Transcript 이측 투명각막절개창을 이용한 백내장 수술에서 인공수

성모병원 안센터
CHANGES IN ASTIGMATISM RELATIVE TO IOL
HAPTIC INSERTION AXIS IN WITH-THE-RULE AND
AGAINST-THE-RULE ASTIGMATISM PATIENTS
Hyun Seung Kim, M.D.
Department of Ophthalmology, St. Mary’s hospital,
The Catholic University of Korea
Authors have no financial interest.
Purpose


To compare astigmatic outcomes caused by axis change of
inserted IOL haptic during clear corneal temporal incision
cataract surgery for patients with WTR and ATR astigmatism
IOL haptic insertion at 180° vs. 90° axis
IOL haptic insertion at 180° axis
at 90° axis
Materials and Methods

138 patients (151 eyes) with LOCS III, No 2-3 cataract

Phacoemulsification cataract extraction + PCL insertion through 3 mm
temporal clear corneal incision by one surgeon.

No suture was done.

Pupil dilatation was done at POD # 1 month
: When IOL rotation was detected from original axis (out of
180±10° or 90±10°), the patient was excluded from the study.

Patient selection criteria (at pre-, and post-operative state)
 WTR astigmatism : Steep axis range 90±20°
 ATR astigmatism : Steep axis range 180±20°
Materials and Methods

Patients divided into 4 groups according to preoperative astigmatism axis
(WTR or ATR) and IOL inserted axis (Haptic in 180° or 90°).
 Group I : preoperative WTR astigmatism + IOL haptic axis at 180° (38 eyes)
 Group II : preoperative WTR astigmatism + IOL haptic axis at 90° (34 eyes)
 Group III : preoperative ATR astigmatism + IOL haptic axis at 180° (36 eyes)
 Group IV : preoperative ATR astigmatism + IOL haptic axis at 90° (43 eyes)

3 types of IOLs (Alcon acrySof SA60AT; Rayner C-flex™; AMO Tecnis ZA9003)
were inserted in the bag.

Astigmatic changes were compared by Autorefractor (BK-F1, Canon) and
Topography (Orbscan II, Orbtek) at preoperative and postoperative 1 day, 1
week, 1 month, 2 months.
Results ; Astigmatisms in WTR & ATR groups
WTR
Haptic 180° (Group I)
Haptic 90° (Group II)
P-value
Preoperative
1.32±1.17
1.46±1.09
0.971
Postoperative 1 week
1.00±0.73
1.34±1.09
0.051
Postoperative 1 month
1.01±0.77
1.49±1.11
0.050
Postoperative 2 months
1.01±0.81
1.53±1.30
0.048
Preoperative
1.20±1.14
1.30±0.79
0.321
Postoperative 1 week
1.34±0.88
1.56±1.11
0.129
Postoperative 1 month
1.42±0.95
1.61±1.07
0.585
Postoperative 2 months
ATR
1.29±0.97
Haptic 180° (Group III)
1.65±1.05
Haptic 90° (Group IV)
0.050
P-value
Preoperative
1.23±0.85
1.34±0.76
0.338
Postoperative 1 week
1.20±0.51
1.18±0.63
0.607
Postoperative 1 month
1.21±0.56
0.97±0.56
0.046
Postoperative 2 months
1.22±0.40
0.91±0.53
0.034
Preoperative
1.41±0.48
1.26±1.09
0.310
Postoperative 1 week
1.32±0.17
1.12±0.63
0.291
Postoperative 1 month
1.25±0.09
0.99±0.57
0.170
Postoperative 2 months
1.19±0.10
1.06±0.54
0.302
Autorefractor
Topography
Autorefractor
Topography
Results ; Astigmatisms in WTR & ATR groups
 Refractive Astigmatism by Autorefractor  Corneal Astigmatism by Topography
WTR Group I & II
WTR Group I & II
 Refractive Astigmatism by Autorefractor  Corneal Astigmatism by Topography
ATR Group III & IV
ATR Group III & IV
Vector Analysis of Mean Refractive Astigmatism
WTR
Haptic 180° (Group I)
Haptic 90° (Group II)
P-value
Postoperative 1 day
1.17±0.94
1.35±1.21
0.321
Postoperative 1 week
1.00±1.01
1.12±0.98
0.217
Postoperative 1 month
1.02±0.87
1.32±0.95
0.049
Postoperative 2 months
0.96±0.77
1.49±1.10
0.017
Postoperative 1 week
1.05±1.15
0.90±1.04
0.766
Postoperative 1 month
1.07±1.23
0.97±1.11
0.723
Postoperative 2 months
1.15±1.10
1.04±0.75
0.667
Haptic 180° (Group III)
Haptic 90° (Group IV)
P-value
Postoperative 1 day
1.54±0.91
1.29±0.96
0.255
Postoperative 1 week
1.47±0.67
1.37±0.85
0.170
Postoperative 1 month
1.49±0.54
1.10±0.75
0.046
Postoperative 2 months
1.35±0.76
1.06±1.02
0.029
Postoperative 1 week
0.95±0.85
1.01±0.88
0.752
Postoperative 1 month
0.62±0.72
0.72±0.83
0.699
Postoperative 2 months
0.62±0.93
0.74±0.577
0.532
Autorefractor
Topography
ATR
Autorefractor
Topography
Vector Analysis of Mean Refractive Astigmatism
 In WTR Patients
 In ATR Patients
WTR Group I & II
ATR Group III & IV
Mean Astigmatism Change
According to IOL Type in ATR Patients
IOL Type
 Single-piece
hydrophobic acrylic IOL
(Alcon acrySof SA60AT)
 Single-piece
hydrophilic acrylic IOL
(Rayner C-flex™)
 Three-piece
acrylic optic
with PMMA haptic IOL
(AMO Tecnis ZA9003)
Refractive Astigmatism
Corneal Astigmatism
Summary


WTR astigmatism group with Haptic axis 180°

Topography : Corneal Astigmatism ↑

Autorefractor : Total Astigmatism ↓

May be a net effect of Ocular residual astigmatism ↓(IOL effect ?)
ATR astigmatism group with Haptic axis 90°

Topography : Corneal Astigmatism ↓

Autorefractor : Total Astigmatism ↓↓

May be a net effect of Ocular residual astigmatism ↓ (IOL effect ?)
Our Hypothesis of IOL Effect

Inserting the IOL in the bag
Capsule bag diameter < Total IOL length
→ Angulation of IOL, Stretching of posterior capsule
→ More astigmatism perpendicular to IOL haptic axis
Development of With-the-Rule effect
Conclusions

When performing cataract surgery by clear corneal temporal incision,
inserting IOL axis parallel to preoperative astigmatism axis could minimize
the surgically induced astigmatism.

The effect was greater with one-piece acrylic IOL than three-piece PMMA
haptic IOL.

Considering the ocular residual astigmatism after cataract surgery may be
important when inserting toric, aspheric and multifocal IOLs.

And the possibility that IOL haptic insertion axis may affect the ocular resi
dual astigmatism should be considered when performing cataract surgery.