Yonsei Med J.  2016 Nov;57(6):1475-1481. 10.3349/ymj.2016.57.6.1475.

Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism

• Lee J
• Lee H
• Kang DS
• Choi JY
• Kim EK
• Kim TI

• KMID: 2427167
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1475

Abstract

PURPOSE
To compare the effectiveness of toric foldable iris-fixated phakic intraocular lens (pIOL) implantation and non-toric foldable iris-fixated pIOL implantation with limbal relaxing incisions (LRIs) for correcting moderate-to-high astigmatism in myopic eyes.
MATERIALS AND METHODS
The medical records of 146 patients (195 eyes) with myopic astigmatism who underwent toric foldable iris-fixated pIOL implantation (toric group; 94 eyes) or non-toric foldable iris-fixated pIOL implantation with concurrent LRIs (LRI group; 101 eyes) were retrospectively reviewed. For subgroup analysis, the two groups were subdivided according to preoperative astigmatic severity [moderate, 2.00 to <3.00 diopters (D); high, 3.00-4.00 D]. Visual and astigmatic outcomes were compared 6 months postoperatively.
RESULTS
The uncorrected distance visual acuity was at least 20/25 in 100% and 98% of the toric and LRI group eyes, respectively. The toric group had lower mean residual cylindrical error (-0.67±0.39 D vs. -1.14±0.56 D; p<0.001) and greater mean cylindrical error change (2.17±0.56 D vs. 1.63±0.72 D; p<0.001) than the LRI group, regardless of the preoperative astigmatic severity. The mean correction index (1.10±0.16 vs. 0.72±0.24; p<0.001) and success index (0.24±0.14 vs. 0.42±0.21; p<0.001) also differed significantly between the groups.
CONCLUSION
Both surgical techniques considerably reduced astigmatism and had comparable visual outcomes. However, toric foldable iris-fixated pIOL implantation was more reliable for correcting moderate-to-high astigmatism in myopic eyes.

Keyword

Lenses; intraocular; limbus corneae; astigmatism

MeSH Terms

Adult
Astigmatism/*surgery
Female
Humans
Iris/*surgery
Keratoplasty, Penetrating
Lens Implantation, Intraocular/*methods
Lenses, Intraocular
Limbus Corneae/*surgery
Male
Middle Aged
Myopia/*surgery
*Phakic Intraocular Lenses
Refraction, Ocular/physiology
Refractive Surgical Procedures
Retrospective Studies
Treatment Outcome
Visual Acuity/physiology

Figure

• 

  Fig. 1 The mean profile graph of the toric and LRI groups. Toric group, toric foldable iris-fixated phakic intraocular lens implantation; LRI group, non-toric foldable iris-fixated phakic intraocular lens implantation with limbal relaxing incisions.

• 

  Fig. 2 Comparison of astigmatism severity before and 6 months after surgery in the (A) toric and (B) LRI groups. Toric group, toric foldable iris-fixated phakic intraocular lens implantation; LRI group, non-toric foldable iris-fixated phakic intraocular lens implantation with limbal relaxing incisions; D, diopters.

• 

  Fig. 3 Scatter plots of the J0 and J45 vectors [in diopters (D)], calculated by power vector analysis, in the (A) toric and (B) LRI groups. Black diamonds and grey squares indicate preoperative and 6-month postoperative values, respectively. Toric group, toric foldable iris-fixated phakic intraocular lens implantation; LRI group, non-toric foldable iris-fixated phakic intraocular lens implantation with limbal relaxing incisions.

• 

  Fig. 4 Relationship between the target-induced astigmatism vector and the surgically induced astigmatism vector in the (A) toric and (B) LRI groups. The dashed line represents the ideal situation, in which the intended and achieved cylindrical corrections are equal. Toric group, toric foldable iris-fixated phakic intraocular lens implantation; LRI group, non-toric foldable iris-fixated phakic intraocular lens implantation with limbal relaxing incisions; D, diopters; TIA, target-induced astigmatism; SIA, surgically induced astigmatism.

Reference

1. Ruckhofer J, Seyeddain O, Dexl AK, Grabner G, Stoiber J. Correction of myopic astigmatism with a foldable iris-claw toric phakic intraocular lens: short-term follow-up. J Cataract Refract Surg. 2012; 38:582–588.

2. Doors M, Budo CJ, Christiaans BJ, Luger M, Marinho AA, Dick HB, et al. Artiflex toric foldable phakic intraocular lens: short-term results of a prospective European multicenter study. Am J Ophthalmol. 2012; 154:730.e2–739.e2.

