Current approaches to residual astigmatism correction after phacoemulsification
DOI: 10.32364/2311-7729-2022-22-1-51-57
M.M. Bikbov, O.I. Orenburkina, A.E. Babushkin, A.M. Tulyakova
Ufa Research Institute of Eye Diseases, Ufa, Russian Federation
Residual astigmatism or ametropia are relatively common after phacoemulsification. This entity is accounted for by inaccurate intraocular lens (IOL) power calculation or improper preoperative examination. As a result, target refraction is not achieved. Spectacle correction of astigmatism in pseudophakia has several drawbacks and is often poorly tolerated, leaving patients unsatisfied with surgical outcomes.
This paper reviews state-of-the-art surgical techniques for correcting residual astigmatism after cataract surgery. These include laser (photorefractive keratectomy/PRK and laser in situ keratomileusis/LASIK), Femto laser (arcuate keratotomy), and intraocular (add-on toric IOL implantation) procedures. The authors address published data on the pros and cons of these interventions. These techniques empower surgical correction of astigmatism and provide the best possible vision for patients. Finally, this paper discusses postoperative management using tear substitutes.
Keywords: phacoemulsification, residual astigmatism, PRK, LASIK, femtosecond arcuate incisions, add-on toric IOLs.
For citation: Bikbov M.M., Orenburkina O.I., Babushkin A.E., Tulyakova A.M. Current approaches to residual astigmatism correction after phacoemulsification. Russian Journal of Clinical Ophthalmology. 2022;22(1):51–57 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-51-57.
About the authors:
Mukharram M. Bikbov — Dr. Sc. (Med.), Professor, Corresponding Member of the Academy of Sciences of the Republic of Bashkortostan, Director; ORCID iD 0000-0002-9476-8883.
Olga I. Orenburkina — C. Sc. (Med.), Head of the Laboratory of Lens Surgery and Intraocular Correction; ORCID iD 0000-0001-6815-8208.
Aleksandr E. Babushkin — Dr. Sc. (Med.), Head of the Division of Scientific Researches; ORCID iD 0000-0001-6700-0812.
Azaliya M. Tulyakova — junior researcher of the Department of Medical Epidemiology and Ophthalmological Care; ORCID iD 0000-0002-7654-7868.
Ufa Research Institute of Eye Diseases, 90, Pushkin str., Ufa, 450008, Russian Federation.
Contact information: Olga I. Orenburkina, e-mail: linza7@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 24.02.2021.
References
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20. Laptev B.V., Shilovskikh O.V., Fechin O.B. An additional IOL implantation for the correction of complex types of postoperative ametropia is the first experience. Reflection. 2016;2:73–76 (in Russ.).
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22. Gerten G., Kermani O., Schmiedt K. et al. Dual intraocular lens implantation: Monofocal lens in the bag and additional dif-fractive multifocal lens in the sulcus. J Cataract Refract Surg. 2009;35(12):2136–2143. DOI: 10.1016/j.jcrs.2009.07.014.
23. Sauder G. Secondary toric intraocular lens implantation in pseudophakic eyes. The add-on IOL system. Ophthalmologe. 2007;104(12):1041–1045. DOI: 10.1007/s00347-007-1660-4.
24. Ferreira T.B., Pinheiro J. Clinical results with a supplementary toric intraocular lens for the correction of astigmatism in pseudophakic patients. Eur J Ophthalmol. 2015;25:302–308. DOI: 10.5301/ejo.5000564.
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32. Rumyantseva O.A., Ukhina T.V. Studying the pathogenesis of epithelial hyperplasia and refractive regression after photorefractive surgery. Clinical ophthalmology. 2000;1(4):100–104 (in Russ.).
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40. Piñero D.R., Ayala Espinosa M.J., Alió J.L. LASIK outcomes following multifocal and monofocal intraocular lens implantation. J Refract Surg. 2010;26(8):569–577. DOI: 10.3928/1081597X-20091030-02.
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42. Norouzi H., Rahmati-Kamel M. Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery. J Refract Surg. 2003;19:416–424. DOI: 10.3928/1081-597X-20030701-07.
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45. Ruckle Th., Dexl Alois K., Bachernegg A. et al. Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism. J Cataract Refract Surg. 2013;39:528–538. DOI: 10.1016/j.jcrs.2012.10.043.
