INTRAOPERATIVE ALIGNMENT PROCEDURE FOR TORIC INTRAOCULAR LENSES TO YIELD OPTIMAL SUPPRESSION OF ASTIGMATISM

Transcription

1 INTRAOPERATIVE ALIGNMENT PROCEDURE FOR TORIC INTRAOCULAR LENSES TO YIELD OPTIMAL SUPPRESSION OF ASTIGMATISM Barcelona /09/08 Eyesight&Vision Villa Erbosa GmbH Dr. Andrea Cantagalli Private Hospital,GSD Villa Erbosa, Bologna,Italy The author has no financial or proprietary interest in any product mentioned.

2 Intraoperative aberrometry:a guidance for toric IOL Purpose: To demonstrate the efficacy of intraoperative wavefront guidance to achieve best suppression of astigmatism without prior marking procedure. by using the intraoperative wavefront analyzer I-O-W-A from Eyesight & Vision GmbH, Nuremberg, Germany. Eyesight&Vision Villa Erbosa GmbH 2

3 Intraoperative Wavefront Aberrometer ADVANTAGES 1) SELECTING IOL( SPHERE AND CYLINDER) Confirm or revise the IOL selection (expecially for previous refractive surgery) 2) OPTIMIZING TORIC LENS LOCATION: Posterior corneal astigmatism Surgically induced astigmatism Tilting or head misalignement during preoperative testing 3) TAILORING ARCUATE INCISIONS: LRI(limbal relaxing incisions) AK(arcuate keratotomy) ISAK ( intrastromal arcuate keratotomy) Eyesight&Vision Villa Erbosa GmbH 3

4 Measurement principles - A 2D Microscanner deflects a laserbeam over the cornea - The optical system of the eye generates a flying spot on the retina - The scattered light from the retina is displayed on a position detector PSD - The measured refraction of the eye is displayed binocular into microscope Villa Erbosa 4

5 Measurement principles - The refraction of the eye is the difference (α β) between the angle of entrance α and the measured output angle β of the leaserbeam Villa Erbosa 5

6 Evaluation of the measurement data Wavefront Zernike Corneal data > angle of entrance Retinal image > output angle Processing 192 data points Refraction S / C / Axis IOL power Haigis, Holladay, etc. Eyesight&Vision Villa Erbosa GmbH 6

7 Evaluation of the measurement data - A laserbeam scans the eye area-wide points are sampled by the microprocessor. - The microprocessor calculates the wavefront for different optical zones. for example optical zones of 4,0 mm or 2,3 mm diameter. Villa Erbosa 7

8 Toric IOLs: nailing the target axis MARKING PROCEDURE: Influence of cyclorotation ALSO in orthostatic position (+/-3 ) Sarver, Sanders, Cooke JCRS 2013 Villa Erbosa 8

9 Toric IOLs: nailing the target axis VARIABILITY of the anterior intended axis (autoker, biometry, topography, Scheimpflug, OCT,LED topography) Eyesight&Vision Villa Erbosa GmbH 9

10 Toric IOLs: nailing the target axis NO MARKING PROCEDURE: Eye tracking linked to morphological aspect Eyesight&Vision Villa Erbosa GmbH 10

11 Toric IOLs: nailing the target axis NO MARKING PROCEDURE: Intraoperative WF linked to functional aspect Eyesight&Vision Villa Erbosa GmbH 11

12 Pre-checked IOL Calculation Toric IOL calculator (Ophtec Toric Calc, Soleko Toric Calc, Abbott Toric Calc) Magnitude of cylinder with posterior corneal astigmatism compensation (Scheimpflug,Total Corneal Power) IN THIS STUDY THE INTRAOPERATIVE ABERROMETRY USED JUST FOR TUNING THE FINAL POSITION OF THE TORIC IOL Eyesight&Vision Villa Erbosa GmbH 12

13 Optimization of the pre-checked toric IOL Work flow of optimal suppression of astigmatism Aphakic measurement Intraop. measurement of FUNCTIONAL cylinder & axis Implantation of IOL Pseudophakic measurement Intraop. Check of FUNCTIONAL cylinder & axis Rotation of IOL NO Cylinder minimum? Fine tuning YES Final check Villa Erbosa 13

