ASTIGMATISM AFTER PREVIOUS CORNEAL SURGERIES Dimitrii Dementiev, - - PowerPoint PPT Presentation

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ASTIGMATISM AFTER PREVIOUS CORNEAL SURGERIES Dimitrii Dementiev, - - PowerPoint PPT Presentation

Jan 15, 2023 463 likes •690 views

LENS EXCHANGE WITH IMPLANTATION OF A BITORIC INTRAOCULAR LENS IN EYES WITH SIGNIFICANT ASTIGMATISM AFTER PREVIOUS CORNEAL SURGERIES Dimitrii Dementiev, MD, Anna Shipunova, MD, PhD Irina Ivanchikova, MD, Vera Veshchikova Blue Eye Centro

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SLIDE 1

Dimitrii Dementiev, MD, Anna Shipunova, MD, PhD Irina Ivanchikova, MD, Vera Veshchikova “Blue Eye” Centro di Chirurgia Oculare, Milano, Italy, “International Center for Ophthalmology” Moscow, Russia

LENS EXCHANGE WITH IMPLANTATION OF A BITORIC INTRAOCULAR LENS IN EYES WITH SIGNIFICANT ASTIGMATISM AFTER PREVIOUS CORNEAL SURGERIES

Financial Interest

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SLIDE 2

To evaluate refractive outcomes, rotational stability and safety after lens exchange for customized AT TORBI 709M (Carl Zeiss) IOL in eyes previously underwent PKP, RK and PRK Purpose

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SLIDE 3

AT TORBI 709M (Carl Zeiss Meditec)

  • Bitoric, plate haptics, Hydrophilic Acrylic,
  • ne piece IOL
  • Aspheric (Aberration-neutral)
  • MICS: Implantable trough 1.5 mm incision
  • 6.0 mm optical/ 11.0 mm total diameter
  • 118.3 A-Const
  • In bag implantation
  • Individual calculation & manufacturing (customized)
  • High rotational stability after surgery
  • Easy rotation during surgery

DIOPTER RANGE: Sphere: -10.0 to +32.0 D, 0.5 D increments Cylinder: +1.0 to +12.0 D, 0.5 D increments

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SLIDE 4

PKP 19 eyes

Post-RK ectasia 4 eyes

Keratoconus 15 eyes

RK 7 eyes PRK 8 eyes

Myopia 15 eyes

Materials & Methods

34 eyes of 33 patients Preexisting induced corneal astigmatism of -3.0 to -12.0 D

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SLIDE 5
  • Uncorrected distance visual acuity (UDVA)
  • Best-corrected distance visual acuity (BDVA)
  • Autorefractokeratometry (Tomey)
  • Slit-lamp examination with photo registration (Takagi, Japan),
  • Software (Adobe Photoshop)
  • Optical biometry, keratometry AC measuraments, WW size (Carl Zeiss IOL Master V.5.4.1,

Carl Zeiss Meditec)

  • Pachymetry, AC depth & angle size (Visante OCT 3.0.1.8 Carl Zeiss Meditec)
  • Corneal topography (ATLAS Revision 3.0.0.39 Carl Zeiss Meditec)

Materials & Methods

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SLIDE 6

Materials & Methods

Questionnaire: spectacle independence, visual disturbances, and satisfaction with vision (1 = completely unsatisfied; 10 = completely satisfied) The toric IOL was customized, calculated and ordered from manufacturers in all cases (Carl Zeiss) Postop Refractive Target: sph - 1.0