46. Ghanem R.C., Azar D.T., Ghanem R.C. Femtosecond-laser arcuate wedge-shape resection to correct hight residual astigmatism after penetrating keratoplasty. J Cataract Refract Surg. 2006;32:1415. DOI: 10.1016/j.jcrs.2006.02.083.
47. Kook D., Bühren J., Klaproth O.K. et al. Astigmatic keratotomy with the femtosecond laser: correction of high astigmatisms after keratoplasty. Ophthalmologe. 2010;108(2):143–150. DOI: 10.1007/s00347-010-2239-z.
48. Hashemian M.N., Habib O., Mehrdad M. et al. Femtosecond laser arcuate keratotomy for the correction of postkeratoplasty high astigmatism in keratoconus. J Res Med Sci. 2017;22:17.
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50. St Clair R.M., Sharma A., Huang D. et al. Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty. J Cataract Refract Surg. 2016;42(4):556–562. DOI: 10.1016 / j.jcrs.2015.12.053.
51. Ryohei N., Terada Y., Mori Y. Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery. Jpn J Ophthalmol. 2015;59(4):209–215. DOI: 10.1007/s10384-015-0383-3.
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2. Khripun K.V. Surgical correction of astigmatism during and after cataract extraction: thesis. SPb., 2016 (in Russ.).
3. Malyugin B.E., Filippov V.O., Treushnikov V.M. Intraocular correction of astigmatism during phacoemulsification: technique and results. Ophthalmosurgery. 2004;4:9–15 (in Russ.).
4. Bikbov M.M., Kazakbaeva G.M., Gilmanshin T.R. et al. Prevalence and associated factors of cataract and cataract-related blindness in the Russian Ural Eye and Medical Study. Sci Rep. 2020;10(1):18157. DOI: 10.1038/s41598-020-75313-0.
5. Gurmizov E.P., Pershin K.B., Pashinova N.F., Tsygankov A.Yu. The results of additional correction by LASIK and PRK methods on pseudophakic eyes, depending on the type of IOL implanted. Clin ophthalmology. 2019;19(2):68 (in Russ.). DOI: 10.32364/2311-7729-2019-19-2-67-72.
6. Kasyanov A.A. Secondary implantation of an additional IOL for correction of refractive errors in intraocular correction of aphakia. Ophthalmology. 2004;1:24–28 (in Russ.).
7. Pershin K.B., Pashinova N.F., Tsygankov A.Yu. et al. Biometrics in calculating IOL optical power as a factor in successful cataract surgery. Cataract and refractive surgery. 2016;16(2):15–22 (in Russ.).
8. Egorova G.B., Fedorova A.A., Bobrovskikh N.V. Influence of long-term wearing of contact lenses on the state of the cornea according to confocal microscopy. Bulletin of Ophthalmology. 2008;6:25–29 (in Russ.).
9. Pershin K.B., Pashinova N.F., Tsygankov A.Yu. et al. Correction of residual ametropia after cataract phacoemulsification. Part 1. Keratorefractive approaches. Ophthalmology. 2017;14(1):18–26 (in Russ.). DOI: 10.18008/1816-5095-2017-1-18-26.
10. Kahraman G., Amon M. New supplementary intraocular lens for refractive enhancement in pceudophakic patients. J Cataract Refract. Surg. 2010;36(7):1090–1094. DOI: 10.1016/j.jcrs.2009.12.045.
11. Gayton J.L., Apple D.J., Pandey S.K. et al. Inerlenticular opacification: clinical pathologic correlation of a complication of posterior chamber piggyback intraocular lenses. J Cataract Refract Surg. 2000;26:330–336. DOI: 10.1016/S0886-3350(99)00433-2.
12. Werner L. Interlenticular opacification: dual-optic versus piggyback intraocular lenses. J. Cataract Refract Surg. 2006;32(4):655–661. DOI: 10.1016/j.jcrs.2006.01.022.
13. Chang S.H.L., Lim G. Secondary pigmentary glaucoma associated with piggyback intraocular lens implantation. J Cataract Refract Surg. 2004;30:2219–2222. DOI: 10.1016/j.jcrs.2004.03.034.
