The Use of Toric Intraocular Lenses. Practical Tips Based on Personal Experience

Wydanie 2/2020
str. 19-23

Autor: Wojciech Kołodziejczyk

Centrum Mikrochirurgii Oka Laser w Warszawie
Kierownik: prof. dr hab. n. med. Jerzy Szaflik.

Summary: 

Intraocular toric lenses are the fastest-growing segment of cataract surgery. In the past, they were used in selected patients as a premium segment, now used more and more frequently in everyday clinical practice. Over 35% of patients are potential candidates for this type of solution. The paper describes step by step the process of using toric intraocular lenses. The most common mistakes both during the initial qualification and during the operation were indicated. During the qualification, attention was paid to the use of the fourth generation calculation algorithms (such as Holladay II, Hill-RBF, Hoffer-H, Barret Universal II), the obligatory use of the corneal topography assessment, taking into account the astigmatism of the posterior surface in accordance with the algorithm of Barrett or Abulafia. It was emphasized that only patients with regular symmetrical astigmatism can be qualified to the toric multifocal lenses use. In case of monofocal toric intraocular lenses, the best result is guaranteed by regular astigmatism, but when using topography, it is also possible to apply off-label, even with irregular astigmatism, informing patients about the limitations and incomplete correction of the defect.

When describing the course of the operation, all activities influencing the achievement of a lasting effect, rotational stability and patient satisfaction were listed. The importance of precisely marking the steep meridian, meticulous and careful execution of a properly profiled main tunnel in the appropriate location and size was emphasized. In addition, attention was drawn to the need to ensure that the remnants of the cortex and viscoelastic are completely removed and that the wound is properly closed and sealed, leaving adequate intraocular pressure as important elements of the surgical technique contributing to the maintenance of permanent rotational stability.

Keywords: toric intraocular lenses, astigmatism, intraocular lens (IOL), cataract surgery, corneal topography.
Słowa kluczowe: astygmatyzm, soczewki wewnątrzgałkowe toryczne, chirurgia zaćmy, topografia rogówki.