Toric IOL *ID *Age Name 20123 IOL Type Date: r [mm] P [D] *Axis [°] r [mm] P [D] *Axis [°] *K1 52,54 162 *K2 37,69 72 Visus sc 24,20 Visus sc Visus cc Visus cc Sphere [D] Cylinder [D] Axis [°] Sphere [D] Cylinder [D] Axis [°] / Date: 30.04.2013 ASAS Nr.
  • Sph. Equ.
[D] Sphere [D] Cylinder [D] Sphere [D] Cylinder [D] Nr.
  • Sph. Equ.
[D] Sphere [D] Cylinder [D] Sphere [D] Cylinder [D] 1 1 0,42 3,26
  • 5,68
9,50 12,00 2 2 0,06 2,92
  • 5,71
10,00 12,00 3 3
  • 0,30
2,57
  • 5,73
10,50 12,00 Axis [°] Axis [°] 162 4,41 1,3375 No. Sphere [D] Cylinder [D] Quantity Delivery date No. Sphere [D] Cylinder [D] Quantity Delivery date Date biometric raw data cannot be verified by CZM. CZM shall not be liable for any potential postoperative refractive errors in connection with the IOL power recommendations submitted. Please send order to: Carl Zeiss Meditec AG, Göschwitzer Strasse 51-52, D - 07745 Jena International Customer Service: Tel +33 5 46 44 85 50 Fax +33 5 46 44 09 24 email: demso.orderexport@meditec.zeiss.com Exclusion of liability: Carl Zeiss Meditec AG (CZM) provides a service for medical practices to calculate the recommended IOL refractive power. Calculation of these power recommendations will be made on the basis of the data of the patient using a proprietary calculation algorithm. The results of IOL calculation performed by CZM should be regarded as non-binding recommendations specifically matched to the CZM IOL product line. Note that these recommendations cannot replace the professional expertise of the health care specialist. Despite careful processing of the data transmitted, postoperative refractive errors cannot be excluded, since (a) prediction of the postoperative IOL position is based on the population mean and may significantly deviate in individual cases, (b) postoperative IOL dislocation (e.g. due to capsular phimosis etc.) cannot be predicted, (c) errors in the transmission of the biometric data cannot be excluded, and (d) accuracy of the STACY (reusable screen transparency) desired (yes/no) Order-No. (Customer) Sign Order (to be filled in by customer) IOL : right (OD) IOL : left (OS) *Correct graphical display of the implantation axis requires Microsoft Office XP or later versions. Calculated with: Postop estimated ACD: OD= / OS= Corneal refractive index n' = Residual Refraction IOL Power Residual Refraction IOL Power Axis = IOL position in eye* Marks = plus-cylinder axis = min. / flat IOL-Meridian Axis = IOL position in eye* Marks = plus-cylinder axis = min. / flat IOL-Meridian Comments Post-Keratoplasty Calculation (to be filled in by *CZM AG) right (OD) left (OS) *Devices Surgery Incision site OD/OS (°) Effect of surgery on K1, K2, (OD/OS) / Refraction Refraction *Target Ref. *Target Ref. Topography attached (yes/no) Topography attached (yes/no) *ACD [mm] *ACD [mm] Eye Glasses Eye Glasses *K1 *K2 *AL [mm] *AL [mm] Biometry / Input data preop (to be filled in by customer - * MANDATORY fields) Surgery Date: right (OD) Surgery Date: left (OS) Fax / E-Mail Address Distributor / Acri.Tec Request / Order to Distributor- / CZM AG *Tel./Fax demso.orderexport@meditec.zeiss.com 51 (18.04.62) *Address Piazza Fontana 6 Davidov, Leonid Milano AT TORBI™ 709M(P) IT Customer / Surgeon Patient *Name Dr. Dementiev, Dimitri 2276_13 *Institute/Clinic Blue eye Request Quotation Order *n=1,332 *n=1,336 *n=1,3375 *n=1,338 Refractive 90° 0° 90° 0° 90° 0° 90° 0° IOL-Berechnung-V23-KW-17--30 04 2013_ASAS.xls Dr.Dementiev_Davidov Version 23 / 01/2012 / RB Date of print: 30.04.2013

51 (18.04.62) Right Eye - OD 709M(P) ° implantation axis Left Eye - OS 709M(P) 162 ° implantation axis AT TORBI™ Guidance for STACY Alignment - IOL Implantation Axis AT TORBI™

IOL-Berechnung-V23-KW-17--30 04 2013_ASAS.xls
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SLIDE 7

MARKING 0° & 180° axis

  • Topic Anestesia (Lidocaine 2%)
  • Under Slit lamp in sit position
  • Just before the surgery to keep the

marks visible

Patient Preparation

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SLIDE 8

SURGICAL TECHNIQUE

  • Topic anestesia 2% Lidocain 20 min prior surgery
  • Midriasis (Fenelefrin,Tropicamid1%, Deltamidrin)
  • Clear Cornea self sealing incision of 2.4 mm MICS
  • f 1.5 Viscoelastic in AC
  • Capsulorexis 5.0-6.0 mm
  • Facoimulsification
  • I/A cortex removal
  • Viscoelastic injection in capsular bag
  • IOL implantation
  • IOL positioning
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SLIDE 9

SURGICAL TECHNIQUE IOL positioning according to steep corneal axis

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SLIDE 10

Mean (SD) Median (Range) Preoperative data p-value PKP group PRK group RK group LogMAR UDVA