14. Chang W.H. Pigmentary dispersion syndrome with a secondary piggyback 3-piece hydrophobic acrylic lens; case report with clinicopathological correlation. J Cataract Refract Surg. 2007;33:1106–1109. DOI: 10.1016/j.jcrs.2007.01.044.
15. Baumeister M., Kohnen Baumeister T., Scheimpflug M. Measurement of intraocular lens position after piggyback implantation of foldable intraocular lenses in eyes with high hyperopia. J Cataract Refract Surg. 2006;32:2098–2104. DOI: 10.1016/j.jcrs.2006.08.033.
16. Kosenko T.G., Kosenko S.M., Klimova O.N. Our experience with Rayner Sulcoflex complementary pseudophakic IOL implantation. In: collection of scientific articles of 14 scientific-practical. conf. "Modern technologies of cataract and refractive surgery". M.; 2013: 107–111 (in Russ.).
17. Amon M. Enhancement of refractive results after cataract surgery and IOL-implantation with a supplementary IOL implanted in the ciliary sulcus. Oftalmología. 2009;53(4):91–95.
18. Bikbov M.M., Bikbulatova A.A., Mannanova R.F. Experience with Sulcoflex aspherical and toric additional intraocular lenses. In: collection of scientific articles FGBU "MNTK" Eye Microsurgery "Modern technologies of cataract and refractive surgery". M.; 2012:36–41 (in Russ.).
19. Bikbov M.M., Bikbulatova A.A., Mannanova R.F. The first results of implantation of an additional pseudophakic IOL Sulcoflex in children and adolescents. Ophthalmosurgery. 2012;3:22–25 (in Russ.).
20. Laptev B.V., Shilovskikh O.V., Fechin O.B. An additional IOL implantation for the correction of complex types of postoperative ametropia is the first experience. Reflection. 2016;2:73–76 (in Russ.).
21. Basarir B., Kaya V., Altan C. et al. The use of a supplemental sulcus fixated IOL (HumanOptics Add-On IOL) to correct pseudophakic refractive errors. Eur J Ophthalmol. 2012;22:898–903. DOI: 10.5301/ejo.5000156.
22. Gerten G., Kermani O., Schmiedt K. et al. Dual intraocular lens implantation: Monofocal lens in the bag and additional dif-fractive multifocal lens in the sulcus. J Cataract Refract Surg. 2009;35(12):2136–2143. DOI: 10.1016/j.jcrs.2009.07.014.
23. Sauder G. Secondary toric intraocular lens implantation in pseudophakic eyes. The add-on IOL system. Ophthalmologe. 2007;104(12):1041–1045. DOI: 10.1007/s00347-007-1660-4.
24. Ferreira T.B., Pinheiro J. Clinical results with a supplementary toric intraocular lens for the correction of astigmatism in pseudophakic patients. Eur J Ophthalmol. 2015;25:302–308. DOI: 10.5301/ejo.5000564.
25. Balashevich L.I. Surgical correction of refractive errors andaccommodation. St. Petersburg: Chelovek; 2008 (in Russ.).
26. Doga A.V. Excimer laser refractive microsurgery of the cornea based on the scanning device "Microscan": Thesis. M., 2004 (in Russ.).
27. Pershin K.B, Aznabaev T.E., Pashinova N.F., Ovechkin I.G. Lasik and PRK — indications for the operation, Advantages and disadvantages. Ophthalmosurgery and therapy. 2004;4(2):3–9 (in Russ.).
28. Ishchenko V.N., Kochubei S.A., Lantukh V.V. et al. The use of UV radiation from excimer lasers in eye microsurgery. Optics and Spectroscopy. 1987;63(5):1132–1138 (in Russ.).
29. Trokel S.L., Srinivasan R., Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983;96(6):710–715. DOI: 10.1016/S0002-9394(14)71911-7.
30. Balashevich L.I. Refractive surgery. SPb.: SPbMAPO; 2002 (in Russ.).
31. Maloney R.K., Chan W.-K., Steinert R. et al. A multicenter trial of photorefractive keratectomy for residual myopia after previous ocular surgery. Ophthalmology. 1995;102:1042–1052. DOI: 10.1016/S0161-6420(95)30913-X.
