Contact: Jose L Güell

José L Güell – [email protected] Update 13 contact Cataract & refractive

this posteriorly located limbal incision the amount of astigmatism induced is clinically insignificant,” he explained. Toric phakic IOLs are also a useful option Hopefully, the different ASTIGMATISM “companies will in some cases. Dr Guell reported that Currently available lenses can provide implantation of phakic IOLs has produced arrange some kind of significant visual benefits good results at his centre in eyes with agreement in order to by Roibeard O’hEineachain in Prague keratoconus, after he and his associates first combine the available stabilise the ectasia by stiffening the corneal technologies so we can collagen through collagen cross-linking. achieve this aim Another option is to use piggyback IOLs. He noted that Rayner produces a type of orrecting the regular component Patients with irregular astigmatism often IOL that is specifically designed for sulcus José Güell MD of an eye with irregular require a highly individualised treatment. implantation, including a model with an astigmatism with toric intraocular Therefore, the peer-reviewed literature astigmatism-correcting component. He noted lenses can often result in a regarding specific lenticular approaches that such IOLs are particularly useful in cases to-order toric IOL, the Lentis T Plus, which satisfactory visual outcome, said Jose Güell is fairly sparse, Dr Güell noted. However, C where the cornea is best left untouched, such provides individual astigmatism correction. MD, director of the Cornea and Refractive several case-studies derived from his own as in eyes with forme fruste keratoconus Surgeons using the IOL can use an online Surgery Unit at IMO Autonomous experience show that those approaches can Occasionally a patient who has undergone calculator to specify the IOL’s dimensions. University of Barcelona, Barcelona, Spain. be of considerable benefit to some patients. piggy-back IOL implantation may require “You can send this data and they can “When you're able to compensate the As an example, he cited the case of a further correction, Dr Güell said. He prepare a customised lens for you, not only regular component in eyes with irregular woman in her mid-50s with irregular described the case of a man with irregular to correct sphere and cylinder, but also astigmatism, visual improvement is so astigmatism from congenital corneal lesions astigmatism who had undergone a radial higher order aberrations. Although only significant in a large number of cases that and coloboma. She wanted refractive keratotomy many years previously. The with preliminary experience, we have found the patient does not regard the irregularity as surgery but was an unsuitable candidate for patient had since undergone implantation vision can be improved significantly when significant,” said Dr Güell at the 16th ESCRS refractive laser ablation. Following clear lens of two IOLs, one in the capsular bag and the we've corrected higher order aberrations, Winter Meeting. extraction and implantation of an AcrySof other in the sulcus. To correct the residual even when the corneal irregular astigmatism Toric IOLs provide an alternative to pseudophakic IOL she had significant ametropia, Dr Güell and his associates remains unchanged,” Dr Güell said. rigid gas-permeable contact lenses, which improvements in her vision, despite some implanted a third lens in the anterior Another development along similar lines is the standard treatment for irregular residual irregular astigmatism, Dr Güell said. chamber, an iris-fixated Artisan/Verisyse lens is the light-adjustable lens, which allows astigmatism, whether the condition results Another patient who achieved a good (AMO) to correct the still residual sphere postoperative correction of residual sphere from keratoconus or corneal grafting, he said. result with a pseudophakic IOL had and cylinder. “Once this was done, visual and cylinder and could theoretically be used The lenses that have been used with success irregular astigmatism as well as cataract. acuity improved to 0.8 in spite of the residual to correct irregular astigmatism and higher include pseudophakic, phakic and piggyback The irregularity of the cornea was a result irregular astigmatism, which was not as order aberrations as well. IOLs. Customised IOLs, specifically designed of keratoplasty, itself performed to correct significant,” Dr Güell said. “Today we can only theoretically for an individual’s corneal optics, are irregularities after radial keratotomy, Dr He noted that the ophthalmic device correct irregular astigmatism with IOLs another option that has recently become Güell said. “One of the advantages of using company, Topcon, has introduced a service experimentally but it will happen in the available, and the future will hopefully see these phakic IOLs (Toric Artiflex) is that that could bode well for the treatment of near future because we already have this light-adjustable IOLs employed in a similar they can be introduced through a 3.1mm astigmatism in general. It produces a made- technology available,” he concluded. manner, he predicted. incision and, especially, when you use

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EUROTIMES | Volume 17 | Issue 11