Zeitschrift für klinische und experimentelle Ophthalmologie
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Image-Guided System versus Axis Registration Technique for Toric Intraocular Lens Alignment in Cataract Surgery

Katsuhito Kinoshita, Yosai Mori, Ryohei Nejima, Nobuyuki Nagai, Keiichiro Minami, Kazunori Miyata

Purpose: To evaluate the Verion^™ image guided system compared with the axis registration method for toric Intraocular Lens (IOL) alignment in a Japanese population.

Methods: This retrospective, comparative case series study included eligible patients undergoing cataract surgery and toric IOL implantation (SN6AT3-6, Alcon) at a single Japanese surgical site (Miyata Eye Hospital, Miyazaki, Japan). Patients were divided into two groups based on the method used to determine axis alignment for toric IOL implantation; the image-guided group, with an intraoperative guidance system (Verion, Alcon), and the manual and topography-based axis registration group. At 1 month postoperatively, subjective cylindrical power and Uncorrected Distance Visual Acuity (UDVA) were evaluated.

Results: A total of 168 eyes of 143 patients were included in the study (image-guided group: 49 eyes; axis registration group: 119 eyes). For the image-guided and axis registration groups, the mean postoperative subjective cylindrical power was <0.8 D and similar percentages of patients in each group achieved postoperative subjective cylindrical power of ≤ 0.5 D, between >0.5 D and ≤ 1.0 D, and >1.0 D, with each toric IOL tested. For both groups, mean UDVA was ~ 0.0 logarithms of Minimum Angle of Resolution (logMAR) and a monocular UDVA of 0.1 logMAR or better was achieved by a similar proportion of patients in each group. There were no significant differences in cylindrical power and UDVA between the two groups (P>0.05 for both outcomes).

Conclusion: The image-guided system and topography based-axis registration marking were similar in effectiveness with regard to astigmatic correction effect and visual UDVA outcomes. The use of image-guided systems for toric IOL alignment may provide additional benefits, such as less patient discomfort, decreased surgical duration, and a more streamlined workflow.