32. Rumyantseva O.A., Ukhina T.V. Studying the pathogenesis of epithelial hyperplasia and refractive regression after photorefractive surgery. Clinical ophthalmology. 2000;1(4):100–104 (in Russ.).
33. Kurenkov V.V. Guide to Excimer Laser Corneal Surgery. M.: RAMN, 2002 (in Russ.).
34. Ang E.K. Outcomes of laser refractive surgery for myopia. J Cataract Refract Surg. 2009;35(5):921–933. DOI: 10.1016/j.jcrs.2009.02.013.
35. Artola A., Ayala M.J., Claramonte P. et al. Photorefractive keratectomy for residual myopia after cataract surgery. J Cataract Refract Surg. 1999;25:1456–1460. DOI: 10.1016/S0886-3350(99)00233-3.
36. Pershin K.B., Pashinova N.F. Complications of LASIK: analysis of 12,500 operations. Wedge ophthalmic surgery. 2001;1(4):96–100 (in Russ.).
37. Henry C.R., Canto A.P., Galor A. Epithelial ingrowth after LASIK: clinical characteristics, risk factors, and visual outcomes in patients requiring flap lift. J Refract Surg. 2012;28(7):488–492. DOI: 10.3928/1081597X-20120604-01.
38. Mohammadpour M., Jabbarvand M. Risk factors for ectasia after LASIK. J Cataract Refract Surg. 2008;43:1056. DOI: 10.1016/j.jcrs.2008.02.039.
39. Norouzi H., Rahmati-Kamel M. Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery. J Refract Surg. 2003;19:416–424. DOI: 10.3928/1081-597X-20030701-07.
40. Piñero D.R., Ayala Espinosa M.J., Alió J.L. LASIK outcomes following multifocal and monofocal intraocular lens implantation. J Refract Surg. 2010;26(8):569–577. DOI: 10.3928/1081597X-20091030-02.
41. Pershin K.B., Pashinova N.F. Fine tuning excimer laser correction after intraocular lens implantation and corneal transplantation. J Refract Surg. 2000;16(2):257–260. DOI: 10.3928/1081-597X-20000302-13.
42. Norouzi H., Rahmati-Kamel M. Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery. J Refract Surg. 2003;19:416–424. DOI: 10.3928/1081-597X-20030701-07.
43. Kostenev S.V., Chernykh V.V. Femtosecond laser surgery: principles and application in ophthalmology. Novosibirsk: Nauka; 2012 (in Russ.).
44. Pateeva T.Z. Femtolaser correction of myopia: Thesis. Moscow; 2011 (in Russ.).
45. Ruckle Th., Dexl Alois K., Bachernegg A. et al. Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism. J Cataract Refract Surg. 2013;39:528–538. DOI: 10.1016/j.jcrs.2012.10.043.
46. Ghanem R.C., Azar D.T., Ghanem R.C. Femtosecond-laser arcuate wedge-shape resection to correct hight residual astigmatism after penetrating keratoplasty. J Cataract Refract Surg. 2006;32:1415. DOI: 10.1016/j.jcrs.2006.02.083.
47. Kook D., Bühren J., Klaproth O.K. et al. Astigmatic keratotomy with the femtosecond laser: correction of high astigmatisms after keratoplasty. Ophthalmologe. 2010;108(2):143–150. DOI: 10.1007/s00347-010-2239-z.
48. Hashemian M.N., Habib O., Mehrdad M. et al. Femtosecond laser arcuate keratotomy for the correction of postkeratoplasty high astigmatism in keratoconus. J Res Med Sci. 2017;22:17.
49. Kiraly L., Hermann C., Amm M., Duncker G. Reduction of astigmatism by arcuate incisions using the femtosecond laser after corneal transplantation. Klin Monatsbl Augenheilkd. 2008;225(1):70–74. DOI: 10.1055/s-2008-1027126.
50. St Clair R.M., Sharma A., Huang D. et al. Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty. J Cataract Refract Surg. 2016;42(4):556–562. DOI: 10.1016 / j.jcrs.2015.12.053.
51. Ryohei N., Terada Y., Mori Y. Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery. Jpn J Ophthalmol. 2015;59(4):209–215. DOI: 10.1007/s10384-015-0383-3.
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