Femtolaser Assisted Cataract Surgeryand Toric Lenses in Patients with Astigmatism. Review

The presence of concomitant corneal astigmatism is the most common cause of low visual functions in patients with surgical treatment of cataracts. The implantation of toric intraocular lenses is procedure of choice in the correction of corneal astigmatism from 1.0 DPT and more in patients with cataracts. Successful results depend on several factors, the most important of which: the correct and stable position of the intraocular lens (IOL) in the capsule bag, the absence of residual astigmatism, the choice of the implanted IOL’s model, taking into account material and design of lens elements. Deviation of the cylindrical component by 10 degrees reduces visual acuity up to 35 %. Repeated intervention for the purpose of toric lens reposition, according to the literature, varies from 0,65 to 9 % and is carried out with the rotation of IOL more than 10°. Femtolaser-assisted phacoemulsification allows partially automate the surgical process, making it more efficient and safe, creating a theoretical advantage over manual techniques of surgery. In practice, the capsulorexis formed by the femtolaser is characterized by a regular rounded shape with a given diameter and provides a coating of optical part of IOL for 360°, which, according to various sources, contributes to a lesser degree of decentralization and tilt of the lens in the capsule bag and can be considered as one of the reasons for obtaining a more accurate refractive result and, as a consequence, higher visual functions. The review presents the results of clinical studies of corneal astigmatism correction during standard and femtolaser-assisted phacoemulsification with implantation of various models of toric IOLs: visual acuity, rotational stability, residual astigmatism percentage, wave front change. Researchers continue to discuss the advantages and disadvantages of modern technologies. However, the problem of increasing the predictability of the surgical outcome in order to obtain a higher refractive result both in the early and in the long-term postoperative period remains unquestionable.

astigmatism, toric intraocular lenses, femtosecond laser-assisted cataract surgery

1. Shhuko A.G., Shanturova M.A., Senchenko N.Ya., Mishhenko O.P., Makarova E.K., Tjazhev M.Yu., Antipin A.G. Way to success. Stages of phacoemulsification development in Russia = Sovremennyetehnologii v oftal’mologii. 2017;3:21–24 (In Russ.).

2. Khripun K.V., Astakhov S.Yu. Astigmatism correction in highly hyperopic patients — which way to choose? Ophthalmology journal = Oftalmologiceskie vedomosti. 2014;7(2):9–11 (In Russ.). DOI: 10.17816/OV201429-12

3. Mohammadi M., Naderan M., Pahlevani R., Jahanrad A. Prevalence of corneal astigmatism before cataract surgery. Int. Ophthalmol. 2016;36(6):807–817. DOI: 10.1007/s10792-016-0201-z

4. Bailey-Wilson J.E.A genome-wide association study of corneal astigmatism: Shah R.L., Li Q., Zhao W., Tedja M.S., Tideman J.W.L., Khawaja A.P., Fan Q., Yazar S., Williams K.M., Verhoeven V.J.M., Xie J., Wang Y.X., Hess M., Nickels S., Lackner K.J., Pärssinen O., Wedenoja J., Biino G., Concas M.P., Uitterlinden A., Rivadeneira F., Jaddoe V.W.V., Hysi P.G., Sim X., Tan N., Tham Y.C., Sensaki S., Hofman A., Vingerling J.R., Jonas J.B., Mitchell P., Hammond C.J., Höhn R., Baird P.N., Wong T.Y., Cheng C.Y., Teo Y.Y., Mackey D.A., Williams C., Saw S.M., Klaver C.C.W., Guggenheim J.A., Bailey-Wilson J.E. A genome-wide association study of corneal astigmatism: The CREAM Consortium. Molecular Visin. 2018;24:127–142.

5. Radzihovskij B.L. Astigmatism of the human eye. Moscow: Medicina, 1969. 196 р. (In Russ.).

6. Qammar A., Mullaney P. Paired opposite clear corneal incisions to correct preexisting astigmatism in cataract patients. J Cataract Refract Surg. 2005;31(6):1167–1170. DOI: 10.1016/j.jcrs.2004.11.053

7. Ouchi M., Kinoshita S. AcrySof IQ toric IOL implantationcombined with limbal relaxing incision during. cataract surgery foreyes with astigmatism 2,50 D. J Refract Surg.2011;27(9):643–647. DOI: 10.3928/1081597x-20110317-03

8. Dexl A.K., Jell G., Strohmaier C., Seyeddain O., Riha W., Ruckl T., Bachernegg A., Grabner G. Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia. J Cataract Refract Surg. 2015;41(3):566– 575. DOI: 10.1016/j.jcrs.2014.05.051

9. Zaldivar R., Oscherow S., Piezzi V. Bioptics in phakic and pseudophakic intraocular lens with the Nidek EC-5000 eximer laser. J Refractive Surgery. 2002;18(6):234–237.

