Titiyal Jeewan S, Kaur Manpreet, Jose Cijin P, Falera Ruchita, Kinkar Ashutosh, Bageshwar Lalit Ms
Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Clin Ophthalmol. 2018 Apr 24;12:747-753. doi: 10.2147/OPTH.S164175. eCollection 2018.
To compare toric intraocular lens (IOL) alignment assisted by image-guided surgery or manual marking methods and its impact on visual quality.
This prospective comparative study enrolled 80 eyes with cataract and astigmatism ≥1.5 D to undergo phacoemulsification with toric IOL alignment by manual marking method using bubble marker (group I, n=40) or Callisto eye and Z align (group II, n=40). Postoperatively, accuracy of alignment and visual quality was assessed with a ray tracing aberrometer. Primary outcome measure was deviation from the target axis of implantation. Secondary outcome measures were visual quality and acuity. Follow-up was performed on postoperative days (PODs) 1 and 30.
Deviation from the target axis of implantation was significantly less in group II on PODs 1 and 30 (group I: 5.5°±3.3°, group II: 3.6°±2.6°; =0.005). Postoperative refractive cylinder was -0.89±0.35 D in group I and -0.64±0.36 D in group II (=0.003). Visual acuity was comparable between both the groups. Visual quality measured in terms of Strehl ratio (<0.05) and modulation transfer function (MTF) (<0.05) was significantly better in the image-guided surgery group. Significant negative correlation was observed between deviation from target axis and visual quality parameters (Strehl ratio and MTF) (<0.05).
Image-guided surgery allows precise alignment of toric IOL without need for reference marking. It is associated with superior visual quality which correlates with the precision of IOL alignment.
比较图像引导手术或手动标记方法辅助下的散光人工晶状体（IOL）定位及其对视觉质量的影响。
这项前瞻性比较研究纳入了80例白内障且散光≥1.5 D的患者，通过使用气泡标记的手动标记方法（I组，n = 40）或Callisto eye和Z轴对准（II组，n = 40）进行散光IOL定位的超声乳化手术。术后，使用光线追踪像差仪评估对准精度和视觉质量。主要观察指标是与植入目标轴的偏差。次要观察指标是视觉质量和视力。在术后第1天和第30天进行随访。
在术后第1天和第30天，II组与植入目标轴的偏差明显小于I组（I组：5.5°±3.3°，II组：3.6°±2.6°；P = 0.005）。I组术后屈光柱镜为-0.89±0.35 D，II组为-0.64±0.36 D（P = 0.003）。两组之间的视力相当。以斯特列尔比（<0.05）和调制传递函数（MTF）（<0.05）衡量的视觉质量在图像引导手术组中明显更好。观察到与目标轴的偏差与视觉质量参数（斯特列尔比和MTF）之间存在显著负相关（P < 0.05）。
图像引导手术无需参考标记即可实现散光IOL的精确对准。它与卓越的视觉质量相关，而视觉质量与IOL对准的精度相关。
