Astigmatism Management With Toric IOL in Lens Replacement Surgery Guided by Intraoperative Aberrometry in Post-LASIK Patients

Sunday, April 19, 2015: 3:26 PM
Room 4 (San Diego Convention Center)
Dan B. Tran, MD
Lisa D. Garbutt, MD
Valentina Vargas, MD

To assess visual outcomes and presenting surgical technique in previous LASIK pseudophakic patients treated with a toric intraocular lens guided by intraoperative aberrometry.

Retrospective consecutive case study of 25 eyes of previous LASIK patients who underwent lens replacement surgery with toric IOL implants.  All patients had preoperative corneal topography, IOL Master measurement and Optiwave Refractive Analysis (ORA) intraoperative aberrometry.   The mean absolute error of spherical equivalent and residual cylinder errors data at three month postop are reported.  Factors influencing the decision of using a toric IOL versus non-toric IOL are analyzed.  Technique of using ORA in these cases are presented

Preliminary data on a subset of patients showed 76% of eyes were within 0.50D of the predicted spherical equivalence (SE).  The mean keratometric astigmatism was reduced from 1.36 D ± 0.53D preoperatively to 0.31D ± 0.21D postoperatively.  All final data will be available at the time of presentation.  Patients with consistent preoperative anterior keratometry and intraoperative ORA had excellent refractive outcomes with toric IOL.  Intraoperative IOPs can influence ORA measurements significantly in these cases.

Toric IOL implants are effective in reducing corneal astigmatism for lens replacement surgery on previous LASIK patients when guided by ORA.  The accuracy is high when the ORA intraoperative aphakic astigmatism axis measured is consistent with anterior keratometric axis measured preoperatively.  In the case of significant inconsistent in axis measurement preoperatively and intraoperatively, a toric IOL implant may not be recommended.  Management of intraocular pressure during ORA measurement is critical to get accurate results.