10. Rubenstein J.B., Raciti M. Approaches to corneal astigmatism in cataract surgery. Curr Opin Ophthalmol. 2013;24(1):30–34. DOI: 10.1097/ICU.0b013e32835ac853

11. Liu H.H., Hu Y., Cui H.P. Femtosecond laser in refractive and cataract surgeries. International Journal of Ophthalmology. 2015;8(2):419–426. DOI: 10.3980/j. issn.2222-3959

12. Trikha S., J., Morris R.J., Anderson D.F., Hossain P. The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn? Eye (Lond). 2013;27(4):461–473. DOI: 10.1038/eye.2012.293

13. Pershin K.B., Pashinova N.F., Cygankova A.Yu., Gurmizov E.P., Zubenko O.Yu. Femtolaser arcuate keratotomy and cataract extraction in middle-aged and elderly patients with corneal astigmatism. Point of view. East-West = Tochka zrenija. Vostok — Zapad. 2017;1:67–70 (In Russ.).

14. Raoof-Danesshvar D., Mian I.S. Femtosecond Laser-Assisted Astigmatism Correction. In: Astigmatism — Optics, Physiology and Management. 2012:194–199. DOI: 10.5772/759

15. St Clair R.M., Sharma A., Huang D., Yu F., Goldich Y., Rootman D., Yoo S., Cabot F., Jun J., Zhang L., Aldave A.J. Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty. Cataract. Refract. Surg. 2016;42(4):556–562. DOI: 10.1016/j.jcrs.2015.12.053

16. Kiraly L., Hermann C., Amm M., Duncker G. Reduction of astigmatism by arcuate incisions using the femtosecond laser after corneal transplantation. Klin. Monatsbl. Augenheilkd. 2008;225(1):70–74.

17. Kook D., Bühren J., Klaproth O.K., Bauch A.S., Derhartunian V., Kohnen T. Astigmatic keratotomy with the femtosecond laser: correction of high astigmatisms after keratoplasty. Ophthalmologe. 2010;108(2):143–150. DOI: 10.1007/s00347-0102239-z

18. St. Clair R.M., Sharma A., Huang D., Yu F., Goldich Y., Rootman D., Yoo S., Cabot F., Jun J., Zhang L., Aldave A.J. Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty. J Cataract Refract Surg. 2016;42(4):556–562. DOI: 10.1016/j.jcrs.2015.12.053

19. Daxer A. Corneal intrastromal implantation surgery for the treatment of moderate and high myopia. J Cataract Refract Surg. 2008;34:194–198. DOI: 10.1016/j. jcrs.2007.10.011

20. Aristeidou A., Taniguchi E.V.,TsatsosM., Muller R., Alinden C., Pineda R., Paschalis E.I. The evolution of corneal and refractive surgery with the femtosecond laser. Eye Vis (Lond). 2015;2:12. DOI: 10.1186/s40662-015-0022-6

21. Sabaani N., Malki S., Jindan M., Assiri A., Swailem S. Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism. Saudi J Ophthalmol. 2016;30(3):163–168. DOI: 10.1016/j.sjopt.2016.04.003

22. Chan T.C., Ng A.L., Cheng G.P., Wang Z., Woo V.C., Jhanji V. Corneal Astigmatism and Aberrations After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy: Two-Year Results. American Jurnal of Ophthalmology. 2016;170:83–90. DOI: 10.1016/j.ajo.2016.07.022

23. Krachmer J.H., Fenzl R.E. Surgical correction of high postkeratoplasty astigmatism: relaxing incisions versus wedge resection. Arch Ophthalmol.1980;98:1400–1402. DOI: 10.1001/archopht.1980.01020040252007

24. Nichamin L.D. Nomogram for limbal relaxing incisions. J Cataract Refract Surg. 2006;32(9):1408. DOI: 10.1016/j.jcrs.2006.03.046

25. Bahar I., Levinger E., Kaiserman I., Sansanayudh W., Rootman D.S. IntraLase-enabled astigmatic keratotomy for postkeratoplasty astigmatism. Am J Ophthalmol. 2008;146(6):897–904. DOI: 10.1016/j.ajo.2008.07.004

26. Nubile M., Carpineto P., Lanzini M., Calienno R., Agnifili L., Ciancaglini M., Mastropasqua L. Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology. 2009;116(6):1083–1092. DOI: 10.1016/j. ophtha.2009.01.013

