Cataract surgery with toric lens. Assessment through tomography and intraoperative aberrometry ORA

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. S275
• Main Authors: Buey Sayas, María Ángeles, Pascual, Paula Casas, Alonso, Sofia Bielsa, Rodriguez, Nuria López, Monzon, Sara Marco, Fernández, Miguel Castillo, Álvarez, Constanza Caramello, Ascaso, Javier
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01-12-2022
• Subjects: Astigmatism; Cataracts; Cornea; Eye surgery; Surgery
• DOI: 10.1111/j.1755-3768.2022.0393
• EISSN: 1755-3768
• ISSN: 1755-375X

Purpose: Nowadays, cataract surgery not only aims at the extraction of the opacified lens. Promoted by advances in the last decade, this medical procedure has evolved into a refractive technique whose purpose is emmetropia. The current intention, from an optical point of view, is to obtain a residual refractive error within ±0.50 diopters of spherical equivalent, and <0.75 diopters in the residual cylinder. Consequently, a prospective single‐center cross‐sectional study was performed at the Ophthalmology Department of the Lozano Blesa University Hospital of Zaragoza, which was conducted from July 2021 to February 2022.
Methods: Including a total of 42 eyes of 34 patients (38% male, 62% female), with astigmatism greater than 2.00 keratometric diopters undergo cataract surgery. The surgical procedure is carried out using FLACS femtosecond laser‐assisted surgery, altogether with implantation of toric intraocular lenses (Alcon SN6AT2‐9). Inclusion criteria pursued uncomplicated interventions, performed by a single surgeon and with a NRR (No Rotation Recommended) outcome.
Results: The mean ages were 69.5 ± 11.89 years (39–90), the mean axial length was 23.61 ± 2.38 mm. The corneal dioptric power was 3.10 ± 1.22 D anterior surface contribution, and 0.58 ± 0.40 D posterior surface contribution. It is worth highlighting that the contribution or the posterior surface in ATR eyes (against the rule) was only 0.21 ± 0.15 D. Using vector analysis, mean (standard deviation) and median (interquartile range) from a vector of astigmatism we obtained the following results: ORA's IOL recommendation and the preoperative prediction coincided in 50% of the cases (final astigmatism mean 0.76D ± 0.47 D). In the 50% remaining cases where they did not match, the biometer‐recommended IOL was inserted (final astigmatism mean 0.84 D ± 0.77 D).
Conclusions: To sum up, compared with standard methods, we show that the use of ORA intraoperative aberrometry system increases predictability and safety during the intervention, improving efficacy and giving better outcomes. The use of FLACS femtosecond laser‐assisted surgery and intraoperative guidance systems make phacoemulsification surgery a more reproducible technique.