1. Early experience of phacoemulsification
cataract surgery with Toric IOLS
Hany EL-Defrawy
Tariq Ayoub
Hadi Zambarakji

2. Magnitude of the problem
 The prevalence of astigmatism increases
with age
 Approximately 50% of the population older
than 60 years has more than 1D of
astigmatism
 22% of cataract surgery candidates have
pre-existing astigmatism exceeding 1.5 D
(Hoffer KJ,1980), (Ferrer-Blasco et al 2009)

3. What are the treatment options?
 Peroperative
 Postoperative

4. Surgical options
 Astigmatic keratotomy
 Limbal relaxing incisions
 PRK
 LASIK
 Toric IOLs

5. What are the Disadvantages of other
modalities?
 LRI
 Astigmatic keratotomy
 PRK
 LASIK

6.  Purpose: To evaluate toric IOL efficacy in
treating corneal astigmatism
 Method: Retrospective pilot study of 7
patients (11 eyes) who underwent
phacoemulsification and Toric IOL at WX

7. • Inclusion criteria
1. Visually significant cataract
2. Regular corneal astigmatism 3D or more
3. Pharmacologic mydriasis of at least 6 mm to allow
intraoperative and postoperative visualisation of axis marks
4. Intact capsular bag for in the bag implantation at the end of
surgery
• Exclusion criteria
1. Corneal scarring
2. Advanced glaucoma
3. Significant macular disease
4. Irregular astigmatism

8. Preoperative assessment
1. Complete ophthalmic examination
2. Logmar UCVA and BCVA
3. Manifest Refraction
4. Slitlamp examination
5. Keratometry and Biometry using IOLMaster
6. Toric cylindrer power and axis placement
was provided by manufacturer.

9. Postoperative follow up
 Allpatients were evaluated at one day to
assess the lens position
 A refraction was done at one day and one
month
 One patient required reposition of the IOL

10. Toric IOL
1. Reversible and adjustable
2. Predictable and effective

11. Surgical tips
 Preoperative reference marking ?
 Intraoperative reference marking
 Incision location
 Meticulous removal of OVD with attention to
avoid rotation of the IOL
 Lens alignment

12. Results
Preoperative Preoperative Post Postoperative
spherical cylinder operative cylinder
error spherical
error
Mean -2.55 -3.20
Mean -0.069 -0.91
Standard 5.28 0.93 Standard 0.63 0.56
deviation deviation
Range -1.25 to 0.75 -2.25 to -0.25
Range -14 to 4.25 -5 to 1.5

13. Paired T test
P =0.141>0.05

14. Paired T test
P<0.001

15. Refraction(pre-Operation)
Spherical 0
-15 -13 -11 -9 -7 -5 -3 -1 1 3 5
-1
-2
-3
-4
-5
-6
Cylindrical

16. Refraction(post-Operation)
Spherical 0
-1.5 -1 -0.5 0 0.5 1
-0.5
-1
-1.5
-2
-2.5
Cylindrical

17. Refraction(pre & post-Operation)
Spherical 0
-15 -13 -11 -9 -7 -5 -3 -1 1 3 5
-1
-2
-3
-4
-5
-6
Cylindrical
Spherical(pre) Cylindrical(pre) Spherical(post) Cylindrical(post)

18. Paired T test
P<0.001

19. Drawbacks of this study
 Small sample size and not powered
 Non comparative
 We did not assess the IOL position after 1
month
 A recent study showed the toric IOL
misalignment from the intended axis occurs
mostly during the first month (Mingo Botin
etal J Cataract and refractive surgery 2010)