27. Hosny M., Azzam S., Oweis W. Limbal Relaxing Incisions versus Penetrating Limbal Relaxing Incisions for the Management of Astigmatism in Cataract Surgery. Ophthalmology & Visual System. 2015;2(5):00062. DOI: 10.15406/aovs.2015.02.00062

28. Shimizu K., Misawa A., Suzuki Y. Toric intraocular lenses: Correcting astigmatism while controlling axis shift. J Cataract Refract Surg. 1994;20:523–526. DOI: 10.1016/ s0886-3350(13)80232-5

29. Kolesnikov A.V., Shevyakova O.V. Toric Acrysof® Torik® IOLs are the efficacy of one-stage cataract surgery and corneal astigmatism. In: Modern technologies of cataract and refractive surgery — 2012. Cataract surgery. — 2012. Khirurgiyakatarakty. 2012. P. 84 (In Russ.).

30. Statham M., Apel A., Stephensen D. Comparison of the AcrySof SA60 spherical intraocular lens and the AcrySofToric SN60T3 intraocular lens outcomes in patients with low amounts of corneal astigmatism. Clin. Exp. Ophthalmol. 2009;37(8):775– 779. DOI: 10.1111/j.1442-9071.2009.02154.x

31. Masayuki O. 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. DOI: 10.2147/OPTH. S61373

32. Luck J. Customized ultra-high-power toric intraocular lens implantation for pellucid marginal degeneration and cataract. J Cataract Refract Surg. 2010;36(7):1235– 1238. DOI: 10.1016/j.jcrs2010.04.009

33. Kersey J.P., O’Donnell A., IIIingworth C.D. Cataract surgery with toric intraocular lenses can optimize uncorrected postoperative visual acuity in patients with marked corneal astigmatism. Cornea. 2007;26(2):133–135. DOI: 10.1097/ ico.0b013e31802be5cc

34. Farooqui J.H., Koul A., Dutta R., Shroff N.M. Determinationofpost-operativetoric IOL alignment — Analyzedby two different methods: Slit-lamp versus Adobe Photoshop. Sudanese. J.Ophthalmol. 2014;6:57–61. DOI: 10.4103/1858-540x.150996

35. Zuberbuhler B., Signer T., Gale R., Haefliger E. Rotational stability of the AcrySof SA60TT toric intraocular lenses: a cohort study. BMC Ophthalmol. 2008;8:8. DOI: 10.1186/1471-2415-8-8

36. Strenn K., Menapace R., Vass C. Capsular bag shrinkage after implantation of an open-loop silicone lens and a poly(methyl methacrylate) capsule tension ring. J. Cataract. Refract. Surg. 1997;23:1543–1547. DOI: 10.1016/s0886-3350(97)80027-2

37. Ganesh S., Pereira S., Prabhu S. Influence of axial length on Toric IOL rotational stability — a retrospective study. Journal of Dental and Medical Sciences. 2015;14(10):91–96. DOI: 10.9790/0853-141039196

38. Weinand F., Jung A., Stein A., Pfützner A., Becker R., Pavlovic S. Rotation stability of a single-piece hydrophobic acrylic intraocular lens: new method for high-precision rotation control. J Cataract Refract Surg. 2007;33(5):800–803. DOI: 10.1016/j. jcrs.2007.01.030

39. Ruchkin M.P., Fedjashev G.A. AcrySoftoric toric intraocular lens implantation with modified marking of the cylindrical component: assessment of rotational stability. Modern technologies in ophthalmology = Sovremennyetehnologii v oftal’mologii. 2015;7(3):142–143 (In Russ.).

40. Chang D.F. Repositioning technique and rate for toric intraocular lens. J. Cataract. Refract. Surg. 2009;35:1315–1316. DOI: 10.1016/j.jcrs.2009.02.035

41. Lubiński W., Kańmierczak B., Gronkowska-Serafin J., Podborączyńska-Jodko K. Clinical outcomes after uncomplicated cataract surgery with implantation of the tecnistoric intraocular lens. J.Ophthalmol. 2016;32:572–17. DOI: 10.1155/2016/3257217

42. Xue K, Jolly J.K., Mall S.P., Haldar S., Rosen P.H., MacLaren R.E. Real-world refractive outcomes of toric intraocular lens implantation in a United Kingdom National Health Service setting. BMC Ophthalmol. 2018;18(1):30. DOI: 10.1186/s12886-0180692-7

43. Razmjoo H., Ghoreishi M., Milasi A. M., Peyman A., Jafarzadeh Z., Mohammadinia M., Kobra N. Toric Intraocular Lens for Astigmatism Correction in Cataract Patients. Adv Biomed Res. 2017;6:123. DOI: 10.4103/2277-9175.216777

