removed from behind the IOL. Postoperative- ly, he achieved 20/20 (J3/J1), with a resolution of the waxy vision and a happy patient. "Presbyopia-correcting IOLs raise the bar for delivering a full range of vision. They add complex- ity to patient selection and expecta- tions, and require a higher level of surgical precision to achieve excep- tional outcomes," he said. EW References 1. 2016 ASCRS Clinical Survey supplement. supplements.eyeworld.org. Accessed June 7, 2017. 2. Carones F. Residual astigmatism threshold and patient satisfaction with bifocal, trifocal and extended range of vision intraocular lens- es (IOL). Open J of Ophthalmol. 2017;7:1–7. Editors' note: Dr. Garg has financial interests with Alcon, Carl Zeiss Meditec (Jena, Germany), and Johnson & John- son Vision. Pinch no more. NT Xpand Iris Speculum Features Visit Diamatrix.com/XpandNT or call us 800.867.8081 for more info or to schedule a demo. DIAMATRIX ● ● Quality Value Innovation ® Elegant Design Better Visual Access Simple Interoperative Manipulation Forceps Style Injector

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