Does Toric Marking Really Matter: Our Experience With Eyeballing It
Purpose
Much has been discussed with very little written about cyclotorsion in patients undergoing laser cataract surgery. With non-sedated patients who are able to fixate on a distant (ceiling) target, cyclotorsion should be minimal. We report our results with simply placing the suction interface on the operative eye while patient is instructed to fixate on a ceiling-mounted target.
Methods
This is a retrospective chart review of 16 eyes with pre-operative corneal astigmatism that underwent femtosecond laser-assisted cataract surgery (Catalys, AMO) and received concurrent anterior-based, 80% ablation depth, 9 mm OZ, corneal arcuate incisions (AK) created by the femtosecond laser. No Toric markings were placed on the operative eye prior to initiation of the laser arcuate incisions. Instead, patients are instructed to keep both eyes open and fixate on a ceiling-mounted target while laying supine during the femtosecond laser treatment. Our primary outcome measure compared the intended axis of astigmatism correction versus the actual axis of AK incisions.
Results
Our data show that the intended axis of AK incisions is not significantly different from the actual axis of AK incisions. Any amount of cyclotorsion exhibited using our protocol is negligible. The post-operative corneal astigmatism is significantly reduced with the use of laser-created AK incisions, even when performed without pre-operative Toric marking.
Conclusion
Femtosecond laser-assisted cataract surgery yields predictable post-operative refractive results. Laser arcuate incisions in the cornea can be accurately placed in the correct axis by having patients fixate on a distant ceiling target. This protocol eliminates the need for pre-operative Toric marking on the cornea.