EyeWorld Asia-Pacific September 2021 Issue

New Toric on the Block Ronald Yeoh, MD , Singapore Correction for corneal astigmatism using toric IOLs has been a major ad- vancement in the past de- cade. However, the main challenges to successful toric usage include inertia, biometry, and implantation technique. The greatest challenge for surgeons, though, is a fear of malro- tation. Previous studies have found TECNIS Toric I IOLs required repositioning and tended to rotate coun- terclockwise. Recently, Johnson & Johnson Vision designed an improved toric IOL with greater rota- tional stability. Many rede- signs were experimented with, but a simple solution worked the best. Because the TECNIS Toric I IOL has polished and smooth hap- tics, the TECNIS Toric II IOL was designed to have unpolished and frosted haptics. The roughness of the Toric II haptic is what gives the IOL its rotational stability. Surgeons not familia with the new TECNIS Toric II platform may wonder whether the IOL will ro- tate easily if it has a rough haptic, whether the rough haptic can tear the poste- rior capsule, and whether back-rotation can be done with this new IOL. Ron- ald Yeoh, MD, Singapore presented a case in which the IOL was injected, using a platinum injector and cartridge, but was 16 degrees shy of the in- tended position. Dr. Yeoh managed a big rotation of 60-70 degrees to bring the IOL into alignment, but was still about 10 degrees shy of the perfect posi- tion. A last adjustment was made using the toric manipulator to snag the haptic and push it into the correct position. When Dr. Yeoh turned on the optical coherence tomog- raphy (OCT) machine, he was able to see the lens sitting snugly on the pos- terior capsule, maintaining its stability. In a different case, Dr. Yeoh was able to maneuver the IOL into perfect alignment having done a back-rotation by grasping the haptic. Dr. Yeoh provided surgical pearls for implanting any IOL. He suggests inject- ing the IOL and aligning the axis 10 degrees shy. Then, one should remove the ophthalmic viscosur- gical device (OVD) behind the IOL and dial the IOL into the intended position. Dr. Yeoh cautions to be aware of over-rotation. Then, press the IOL on to the posterior capsule using the side port and leave the eye softish. Dr. Yeoh will counsel all of his patients to avoid sudden movements within the first hour after surgery. Addi- tionally, he recommends no jogging or eye rubbing for the following 2 weeks. With proper technique and the improved haptics of the TECNIS Toric II IOL, surgeons will now be able to experience ease of use with this new platform. Copyright 2021 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2021 PP2021MLT5790 From OCT imaging, one can see on the right hand side that the TECNIS Toric II IOL is sitting snugly on the posterior capsule against the back of the lens, maintaining its stability. “ With the new haptic design of TECNIS TORIC II, it is still possible to manueuver the IOL into the perfect alignment . ” Ronald Yeoh, MD The TECNIS Toric II IOL was designed to have unpolished and frosted haptics which gives the IOL rotational stability compared to the smooth haptic design of the TECNIS Toric I IOL.