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Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism

Abstract

Purpose

To assess whether the outcomes of toric intraocular lens (IOL) implantation in eyes with oblique astigmatism can be improved by direct measurements of posterior corneal astigmatism using anterior segment optical coherence tomography (AS-OCT) instead of by using anterior corneal measurements alone.

Study design

Retrospective case series.

Methods

Two toric IOL power calculation methods were compared: anterior corneal astigmatism was used in the keratometry group, whilst total corneal astigmatism determined by ray tracing through the measured anterior and posterior corneal surfaces was used in the AS-OCT group. In a total of 279 eyes of 232 patients, subgroup analysis was conducted for with-the-rule (WTR) (85 eyes in the keratometry group and 34 eyes in the AS-OCT group), against-the-rule (ATR) (73/29 eyes), and oblique (26/32 eyes) astigmatism.

Results

In the WTR and ATR astigmatism groups, the uncorrected distance visual acuity (UDVA) was significantly better in the AS-OCT group than in the keratometry group (P = 0.012 and P < 0.001, Mann–Whitney test), and the residual astigmatism was significantly smaller in the AS-OCT group than in the keratometry group (P = 0.037 and P < 0.001). In eyes with oblique astigmatism, the UDVA (P = 0.299) and residual astigmatism (P = 0.373) of the keratometry and AS-OCT groups did not differ.

Conclusion

Incorporation of posterior corneal astigmatism measured with AS-OCT can significantly improve the outcomes of toric IOL implantation in eyes with WTR and ATR astigmatism, but not in eyes with oblique astigmatism.

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References

  1. Savini G, Næser K. An analysis of the factors influencing the residual refractive astigmatism after cataract surgery with toric intraocular lenses. Invest Ophthalmol Vis Sci. 2015;56:827–35.

    Article  Google Scholar 

  2. Ho JD, Tsai CY, Liou SW. Accuracy of corneal astigmatism estimation by neglecting the posterior corneal surface measurement. Am J Ophthalmol. 2009;147:788–95.

    Article  Google Scholar 

  3. Koch DD, Ali SF, Weikert MP, Shirayama M, Jenkins R, Wang L. Contribution of posterior corneal astigmatism to total corneal astigmatism. J Cataract Refract Surg. 2012;38:2080–7.

    Article  Google Scholar 

  4. Koch DD, Jenkins RB, Weikert MP, Yeu E, Wang L. Correcting astigmatism with toric intraocular lenses: effect of posterior corneal astigmatism. J Cataract Refract Surg. 2013;39:1803–9.

    Article  Google Scholar 

  5. Ueno Y, Hiraoka T, Beheregaray S, Miyazaki M, Ito M, Oshika T. Age-related changes in anterior, posterior, and total corneal astigmatism. J Refract Surg. 2014;30:192–7.

    Article  Google Scholar 

  6. Goggin M, Zamora-Alejo K, Esterman A, van Zyl L. Adjustment of anterior corneal astigmatism values to incorporate the likely effect of posterior corneal curvature for toric intraocular lens calculation. J Refract Surg. 2015;31:98–102.

    Article  Google Scholar 

  7. Goggin M, van Zyl L, Caputo S, Esterman A. Outcome of adjustment for posterior corneal curvature in toric intraocular lens calculation and selection. J Cataract Refract Surg. 2016;42:1441–8.

    Article  Google Scholar 

  8. Eom Y, Ryu D, Kim DW, Yang SK, Song JS, Kim SW, et al. Development of a program for toric intraocular lens calculation considering posterior corneal astigmatism, incision-induced posterior corneal astigmatism, and effective lens position. Graefes Arch Clin Exp Ophthalmol. 2016;254:1977–86.

    Article  Google Scholar 

  9. Ferreira TB, Ribeiro P, Ribeiro FJ, O’Neill JG. Comparison of astigmatic prediction errors associated with new calculation methods for toric intraocular lenses. J Cataract Refract Surg. 2017;43:340–7.

    Article  Google Scholar 

  10. Ferreira TB, Ribeiro P, Ribeiro FJ, O’Neill JG. Comparison of methodologies using estimated or measured values of total corneal astigmatism for toric intraocular lens power calculation. J Refract Surg. 2017;33:794–800.

    Article  Google Scholar 

  11. LaHood BR, Goggin M, Esterman A. Assessing the likely effect of posterior corneal curvature on toric IOL calculation for IOLs of 2.50 D or greater cylinder power. J Refract Surg. 2017;33:730–4.