1.05 (0.32) 1.00 (0.40 to 1.52) 0.93 (0.52) 1.30 (0.20 to 1.30) 1.20 (0.30) 1.00 (1.00 to 1.80) 0.776

Manifest sphere (D)

  • 2.64 (2.57)
  • 2.50 (-8.25 to 1.50)

0.53 (2.03) 1.25 (-4.00 to 2.25)

  • 1.18 (3.65)
  • 1.50 (-7.00 to 3.00)

0.029

Manifest cylinder (D)

  • 9.08 (1.92)
  • 9.00 (-12.00 to -6.00)
  • 4.67 (1.36)
  • 5.00 (-6.00 to -2.50)
  • 6.04 (1.21)
  • 6.50 (-7.00 to -3.75)

<0.001

Manifest SE (D)

  • 7.18 (2.86)
  • 8.00 (-12.50 to -1.50)
  • 1.80 (2.37)
  • 0.75 (-7.00 to 0.075)
  • 4.20 (3.89)
  • 5.00 (-10.25 to 0.25)

<0.003

LogMAR CDVA

0.42 (0.21) 0.50 (0.00 to 0.80) 0.35 (0.21) 0.50 (0.10 to 0.50) 0.49 (0.04) 0.50 (0.40 to 0.50) 0.587

Mean (SD) Median (Range) Postoperative data p-value PKP group PRK group RK group LogMAR UDVA

0.29 (0.21) 0.30 (0.05 to 1.00) 0.12 (0.03) 0.10 (0.10 to 0.17) 0.20 (0.07) 0.17 (0.10 to 0.30) 0.018

Manifest sphere (D)

  • 1.41 (1.70)
  • 0.50 (-5.00 to 0.50)
  • 0.09 (0.42)

0.00 (-1.00 to 0.50)

  • 0.39 (0.20)
  • 0.50 (-0.50 to 0.00)

0.132

Manifest cylinder (D)

  • 3.00 (1.60)
  • 3.00 (-6.00 to 0.00)
  • 0.94 (0.73)
  • 0.88 (-2.00 to -0.25)
  • 0.79 (0.17)
  • 0.75 (-1.00 to -0.50)

0.003

Manifest SE (D)

  • 2.91 (2.05)
  • 2.75 (-7.50 to 0.00)
  • 0.56 (0.60)
  • 0.44 (-2.00 to -0.13)
  • 0.79 (0.20)
  • 0.88 (-1.00 to -0.50)

0.004

LogMAR CDVA

0.07 (0.04) 0.10 (0.00 to 0.10) 0.01 (0.00) 0.01 (0.01 to 0.01) 0.08 (0.03) 0.10 (0.05 to 0.10) 0.088

34 eyes of 33 patients Mean age: 41.5 ± 6,4 years (31-51) Mean postoperative follow-up – 31.3± 8.1 months (22-55) The mean interval from previous surgery to toric IOL implantation 9.9 ±6.1 years (3-22)

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0,2 0,4 0,6 0,8 1 1,2

pre op 1 month 6 months 12 months 24 months 30 months

PRK PKP RK

Mean UCVA (LogMAR)

Efficacy

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SLIDE 12

EFFICACY

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SLIDE 13

SAFETY

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SLIDE 14

PREDICTABILITY

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Post RK Post PRK

Scatter plot of polar astigmatic vectors

Pre-operative corneal astigmatism Post-operative refractive cylindrical error

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Post PKP

Scatter plot of polar astigmatic vectors

Pre-operative corneal astigmatism Post-operative refractive cylindrical error

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SLIDE 17

Stability

  • 2
  • 1,5
  • 1
  • 0,5

0,5 1 1,5 2

pre op 1 month 6 months 12 months 24 months 30 months

RK PKP PRK

Mean Manifest spherical equivalent (D)

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SLIDE 18

ROTATIONAL STABILITY

≤2° - 86% ≤5° - 100%

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SLIDE 19

PATIENT SATISFACTION

  • 1. Spectacle independence – 63, 7%
  • 2. Visual disturbance (halo and glare) – 21,4%,
  • 3. Satisfaction with vision: - 92,3%
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SLIDE 20

Customized Refractive Lens Exchange for AT TORBI Toric IOL (Carl Zeiss)

  • Effective
  • Safe
  • Predictable
  • Stable

solution for correction of high level of induced corneal astigmatism in eyes that underwent corneal transplantation and corneal refractive procedures

CONCLUSION

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SLIDE 21

THANK YOU

Dimitrii Dementiev, MD Milano, Italy Moscow, Russia