Hindawi Publishing Corporation Journal of Ophthalmology Volume 2016, Article ID 3257217, 6 pages http://dx.doi.org/10.1155/2016/3257217
Clinical Study Clinical Outcomes after Uncomplicated Cataract Surgery with Implantation of the Tecnis Toric Intraocular Lens Wojciech LubiNski, Beata Kafmierczak, Jolanta Gronkowska-Serafin, and Karolina PodbordczyNska-Jodko Clinic of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland Correspondence should be addressed to Wojciech Lubi´nski;
[email protected] Received 20 November 2015; Revised 29 January 2016; Accepted 2 February 2016 Academic Editor: Lisa Toto Copyright © 2016 Wojciech Lubi´nski et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate the clinical outcomes after uncomplicated cataract surgery with implantation of an aspheric toric intraocular lens (IOL) during a 6-month follow-up. Methods. Prospective study including 27 consecutive eyes of 18 patients (mean age: 66.1 ± 11.4 years) with a visually significant cataract and corneal astigmatism ≥ 0.75 D and undergoing uncomplicated cataract surgery with implantation of the Tecnis ZCT toric IOL (Abbott Medical Optics). Visual, refractive, and keratometric outcomes as well as IOL rotation were evaluated during a 6-month follow-up. At the end of the follow-up, patient satisfaction and perception of optical/visual disturbances were also evaluated using a subjective questionnaire. Results. At 6 months after surgery, mean LogMAR uncorrected (UDVA) and corrected distance visual acuity (CDVA) were 0.19 ± 0.12 and 0.14 ± 0.10, respectively. Postoperative UDVA of 20/40 or better was achieved in 92.6% of eyes. Mean refractive cylinder decreased significantly from −3.73 ± 1.96 to −1.42 ± 0.88 D (𝑝 < 0.001), while keratometric cylinder did not change significantly (𝑝 = 0.44). Mean absolute IOL rotation was 1.1 ± 2.4∘ , with values of more than 5∘ in only 2 eyes (6.9%). Mean patient satisfaction score was 9.70 ± 0.46, using a scale from 0 (not at all satisfied) to 10 (very satisfied). No postoperative optical/visual disturbances were reported. Conclusion. Cataract surgery with implantation of the Tecnis toric IOL is an effective method of refractive correction in eyes with corneal astigmatism due to the good IOL positional stability, providing high levels of patient’s satisfaction.
1. Introduction Approximately 60% of patients undergoing cataract surgery have more than 0.75 D of corneal astigmatism [1]. If uncorrected, this astigmatism results in reduced visual acuity and increased spectacle dependence in pseudophakic eyes [2]. The correction of corneal astigmatism in cataract surgery can be achieved using different surgical techniques (corneal or limbal relaxing incisions, modification of the placement of the incision site) [3, 4] or by implanting a toric intraocular lens (IOL) [5]. Several studies have reported successful visual and refractive outcomes after implantation of different models of toric IOL [5–19]. The Tecnis ZCT toric IOL combines an aspheric profile with a toric optic. To this date, only few clinical results with this specific type of toric IOL have been published, several with a rather short follow-up of less than 6 months [9, 13, 15, 16, 19]. The purpose of the current
study was to report our clinical outcomes at 6 months after uncomplicated cataract surgery with implantation of the Tecnis ZCT toric IOL.
