Correction of High Myopic Astigmatism by Toric Implantable Contact Lenses (T-ICL).

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Correction of High Myopic Astigmatism by Toric
Implantable Contact Lenses (T-ICL).

• Andrey I. Kovalev, Oksana S. Averyanova
• AILAS Medical Center Kiev, Ukraine

The authors of this poster have no financial
interest in any products and technologies
mentioned in this presentation.
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Introduction

• Key point of successful T-ICL implantation is
  exact lens axis alignment.
• Starting point
• estimation and marking of main meridian of
  the cornea (horizontal or vertical).
• Second step
• having main meridian as a reference,
  estimation and marking of the exact meridian of
  the lens alignment.

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Classical 2 Steps Approach for Estimation and
Marking of Corneal Meridians

• First Step (Pre-Operative)

• Estimation and Marking of Horizontal Meridian
• By Sight
• By Gravity Marker
• By Horizontal Slit of Slit Lamp

• Second Step (Intra-Operative)

• marking of the exact meridian of the lens
  alignment (Mendoz Ring or Similar Instruments).

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Advantages and Disadvantages of 2 Steps Classical
Corneal Marking

• Advantages

• Disadvantages

1. Time Consuming
2. Additional Intra-Operative Manipulations
3. Grating Period of Instruments 10 Degree of Arc
   Low Accuracy

• ? ? ? ? ?

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Optimal Marking

1. Pre-Operative
2. One Step
3. By Precision Protractor

Optimal Instrument Slit Lamp with 360 ocular
protractor
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Corneal Marking, NOT Conjunctival

• Conjunctival Marker size
• is 5 Degree of Arc

• Corneal Spatula
• is More Precise

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Methods
Purpose

• To evaluate the efficacy, safety and stability of
  High Myopic Astigmatism correction by Phakic
  Posterior Chamber Toric Intraocular Lens (T-ICL,
  STAAR, Switzerland).

• Retrospective analysis of 2 Groups of Patients
  withHigh Myopic Astigmatism corrected by T-ICL
  implantation.
• Both groups were matching in age, statue and
  degree of myopia

Group 1 (33eyes) Group 1 (33eyes) Group 2 (89 eyes) Group 2 (89 eyes)
PreOp. Refractive Sph. Mean Range Mean Range
PreOp. Refractive Sph. -13.3 /- 3.37 D -4.75 to -22.00 D 13.4 /- 3.7 D -5.0 to -22.0 D
PreOp. Refractive Cyl. Mean Range Mean Range
PreOp. Refractive Cyl. 3.1 /- 1.7 D 1.5 to 6.0 D 3.1 /-1.6 D 1.75 to 6.0 D

Patients were followed up 1 day, 1 week, 1, 3,
and 6 months postoperatively.
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Group 1 33 T-ICLs
Group 2 89 T-ICLs

• T-ICLs aligned by classical 2 Steps procedure
• clear corneal tunnel

• T-ICLs aligned by direct preoperative marking of
  horizontal and exact axis of the lens orientation
  under SL with 360 ocular protractor
• limbal-corneal tunnel

• Real T-ICL patient photo

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Results 6 months
100 patients was within 1.00D, and 88 /-0.5D from intended refraction 100 patients was within 1.00D, and 88 /-0.5D from intended refraction 100 patients was within 1.00D, and 88 /-0.5D from intended refraction
Group 1 Group 2

Residual Cyl. 0.62 /- 0.47D (0 1.25D) 0.38 /- 0.24D (0.25 0.75D)

Axis Misalignment of T-ICL 7.34.5 (0 to 15) 3.22.1 (0 to 5)

Induced Corneal Astigmatism 0.560.21 D (0.25 to 0.75 D) 0.210.14 D (0.0 to 0.32 D)

There were NO T-ICL Rotation in Any Group of Patients There were NO T-ICL Rotation in Any Group of Patients There were NO T-ICL Rotation in Any Group of Patients
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Comments
Group 1 Group 2
Axis Misalignment of T-ICL 7.34.5 (0 to 15) 3.22.1 (0 to 5)

• Twice Better Alignment of the Lenses in Group 2.

Group 1 Group 2
Induced Corneal Astigmatism 0.560.21 D (0.25 to 0.75 D) 0.210.14 D (0.0 to 0.32 D)

• Twice Less Corneal Astigmatism Induced in Group 2

NO T-ICL Rotation in Any Group of Patients
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Conclusions

• Toric ICL are safe and effective for correction
  of High Myopic Astigmatism.
• Limbal (versus Clear Corneal) tunnels are more
  astigmatically neutral.
• Preoperative meticulous marking of the axis
  under SL facilitates more accurate alignment of
  the lenses.
• T-ICLs have very good rotational stability.

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Thank You for Attantion
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