14 Functional aphakic axis Intraoperative identification aphakic axis Eyesight&Vision Villa Erbosa GmbH 14

15 Case 1: intraoperative refraction aphakic eye Villa Erbosa 15

16 Intraoperative refraction check - pseudophakic eye FINE TUNING UNTIL THE LOWEST CYL VALUE!!! Eyesight&Vision Villa Erbosa GmbH 16

17 Case 1: intraoperative fine tuning of astigmatism Rotates into wrong direction Setting intraocular pressure check Rotates into right direction Lens is rotated to minimize the cylinder Villa Erbosa 17

18 Case 1: final intraoperative refraction check Villa Erbosa 18

19 Intraoperative versus postop WF/ Subjective refraction Intraoperative refraction I O W A Postoperative Wavefront* Postoperativ subjective refraction IOL SE/dpt S/dpt C/dpt Axis SE/dpt S/dpt C/dpt Axis SE/dpt S/dpt C/dpt Axis Precizon Toric 25,75 cyl2,5 0,71 0,47 0, ,12 0,87 0, , Soleko Toric 18,5 cyl 1,25 0,53 0,1 1, ,56 +1,0 0, ,375 0,75 0,75 80 Soleko Toric 20,25 cyl 1,5 0,01 0,24 0, ,68 +1,37 1, Tecnis Toric cyl 5,25 0,86 0,67 0, ,5 0,25 0,5 85 0, Soleko Toric 21,75 cyl 2 0,32 0,18 0, ,56 0,25 0, ,5 0,25 0,5 80 Soleko Toric 18,75 cyl 2 0,47 0,44 0, ,5 0,12 0, ,5 0,5 0 0 * HOYA itrace Villa Erbosa 19

20 Results for toric IOLs Postoperative refraction IOL SimK (IOL MASTER) SE/dpt. S/dpt. C/dpt. A Precizon Toric 25,75 cyl 2,5 1.79@92 0, Soleko Toric 18,5 cyl 1, @3 0,375 0,75 0,75 80 Soleko Toric 20,25 cyl 1,5 1.04@ Tecnis Toric 22,0 cyl 5, @113 0, Soleko Toric 22,5 cyl 2, @179 +0,75 +0, Soleko Toric 18,5 cyl 2, @ Soleko Toric 23,75 cyl 2, @ Soleko Toric 21,75 cyl @157 0,5 0,25 0,5 80 Soleko Toric 18,25 cyl @178 0,5 0,5 0 0 Soleko Toric 20,5 cyl @53 +0,25 +0,5 0,5 6 Soleko Toric 23 cyl 2,5 1.48@6 1,5 1,5 0 0 Soleko Toric 26 cyl @117 +0,5 +1,0 1,0 55 Villa Erbosa TOT N. 12 CASES (IOL PLANE): 2.50 CYL N.6 < 2.50 CYL N.6 20

21 Follow up results - alignement of torical IOL without preoperative marking Corrected results if - IOL has rotated postoperatively and 1 day follow up confirmed intraop. cylinder - IOL cylinder << preop. cornea cylinder Villa Erbosa 21

22 Reports Patients were (2.4 times) more likely to have less than 0.5 D of residual refractive astigmatism with the use of the aberrometry Hatch said. Kathryn M. Hatch, M.D. Eyesight&Vision Villa Erbosa GmbH 22

23 Reports the randomized, prospective, contralateral eye study included 111 eyes that underwent intraoperative aberrometry with ORA system with VerifEye (Alcon) or preoperative measurement with a toric calculator 89,2% of eyes had astigmatism of 0.5 D 1 month after surgery 76,7% of eyes had astigmatism of 0.5 D Robert J. Cionni, M.D. Eyesight&Vision Villa Erbosa GmbH 23

24 Summary SUMMARY No prior marking procedure Identification of the real astigmatic axis Optimization of the final position of the predetermined toric IOL Real time refractive analysis on the microscope (easy and fast procedure) QUESTION MARKS Is the intraoperative cornea THE SAME as the day after?? Does the IOL mantain the final intraoperative position? Is the intraoperative WF evaluation absolutely accurate? Villa Erbosa 24

25 Conclusions Intraoperative wavefront technology provides an easy way to align toric IOL Realtime intraoperative wavefront technology equips the surgeon with a guidance tool to optimize the suppression of astigmatism without preoperative marking High correlation between the intraoperative refraction and the follow-up examination results Villa Erbosa 25

26 THANK YOU! 26