EyeWorld Asia-Pacific December 2017 Issue

still waxy, and the IOL was ori- ented at 198 degrees, which was off by about 40 degrees. “There are multiple factors at play here: error in the astigmatic or sphere power calculation and IOL selection, an axis alignment error, IOL decentration or optic tilt, induced astigmatism related to wound healing, or surface ir- regularity. At this point the ques- tion is whether to rotate or not,” Dr. Garg said. “I consider IOL rotation if the patient is unhappy with the IOL off-axis, if there is no significant spherical error (from target), if the ocular surface is optimized, if the refraction is stable, and if the posterior capsule is intact. If the axis is off from intended, using astigmatismfix. com you can calculate the opti- mal refractive result using vector analysis. I used it in this case, and put all the information into the website and it showed a prospec- tive residual error of –0.75 with very little residual cylinder. I saw the steep axis was off on retroil- lumination from where I put the IOL, so I rotated the lens.” Dr. Garg said that when rotat- ing the IOL, it is important to mark where the IOL was because it serves as a good reference, and then mark the eye again at the position where the IOL should be. Alternatively, one could use image guidance systems. He said using a capsular tension ring (CTR) is a good way to stabilize the bag and hold down the peripheral haptics. Longer, myopic eyes tend to rotate more than shorter eyes, and using a CTR to provide stability can be very helpful, even sometimes when used preemptively. He tries not to get too much OVD behind the lens when rotating the IOL and makes sure that all OVD is removed from behind the IOL. Postoperatively, he achieved 20/20 (J3/J1), with a resolution of the waxy vision and a happy patient. “Presbyopia-correcting IOLs raise the bar for delivering a full range of vision. They add com- plexity to patient selection and expectations, and require a higher level of surgical precision to achieve exceptional outcomes,” he said. EWAP References 1. 2016 ASCRS Clinical Survey supplement. supplements.eyeworld. org. Accessed June 7, 2017. 2. Carones F. Residual astigmatism threshold and patient satisfaction with bifocal, trifocal and extended range of vision intraocular lenses (IOL). Open J of Ophthalmol. 2017;7:1–7. Editors’ note: Dr. Garg has financial interests with Alcon, Carl Zeiss Med- itec (Jena, Germany), and Johnson & Johnson Vision. Contact information Garg: gargs@uci.edu 64 EWAP CATARACT/IOL December 2017 Spoiled for choice – from page 63