    Article  Google Scholar 

  12. Canovas C, Alarcon A, Rosén R, Kasthurirangan S, Ma JJK, Koch DD, et al. New algorithm for toric intraocular lens power calculation considering the posterior corneal astigmatism. J Cataract Refract Surg. 2018;44:168–74.

    Article  Google Scholar 

  13. Preussner PR, Hoffmann P, Wahl J. Impact of posterior corneal surface on toric intraocular lens (IOL) calculation. Curr Eye Res. 2015;40:809–14.

    CAS  Article  Google Scholar 

  14. Hoffmann PC, Abraham M, Hirnschall N, Findl O. Prediction of residual astigmatism after cataract surgery using swept source fourier domain optical coherence tomography. Curr Eye Res. 2014;39:1178–86.

    Article  Google Scholar 

  15. Zhang B, Ma JX, Liu DY, Guo CR, Du YH, Guo XJ, et al. Effects of posterior corneal astigmatism on the accuracy of AcrySof toric intraocular lens astigmatism correction. Int J Ophthalmol. 2016;9:1276–82.

    PubMed  PubMed Central  Google Scholar 

  16. Zhang L, Sy ME, Mai H, Yu F, Hamilton DR. Effect of posterior corneal astigmatism on refractive outcomes after toric intraocular lens implantation. J Cataract Refract Surg. 2015;41:84–9.

    Article  Google Scholar 

  17. Davison JA, Potvin R. Refractive cylinder outcomes after calculating toric intraocular lens cylinder power using total corneal refractive power. Clin Ophthalmol. 2015;9:1511–7.

    PubMed  PubMed Central  Google Scholar 

  18. Abulafia A, Hill WE, Franchina M, Barrett GD. Comparison of methods to predict residual astigmatism after intraocular lens implantation. J Refract Surg. 2015;31:699–707.

    Article  Google Scholar 

  19. Reitblat O, Levy A, Kleinmann G, Abulafia A, Assia EI. Effect of posterior corneal astigmatism on power calculation and alignment of toric intraocular lenses: comparison of methodologies. J Cataract Refract Surg. 2016;42:217–25.

    Article  Google Scholar 

  20. Park DY, Lim DH, Hwang S, Hyun J, Chung TY. Comparison of astigmatism prediction error taken with the Pentacam measurements, Baylor nomogram, and Barrett formula for toric intraocular lens implantation. BMC Ophthalmol. 2017;17:156.

    Article  Google Scholar 

  21. Schröder S, Mäurer S, Eppig T, Seitz B, Rubly K, Langenbucher A. Comparison of corneal tomography: repeatability, precision, misalignment, mean elevation, and mean pachymetry. Curr Eye Res. 2018;43:709–16.

    Article  Google Scholar 

  22. Ueno Y, Hiraoka T, Miyazaki M, Ito M, Oshika T. Corneal thickness profile and posterior corneal astigmatism in normal corneas. Ophthalmology. 2015;122:1072–8.

    Article  Google Scholar 

  23. Næser K. Assessment and statistics of surgically induced astigmatism. Acta Ophthalmol. 2008;86:1–28.

    Article  Google Scholar 

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Correspondence to Tetsuro Oshika.

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Conflicts of interest

S. Nakano, Research grant (HOYA, Santen), Honorarium for Speaker (Alcon, Johnson & Johnson, HOYA, Santen, Kowa); M. Iida, None; Y. Hasegawa, Honorarium for Speaker (Johnson & Johnson, Santen, Nikon, Senju, Zeiss), Research grant (Santen); T. Hiraoka, Honorarium for Speaker (Johnson & Johnson, Santen, Senju, Menicon, Otsuka), Research grant (TOMEY, Seed, Novartis, Alfa corporation); T. Oshika, Research grant (Kai, Novartis, Pfizer, Santen, Senju, Kowa, Topcon, HOYA), Consultant fee (Alcon, Mitsubishi Tanabe, Santen), Honorarium for Speaker (Alcon, Johnson & Johnson, Santen, Senju, TOMEY, Otsuka, Kowa, Japan Focus, HOYA), Non-financial support (TOMEY).

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Corresponding Author: Tetsuro Oshika

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Nakano, S., Iida, M., Hasegawa, Y. et al. Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism. Jpn J Ophthalmol 65, 288–294 (2021). https://doi.org/10.1007/s10384-021-00812-0

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  • DOI: https://doi.org/10.1007/s10384-021-00812-0

Keywords

  • Anterior segment optical coherence tomography
  • Oblique astigmatism
  • Posterior corneal astigmatism
  • Toric intraocular lens