Eyeworld

EW CATARACT 25 May 2018 expensive of a return to the OR, and the theoretic risk for infection or zonular damage have him trying to avoid the need altogether. The IOLs that they did have to rotate in the study period, however, were stable afterward, Dr. Lee noted. "I think the take-home message is that if you have an IOL rotation, wait a couple of weeks, then fix it because your patient will be much better off," Dr. Lee said. Dr. Chang said he prefers the AcrySof as a monofocal toric option, but he also implants many Symfony and Symfony toric IOLs. If the first eye develops 10 degrees or more of misalignment, he'll reposition it simultaneously with cataract surgery in the second eye. He'll then use a capsular tension ring (CTR) with the Symfony toric in the second eye. He said he might also use a CTR if the patient has high axial myopia or conditions that would make repo- sitioning difficult, such as a small pupil, or if the patient is from out of town. "I think that a CTR reduces ro- tation, but we didn't directly study or prove this," Dr. Chang said. The Inoue et al. study also mentioned limiting patient activity in the immediate postop period as a possible way to prevent IOL rota- tion. "I routinely tell all patients im- mediately upon conclusion of their surgery to keep their eye relaxed and avoid squeezing as I remove the speculum and drape," Dr. Lee said. "We use a powered reclining chair in our surgery center, and I tell patients not to make any effort to sit up after the surgery and let the chair do all the work. I also tell them to be extremely careful to avoid eye rubbing, lifting, and straining and to move in 'slow motion' for the first 24 hours." Dr. Chang also said he will tell patients to avoid exercise and limit walking immediately following their surgery. "I imagine that once the patient leaves the ASC and starts walking, that may be just enough activity to allow some toric IOLs to move," Dr. Chang said, acknowledging that he has "no idea" if limiting activity during the immediate postop period actually helps prevent rotation. Dr. Chang said he and Dr. Lee have shared their findings with Johnson & Johnson Vision, which is evaluating haptic modifications that could improve rotational stability of the Tecnis toric IOL. He said when adjustable IOLs become available, they will be the best toric platform. "[The] lack of potential rotation following adjustment will be one of the reasons why," Dr. Chang said. EW References 1. Ma JJ, et al. Simple method for accurate alignment in toric phakic and aphakic intra- ocular lens implantation. J Cataract Refract Surg. 2008;34:1631–6. 2. Lee BS, et al. Comparison of the rotational stability of two toric intraocular lenses in 1273 consecutive eyes. Ophthalmology. 2018 Mar 12. Epub ahead of print. 3. Inoue Y, et al. Axis misalignment of toric intraocular lens: placement error and postoperative rotation. Ophthalmology. 2017;124:1424–1425. Editors' note: Dr. Chang has finan- cial interests with Carl Zeiss Meditec, Johnson & Johnson Vision, and RxSight (Aliso Viejo, California). Dr. Lee has no financial interests related to his comments. Contact information Chang: dceye@earthlink.net Lee: bryan@bryanlee.pro

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