3. Guerin MB, Treacy MP, O'Keeffe M. Twelve-month follow-up of the Artiflex toric phakic intraocular lens. Eur J Ophthalmol. 2014; 24:10–13.

4. Muñoz G, Cardoner A, Albarrán-Diego C, Ferrer-Blasco T, Belda-Salmerón L. Iris-fixated toric phakic intraocular lens for myopic astigmatism. J Cataract Refract Surg. 2012; 38:1166–1175.

5. Hirnschall N, Gangwani V, Crnej A, Koshy J, Maurino V, Findl O. Correction of moderate corneal astigmatism during cataract surgery: toric intraocular lens versus peripheral corneal relaxing incisions. J Cataract Refract Surg. 2014; 40:354–361.

6. Mingo-Botín D, Muñoz-Negrete FJ, Won Kim HR, Morcillo-Laiz R, Rebolleda G, Oblanca N. Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery. J Cataract Refract Surg. 2010; 36:1700–1708.

7. Nichamin LD. Astigmatism control. Ophthalmol Clin North Am. 2006; 19:485–493.

8. Lee BS, Lindstrom RL, Reeves SW, Hardten DR. Modern management of astigmatism. Int Ophthalmol Clin. 2013; 53:65–78.

9. Ouchi M. High-cylinder toric intraocular lens implantation versus combined surgery of low-cylinder intraocular lens implantation and limbal relaxing incision for high-astigmatism eyes. Clin Ophthalmol. 2014; 8:661–667.

10. Nichamin LD. Modified astigmatism correction nomogram. J Refract Surg. 2008; 24:562–563.

11. Thibos LN, Horner D. Power vector analysis of the optical outcome of refractive surgery. J Cataract Refract Surg. 2001; 27:80–85.

12. Alpins N. Astigmatism analysis by the Alpins method. J Cataract Refract Surg. 2001; 27:31–49.

13. Alpins NA. A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg. 1993; 19:524–533.

14. Alpins NA, Goggin M. Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery. Surv Ophthalmol. 2004; 49:109–122.

15. Reinstein DZ, Archer TJ, Randleman JB. JRS standard for reporting astigmatism outcomes of refractive surgery. J Refract Surg. 2014; 30:654–659.

16. Dick HB, Alió J, Bianchetti M, Budo C, Christiaans BJ, El-Danasoury MA, et al. Toric phakic intraocular lens: European multicenter study. Ophthalmology. 2003; 110:150–162.

17. Güell JL, Vázquez M, Malecaze F, Manero F, Gris O, Velasco F, et al. Artisan toric phakic intraocular lens for the correction of high astigmatism. Am J Ophthalmol. 2003; 136:442–447.

18. Poll JT, Wang L, Koch DD, Weikert MP. Correction of astigmatism during cataract surgery: toric intraocular lens compared to peripheral corneal relaxing incisions. J Refract Surg. 2011; 27:165–171.

19. Akura J, Matsuura K, Hatta S, Otsuka K, Kaneda S. A new concept for the correction of astigmatism: full-arc, depth-dependent astigmatic keratotomy. Ophthalmology. 2000; 107:95–104.

20. Carvalho MJ, Suzuki SH, Freitas LL, Branco BC, Schor P, Lima AL. Limbal relaxing incisions to correct corneal astigmatism during phacoemulsification. J Refract Surg. 2007; 23:499–504.

21. Budak K, Yilmaz G, Aslan BS, Duman S. Limbal relaxing incisions in congenital astigmatism: 6 month follow-up. J Cataract Refract Surg. 2001; 27:715–719.

22. Lim R, Borasio E, Ilari L. Long-term stability of keratometric astigmatism after limbal relaxing incisions. J Cataract Refract Surg. 2014; 40:1676–1681.

23. Dick HB, Tehrani M, Aliyeva S. Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes. J Cataract Refract Surg. 2004; 30:2284–2289.

24. Tehrani M, Dick HB. Changes in higher-order aberrations after implantation of a foldable iris-claw lens in myopic phakic eyes. J Cataract Refract Surg. 2006; 32:250–254.

25. Can İ, Bayhan HA, Çelik H, Ceran BB. Comparison of corneal aberrations after biaxial microincision and microcoaxial cataract surgeries: a prospective study. Curr Eye Res. 2012; 37:18–24.