44. Ventura B.V., Wang L., Weikert M.P., Robinson S.B., Koch D.D. Surgical management of astigmatism with toric intraocular lenses. Arq. Bras. Oftalmol. 2014;77(2):125–31. DOI: 10.5935/0004-2749.20140032

45. Visser N., Bauer N.J., Nuijts R.M. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg. 2013;39(4):624–637. DOI: 10.1016/j. jcrs.2013.02.020

46. Tseng S.S., Ma J.K. Calculation the optimal rotation of a misaligned toric intraocular lens. J. Cataract. Refract. Surg. 2008;34(10):1767–1772. DOI: 10.1016/j. jcrs.2008.05.057

47. Penzeva K.V.,Tahtaev Yu.V. RetinalthicknessanalysisafterprimaryposteriorcapsulorexisCataract& refractive surgery = Kataraktal’naja I refrakcionnaja hirurgija. 2012;12(2):17–20 (In Russ.).

48. Fedjashev G.A. A method of increasing the rotational stability of toric intraocular lenses. Pacific Medical journal = Tihookeanskij medicinskij zhurnal. 2015;3:26–28 (In Russ.).

49. Findl O., Hirnschall N., Draschl P., Wiesinger J.J. Effect of manual capsulorhexis size and position on intraocular lens tilt, centration, and axial position. J. Cataract. Refract. Surg. 2017;43(7):902–908. DOI: 10.1016/j.jcrs.2017.04.037

50. Filkorn T., Kovacs I., Kranitz K., Takacs A.I., Horvath E., Knorz M.C., Nagy Z.Z. Intraocular lens calculation results and refractive outcomes after femtosecond laserassisted and conventional cataract surgery. In Femtosecond laser-assisted cataract surgery. Edit Nagy Z.Z. SLACK Inc. 2014. P. 33–35.

51. Norrby S. Sources of error in intraocular lens power calculation. J. Cataract. Refract Surg.2008;34(3):368–376. DOI: 10.1016/j.jcrs.2007.10.031

52. Sanders D.R., Higginbotham R.W., Opatowsky I.E., Confino J. Hyperopic shift in refraction associated with implantation of the single-piece Collamer intraocular lens. J. Cataract Refract Surg.2006;32:2110–2112. DOI: 10.1016/j.jcrs.2006.07.030

53. Filkorn T., Kovács I., Takács A., Horváth E., Knorz M.C., Nagy Z.Z. Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. J. Refract. Surg. 2012;28(8):540–544. DOI: 10.3928/1081597X-20120703-04

54. Davidorf J.M. Impact of Capsulorhexis Morphology on the Predictability of Intraocular Lens Power Calculations. J. Eye Cataract. Surg. 2015;1(1):7. DOI: 10.21767/2471-8300.100007

55. Anisimova S.Yu., Trubilin V.N., Trubilin A.V., Anisimov S.I. Comparison of mechanical and femtosecond capsuleorexis during cataract phacoemulsification. Cataract& refractive surgery = Kataraktal’naja I refrakcionnaja hirurgija. 2012;12(4):16– 18 (In Russ.).

56. Qian D.W., Guo H.K., Jin S.L., Zhang H.Y., Li Y.C. Femtosecond laser capsulotomy versus manual capsulotomy: Meta-analysis. Int. J. Ophthalmol. 2016;9(3):453–458. DOI: 10.18240/ijo.2016.03.23

57. Anisimova S.Yu., Merkushenkova D.A., Anisimova N.S. Clinical results of the implantation of toric IOLs after phacoemulsification with femtolaser follow-up. Modern technologies in ophthalmology=Sovremennyetehnologii v oftal’mologii. 2015;8(4):17–20 (In Russ.).

58. Kaur M., Shaikh F., Falera R., Titiyal J.S. Optimizing outcomes with toric intraocular lenses. Indian. J. Ophthalmol. 2017;65(12):1301–1313. DOI: 10.4103/ijo.IJO_810_17

59. Espaillat A., Pérez O., Potvin R. Clinical outcomes using standard phacoemulsification and femtosecond laser-assistedsurgerywith toric intraocular lenses. Clin Ophthalmol. 2016; 10: 555–563. DOI: 10.2147/OPTH.S102083

60. Kranitz K., Mihaltz K., Sandor G.L., Takacs A., Knorz M.C., Nagy Z.Z. Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy. J. Refract. Surg. 2012;28(4):259–263. DOI: 10.3928/1081597X-20120309-01