2. Methods 2.1. Patients. This nonrandomized prospective case series included 27 eyes of 18 patients undergoing cataract surgery with implantation of the Tecnis ZCT toric IOL (Abbott Medical Optics Inc.). Inclusion criteria were visually significant cataract, age of 18 years or older, and preoperative corneal astigmatism of 0.75 D or higher. Patients were excluded from the study when the following conditions were present: potential visual acuity of less than 0.2 LogMAR in each eye due to ocular pathological processes, systemic or ocular medication that could affect vision, any chronic or acute
2 pathology that could alter the result, previous ocular surgery, amblyopia, strabismus, forme fruste or clinical keratoconus, pupil abnormalities, capsular or zonular abnormalities with the potential of inducing IOL decentration or tilting, and participation in another clinical study. The study adhered to the tenets of the Declaration of Helsinki and was approved by the local ethics committee. 2.2. Preoperative and Postoperative Evaluation. Before surgery, all patients underwent a complete ophthalmological examination that included the following: manifest refraction, measurement of LogMAR uncorrected (UDVA), and corrected distance visual acuity (CDVA), biometry and keratometry with the IOLMaster partial coherence interferometry device (Carl Zeiss Meditec AG), corneal topography to exclude irregular astigmatism, slit lamp examination, and dilated funduscopy. The IOL manufacturer’s web-based toric calculator was used to determine the required cylinder power and axis for the IOL that was going to be implanted. The preferred clear corneal incision location was the superior temporal quadrant and the surgeon’s estimated surgically induced corneal astigmatism was 0.75 D. On the first day after surgery, the axis position of the implanted toric IOL was analyzed under pupil dilation (1.0% tropicamide) with the slit lamp by performing a thin coaxial slit rotation until it overlapped the axis margins on the IOL. In two cases of a rotation of the IOL axis of more than 5 degrees the IOL was repositioned in the operating room and were excluded from study. Six months after surgery, manifest refraction, LogMAR UDVA and CDVA, and corneal astigmatism were measured. Patients were asked about the incidence of postoperative optical/visual disturbances, such as arc of light, halos, ghosting, or glare, and about their satisfaction with the achieved visual outcome, using a scale from 0 to 10 (0 = not at all satisfied, 10 = very satisfied). 2.3. Intraocular Lens. The 1-piece aspheric toric IOL Tecnis ZCT has 6.0 mm optic diameter and an overall length of 13.0 mm. It has a 360-degree square edge with frosting to reduce migration of lens epithelial cells and possible glare effects. The C-loop haptics are aimed at providing a 3point fixation in the capsular bag for maintaining good IOL centration and rotational stability. The lens is made of a hydrophobic acrylic material with a high Abbe value (55) which reduces the level of longitudinal chromatic aberration with the potential of improving contrast sensitivity [20]. 2.4. Surgical Technique. Before surgery, after instilling topical anesthetic eye drops and with the patient in supine position, the corneal limbus was marked at the 0∘ , 90∘ , and 180∘ meridian using the toric reference marker AE 2791 (Asico). Intraoperatively the required IOL axis was determined with the aid of the axis marker AE 2794 (Asico). After phacoemulsification, the IOL was inserted into the capsular bag using the Unfolder Platinum 1 system (Abbott Medical Optics Inc.) through a 2.2 mm corneal incision in the superotemporal quadrant. After the removal of the ophthalmic viscosurgical
Journal of Ophthalmology Table 1: Patient demographics and preoperative data in the analyzed sample. Parameter Age (years) Mean ± SD Range Sex (%) Male Female Sphere (D) Mean ± SD Range Cylinder (D) Mean ± SD Range Keratometry (D) K1 (steep) K2 (flat) Axial length (mm) Mean ± SD Range Mean IOL power (D) Sphere Cylinder
Value 66.1 ± 11.4 37 to 79 6 (33%) 12 (67%) −2.70 ± 6.70 −18.50 to 5.50 −3.73 ± 1.96 −8.50 to −1.50 42.58 ± 1.61 45.77 ± 1.82 23.87 ± 1.38 22.19 to 27.83 19.59 ± 4.58 −3.64 ± 0.54
device (Discovisc, Alcon) from the capsular bag, the IOL was rotated, if necessary, to the correct axis position. 2.5. Data Analysis. Distribution of analyzed data was performed using the Kolmogorov-Smirnov test. All data presented in the current study were not normally distributed and therefore nonparametric statistics were used. The Wilcoxon ranked sum test was used to compare changes in visual and refractive parameters between preoperative and postoperative examinations, considering a significance level of 𝑝 < 0.05. The spherocylindrical refractions obtained before and after surgery were converted to vectorial notation using the power vector method described by Thibos and Horner [21]. According to the power vector method, manifest refractions in conventional script notation (𝑆 [sphere], 𝐶 [cylinder] × 𝜑 [axis]) were converted to power vector coordinates and overall blurring strength (𝐵) by the following formulas: 𝑀 = 𝑆 + 𝐶/2; 𝐽0 = (−𝐶/2) cos(2𝜑); 𝐽45 = (−𝐶/2) sin(2𝜑); and 2 1/2 𝐵 = (𝑀2 + 𝐽02 + 𝐽45 ) .
3. Results Twenty seven eyes of 18 patients were enrolled in the study. Table 1 summarizes the patient demographics and the preoperative data. 3.1. Visual and Refractive Outcomes. Table 2 shows the preoperative and 6-month postoperative visual and refractive
Journal of Ophthalmology
3
Table 2: Preoperative and 6-month postoperative visual and refractive outcomes. Parameter (mean ± SD) LogMAR UDVA LogMAR CDVA Manifest refraction Sphere (D) Cylinder (D) Spherical equivalent (D) Keratometric cylinder (D) ∗
Preoperative 0.78 ± 0.22 0.49 ± 0.39
6 months postoperative 0.19 ± 0.12 0.14 ± 0.10
𝑝 value
